Arkansas Journeyman Electrician Application Details

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We have gathered some interesting facts about the ar electrician application. You'll have the assumed time you may need to fill out the form as well as extra details.

QuestionAnswer
Form NameAr Electrician Application
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesapplication for arkansas life time electrician license, arkansas electrician application form, arkansas electrician, application for industrial electrician arkansas

Form Preview Example

ARKANSAS BOARD OF ELECTRICAL EXAMINERS

ARKANSAS DEPARTMENT OF LABOR

10421 West Markham, Little Rock, AR

72205-2190

Phone: 501-682-4549 Fax: 501-682-1765

TRS: 800-285-1131

http://www.arkansas.gov/labor/divisions

THIS APPLICATION MUST BE FILLED OUT COMPLETELY

CHECK APPROPRIATE BOXES: (1) Master

(2)

Examination

Residential Master

 

Reciprocal

Journeyman

 

Temporary

Residential Journeyman

Industrial Maintenance

Air Conditioning Electrician

Specialist Sign Electrician

Date _______________________

Name ______________________________________________ Age _____ Date of Birth ___________

LastFirstMiddle

Residence Address ___________________________________________________________________

StreetCityStateZip Code

Mailing Address ______________________________________________________________________

Street

City

State

Zip Code

Social Security # _________________________________

County ___________________________

Home Phone # (________)___________________ Other Phone # (________)___________________

Arkansas Code Annotated §17-1-104 (Repl. 2001) requires the Electrical Division to transfer name, address, and social security number information on applicants to the Office of Child Support Enforcement. Social security numbers shall otherwise be maintained in a confidential manner as required by this statute.

Have you previously made application for examination with this Board? No Yes, Date: __________

Have you ever held an electrician's license? No Yes, If so, where _______ License # ___________

(submit photocopy)

License type and level ___________________ Original issue date ___________ Valid until _________

Was the license issued by examination? No Yes Exam Date_________________

What testing firm administered the examination: __________________________ Exam Score _______

Have you ever had an electrician's license revoked? No Yes

If Yes, by whom and for what reason? ___________________________________________________

Have you attended an apprenticeship school? No Yes If Yes, number of semesters _______

If Yes, where? ______________________________________________________________________

Apprenticeship Registration/License Number ______________________________________________

AR Electrician Application Form.doc Rev. 07/2009

Page 1 of 5

INSTRUCTIONS FOR LISTING WORK EXPERIENCE AND TRADE-RELATED EDUCATION

PLEASE READ CAREFULLY

Please complete PART I and PART II in detail.

PART I - WORK EXPERIENCE (See Page 3)

The Arkansas Board of Electrical Examiners may contact your present or previous employers to verify your work experience as stated herein.

Verification of employment must be provided by NOTARIZED original letters (not photocopies) or by Affidavit of Employment Experience (see Page 5) from previous or current employers. The verification must include exact employment dates and the exact type of electrical work performed.

Your qualifications will be determined on the basis of information provided by you on this application. It must be factual, clear and complete. Use additional sheets if necessary.

Provide photocopies of any electrical licenses you presently hold or have previously held.

If you have Supervision experience and/or were the Owner of an electrical contracting company, you may attach additional information to your application. You should submit a NOTARIZED letter describing your work experience along with a copy of your advertisement in the telephone directory, a copy of your business stationary, a list of jobs contracted by your company, a photocopy of any state or city business license(s), and any other documents supporting the length of time you have been in business.

PART II - TRADE RELATED EDUCATION AND FORMAL INSTRUCTION (See Page 4)

Read carefully the descriptions of the three classifications of education or instruction listed below. Then turn to Page 4 and, in the space provided, give the information requested. Make your answers as complete and clear as possible. A transcript of credits must be submitted to receive credit for school time.

1.Formal Apprentice Training: If you have been employed by an employer with an approved electrical apprentice training program, list the program and the dates that you were enrolled. If completed, attach a copy of the completion certificate. Requests for acceptance of apprenticeship training must be accompanied by a “Release for Test” form signed by the apprenticeship program and the Arkansas Department of Career Education.

2.Electrical Engineer: A degree in electrical engineering plus two (2) years experience will be accepted for application for a master examination.

3.Military Training in Electrical Wiring. Show in detail exactly what kind of training, schooling, or work experience you received directly related to wiring for installing and repairing electrical apparatus and equipment for light, heat and power. Include the length of time spent and any other information that will assist in evaluating the degree of electrical experience that you have had in construction in this classification.

Submit the application and all supporting documentation to:

ARKANSAS BOARD OF ELECTRICAL EXAMINERS ARKANSAS DEPARTMENT OF LABOR

10421 WEST MARKHAM LITTLE ROCK, AR 72205-2190

AR Electrician Application Form.doc Rev. 07/2009

Page 2 of 5

PART I – WORK EXPERIENCE

LIST PRESENT AND PREVIOUS EMPLOYERS.

 

 

DATES EMPLOYED

 

EMPLOYER INFORMATION

 

FROM

TO

Type of

 

 

Mo/Day/Yr

Mo/Day/Yr

Electrical Work Performed

Name of Company

 

 

 

 

Street Address

 

 

 

 

City/State/Zip

 

 

 

 

Employer Phone Number (

)

 

 

 

Name of Company

 

 

 

 

Street Address

 

 

 

 

City/State/Zip

 

 

 

 

Employer Phone Number (

)

 

 

 

Name of Company

 

 

 

 

Street Address

 

 

 

 

City/State/Zip

 

 

 

 

Employer Phone Number (

)

 

 

 

Name of Company

 

 

 

 

Street Address

 

 

 

 

City/State/Zip

 

 

 

 

Employer Phone Number (

)

 

 

 

Name of Company

 

 

 

 

Street Address

 

 

 

 

City/State/Zip

 

 

 

 

Employer Phone Number (

)

 

 

 

Name of Company

 

 

 

 

Street Address

 

 

 

 

City/State/Zip

 

 

 

 

Employer Phone Number (

)

 

 

 

Name of Company

 

 

 

 

Street Address

 

 

 

 

City/State/Zip

 

 

 

 

Employer Phone Number (

)

 

 

 

AR Electrician Application Form.doc Rev. 07/2009

Page 3 of 5

PART II – TRADE RELATED EDUCATION AND FORMAL INSTRUCTION:

1. FORMAL APPRENTICE TRAINING PROGRAM:

NAME OF PROGRAM /SCHOOL AND COURSE:

DATES: Started /

CREDIT

Completed

HOURS

 

 

 

DAYS

PER WK

HRS/

DAY

2.EDUCATION - VOCATIONAL OR TRADE, CORRESPONDENCE, COLLEGE:

A transcript must be included with the application.

NAME OF SCHOOL AND COURSE:

DATES: Started /

CREDIT

Completed

HOURS

 

 

 

DAYS

PER WK

HRS/

DAY

3.MILITARY TRAINING (Submit photocopy of your DD-214 form)

Military training or experience in electrical work must be detailed and submitted for evaluation with the application.

NAME OF SCHOOL AND COURSE:

DATES: Started /

CREDIT

Completed

HOURS

 

 

 

DAYS

PER WK

HRS/

DAY

I HEREBY STATE THAT THE INFORMATION CONTAINED IN THIS APPLICATION, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. I AGREE TO ABIDE BY ALL RULES AND REGULATIONS OF THE ARKANSAS BOARD OF ELECTRICAL EXAMINERS.

(PLEASE NOTE: FAXED COPIES ARE NOT ACCEPTED)

__________________________________

_____________________________________________

Date

Signature of Applicant

AR Electrician Application Form.doc Rev. 07/2009

Page 4 of 5

Mike Beebe

James Salkeld

Governor

STATE OF ARKANSAS

ARKANSAS DEPARTMENT OF LABOR

ARKANSAS BOARD OF ELECTRICAL EXAMINERS

10421 WEST MARKHAM • LITTLE ROCK, AR 72205-2190

Phone: 501-682-4549

Fax: 501-682-1765

TRS: 800-285-1131

Director

AFFIDAVIT OF EMPLOYMENT EXPERIENCE

TO: Arkansas Board of Electrical Examiners

Applicant Name:

Dates of verification (mm/dd/yyyy) :

From:

 

To:

 

 

Amount of hours in each type of work:

Residential:

 

 

Hours

 

 

Commercial:

 

 

Hours

 

 

Industrial Construction:

 

 

Hours

 

 

Industrial Maintenance:

 

 

Hours

 

 

Sign Specialist:

 

Hours

 

 

TOTAL HOURS:

 

 

 

Work listed above was performed under the supervision of:

Master Electrician:

 

 

License Number:

 

Company Name:

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

City:

 

State:

 

Zip:

 

Phone:

 

Fax:

 

 

 

 

Description of Applicant’s job duties:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I state under oath the above and foregoing employment history is true and correct to the best of my knowledge and belief.

_____________________________________

Employer's Signature

Subscribed and sworn to before me this

______ day of ______________, 20_______.

_______________________________

Notary Public

Employer's Name ( please print or type)

Company

License Number or Title

A separate affidavit must be furnished for each employer listed on the license application.

(Photocopy this form as needed.)

AR Electrician Application Form.doc Rev. 07/2009

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