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. 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.
2 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. 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.
3 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. 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
