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APPLICATION FOR CERTIFICATE OF FITNESS

APPLICANT INFORMATION (PLEASE PRINT) Last Name First Name MI Driver s License Number Mailing Address Phone Number Social Security Number City State Zip Date of Birth (month/day/year) E-MAILW eight Height (feet, inches) TYPE OF APPLICATION ( CHOOSE ONE) Reciprocal Electrical Journeyman 2yr Lic. Plumber Journeyman 2yr Lic. Electrical Journeyman 2yr Lic. Plumber Gas 2yr Lic. Electrical Residential 2yr Lic. Plumber Utility Trainee 2yr Lic. Electrical Trainee 2yr Lic. Plumber Trainee 2yr Lic. Journeyman Power Lineman 2yr Lic. Boiler Class 1 3yr Lic. Power Lineman Trainee 2yr Lic. Boiler Class 2 3yr Lic. Renewal Boiler Class 3 3yr Lic. Duplicate License $ Boiler Class 4 3yr Lic.

Requires a minimum of 4,000 hours of work in the trade. Up to 500 hours of trade-related classroom training can be substituted for 500 hours of the 4,000 hour requirement. This license allows the holder to act as a journeyman on residential sites only. The holder will be considered a trainee level electrician on commercial sites.

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