Transcription of ELECTRICAL LICENSE APPLICATION - Kentucky
1 Form EL-3 (May 2020) Public Protection Cabinet Department of Housing, Buildings and Construction Licensing Branch 500 Mero Street Frankfort, Kentucky 40601 502-573-2002 Fax: 502-573-1598 ELECTRICAL LICENSE APPLICATION Please type or print APPLICATION . Answer all questions on this APPLICATION . A nonrefundable APPLICATION fee or renewal fee of $100 for a Master Electrician applicant and $50 for an Electrician applicant payable to Kentucky State Treasurer shall be submitted with this APPLICATION . Initial APPLICATION Renewal APPLICATION 1. Designate the type of LICENSE : Master Electrician LICENSE Electrician LICENSE 2.
2 Name: _____ Last First MI Address: _____ (Street, Route, or Box Number) City: _____ State: _____ Zip: _____ County: _____ Telephone: (_____) _____ -_____ Birth Month: _____ LICENSE # (if renewal): _____ E-Mail Address: _____ Check if applicable: I am eighteen (18) years of age or older. 3.
3 The following information must be submitted with this APPLICATION : a. (INITIAL only) Mark which is applicable: Test results or Reciprocity. attach proof and required documentation for either selection. b. Work experience: Provide documentation and verification of work experience in accordance KRS (2) or (3) and 815 KAR 35:060. If a training program or education program is being applied instead of work experience, provide documentation and verification of completion of a training program or education program. If completing a four (4) year training program in accordance with KRS (3)(b) , provide verification of completion of two (2) years of the program.
4 C. (RENEWAL only) Continuing Education: Proof of completing the continuing education requirement pursuant to 815 KAR 2:010. I have been convicted of a felony or a misdemeanor in the Commonwealth of Kentucky , any other state, or the United States. YES ____ or NO ____. If you marked yes you have been convicted of a felony or misdemeanor, you may not receive an ELECTRICAL LICENSE at this time. Please contact the Licensing Branch for further information. Pursuant to KRS , if you are in default of student loans backed by the Kentucky Higher Education Assistance Authority, you cannot receive or renew an ELECTRICAL LICENSE unless specified conditions are met.
5 Please contact the Licensing Branch for further information. Signature: _____ Date: _____ If an INITIAL applicant, attach a recent passport-sized, color photograph of applicant taken within the last six months. DO NOT USE STAPLES
