Iowa Electrician License Application Form – Fill Out and Use This PDF

INSTRUCTIONS FOR APPLICATION FOR ELECTRICIAN'S LICENSE

IOWA STATE ELECTRICAL BOARD

Instructions for Filling out the Application for Electrician’s License

AN APPLICATION IS NOT CONSIDERED COMPLETE AND WILL NOT BE PROCESSED UNTIL

ALL ITEMS HAVE BEEN SUBMITTED AS REQUIRED

The application must be completed and signed by the applicant. All information must be typed or clearly printed

in black or blue ink using upper cases letters. The application and all attachments must be submitted on separate pieces of single-sided, 8½‖ x 11‖ plain paper. Please use a paper clip to fasten all pages together, with the check

or money order on top. Do not use staples, use only plain paper.

If one check will be used to pay for multiple applications, a Combined Check Worksheet must be completed and submitted with the applications and payment. The Combined Check Worksheet is available on the

Department’s Website.

All CHECKS TO BE MADE PAYABLE TO: TREASURER- STATE OF IOWA

THE FOLLOWING MATRIX SHOULD BE USED TO DETERMINE WHICH PORTIONS OF THE LICENSE APPLICATION ARE REQUIRED TO BE FILLED OUT BASED ON THE TYPE OF LICENSE THAT IS DESIRED.

Type of	Part 1	Part 2	Part 3	Part 4	Part 5	Part 6	Part 7	Part 8	Part 9	Class B	Certificate
License	License	Personal	Educational	Current	Screening	Practical	Verifiable	Applicant	Electrical	Affidavit/	of
	Type	Information	Record	Electrical	Questions	Electrical	Electrical	Signature	Contractor	Special	Responsible
				Licenses		Work	Work			Electrician	License
				in Force		Experience	Experience			Affidavit	Master
Electrical	X	X		X	X			X	X		X
Contractor
Residential	X	X		X	X			X	X		X
Contractor
Class A	X	X	X	X	X	X	X	X
Master
Electrician
Class B	X	X	X	X	X	X	X	X		X
Master
Electrician
Residential	X	X	X	X	X	X	X	X
Master
Class A	X	X	X	X	X	X	X	X
Journeyman
Electrician
Class B	X	X	X	X	X	X	X	X		X
Journeyman
Electrician
Residential	X	X	X	X	X	X	X	X
Electrician
Special	X	X	X	X	X	X	X	X
Electrician
Apprentice	X	X	X		X	X	X	X
Electrician
Unclassified	X	X	X		X	X	X	X
Person

ALL APPLICANTS MUST PROVIDE QUALIFICATIONS FOR TYPE OF LICENSE DESIRED

Part 1 – LICENSE TYPE

1.DESIGNATE TYPE OF LICENSE DESIRED: - Indicate the type of license desired by checking the appropriate boxes

Electrical Contractor – A person affiliated with an electrical contracting firm or business who is licensed by the board as either a Class A or Class B Master Electrician and who is also registered with the state of Iowa as a contractor

Residential Contractor – A residential electrical contractor license may be issued to a person who is licensed as a class A master electrician, a class B master electrician, or a residential master electrician and who is registered with the state of Iowa as a contractor.

Master Electrician – A person having the necessary qualifications and technical knowledge to properly plan, lay out, and supervise the installation of electrical wiring and equipment for light, heat, and power.

Class A - License was obtained by written supervised examination and is not subject to the restrictions of a Class B license

Class B – License is granted by proven experience since 1998. License is subject to restrictions by the board and local political subdivisions.

Residential Master – A residential master electrician license may be issued to a person who submits to the board a completed application with the applicable fee, who is not disqualified from holding a license pursuant to rule 661—502.4(103), and who meets one of the following requirements: A. Holds a current residential electrician or journeyman electrician license, has 2,000 hours of

verified experience as a residential electrician or a journeyman electrician, and has passed a residential master electrician examination approved by the board; or

B. Holds a current special electrician license with a residential endorsement, has 4,000 hours of verified experience, and has passed a residential master electrician examination approved by the board.

Journeyman Electrician – Persons having the necessary qualifications to wire for or install electrical wiring and equipment.

Class A - License was obtained by written supervised examination and is not subject to the restrictions of a Class B license

Class B – License is granted by proven experience since 1998. License is subject to restrictions by the board and local political subdivisions.

Residential Electrician – A residential electrician license may be issued to a person who submits to the board a completed application with the applicable fee, who is not disqualified from holding a license pursuant

to rule 661—502.4(103), and who meets one of the following requirements:

A. Holds a current residential special electrician license and has held that license for a minimum of one year and has passed a residential electrician examination approved by the board; or

B. Has completed 6,000 hours of experience as an apprentice electrician and has passed a residential electrician examination approved by the board. An applicant may take the examination required by this paragraph after completing 5,000 hours of experience as an apprentice electrician, although the license will not be issued until the applicant has completed 6,000 hours of such experience; or

C. Has completed 4,000 hours of experience working under the direct supervision of a residential master electrician, a residential electrician, a master electrician, or a journeyman electrician; has successfully completed a minimum of one academic year of electrical trade school; and has passed a residential electrician examination approved by the board; or

D. Has completed 8,000 hours of verified experience as a licensed unclassified person and at least 2,000 hours of verified work experience in residential wiring and has passed a residential electrician examination approved by the board; or

E. Has successfully completed a residential electrician apprenticeship program approved by the United States Department of Labor and passed a residential electrician examination approved by the board

Special Electrician – A person having the necessary qualifications to install special classes of electrical wiring, apparatus, equipment, or installations which shall include irrigation system wiring, disconnecting and reconnecting of existing air conditioning and refrigeration equipment, and sign installations.

Apprentice Electrician – A person who is engaged in learning and assisting in the installation, alteration, and repair of electrical wiring, apparatus, and equipment as an employee of a person licensed by the board and is progressing toward the completion of an apprenticeship program registered by the bureau of apprenticeship and training with the United States Department of Labor.

Unclassified Person – Any person other than an apprentice electrician or other person licensed under this licensing act, who , as such person’s principal occupation, is engaged in learning and assisting in the installation, alteration, and repair of electrical wiring, apparatus, and equipment as an employee of a person licensed under this licensing act.

2. APPLICATION FOR LICENSE BY:

Examination – Check this box if you plan to take an examination sponsored by the state of Iowa to obtain an electrical license. All experience requirements and qualifications per the State Electrical Board must be met to allow one to take the examination.

Reciprocal – Check this box if you intend to obtain your license through reciprocity with states that have entered into a reciprocity agreement with the state of Iowa. At this time, Iowa does not have any reciprocity agreements with any other state. Please check the following website for updates of reciprocity agreements. http://www.dps.state.ia.us/fm/electrician/index.shtml

Proof of Work Experience – Check this box if you intend to obtain a Class B license by providing proof of work experience

Existing City License in Iowa – Check this box if you intend to obtain a license by indicating that you currently possess an electrical license that was obtained through a local Iowa political subdivision that required the passing of a written supervised examination in order to obtain licensure. Provide a copy of the license with your application.

Part 2- PERSONAL INFORMATION

NAME – Full Name of applicant – Electrical Contractor Business Name is required in a later section

SOCIAL SECURITY NUMBER – Provide the Social Security number that is used by the applicant. All social security numbers will be kept confidential

MAILING ADDRESS (Mailing Address, City, County, State, Zip Code) - Write the mailing address of the applicant

Part 3 - EDUCATIONAL RECORD

If none of the questions apply, check the NO box for each question and continue to the next section of the form.

Part 4 -CURRENT ELECTRICAL LICENSES IN FORCE

If you do not currently have any electrical licenses in force, leave this section blank or write ―NONE‖ next to CURRENT LICENSES IN FORCE Column.

Type of license, issuing jurisdiction, license number, year license issued, and expiration date of license – Enter the type of license (master, journeyman, electrical contractor, etc.), Jurisdiction that issued license (i.e. City of Des Moines, State of Nebraska, Linn County), License Number, Year license was issued (Original Issue Date), and expiration date of license

IS THIS LICENSE CURRENT/ ACTIVE? – Check the appropriate box if your current license is active and up to date.

WAS THE LICENSE OBTAINED BY EXAMINATION? – Check the appropriate box if the license you currently hold was obtained by passing a written supervised examination.

Part 5 – SCREENING QUESTIONS

Answer all questions in this section. Failure to do so could result in your license being delayed.

Part 6- PRACTICAL ELECTRICAL WORK EXPERIENCE

For Class B License Work Experience please refer to page 5. – If you are applying for a Class B license, page 5 is required to be filled out as well as the verifiable electrical work experience section.

PRATICAL ELECTRICAL EXPERIENCE – On the left side of the section provide the amount of time the applicant was performing at the various levels of electrical occupations. On the right side of the section provide the percentage of time that the applicant spent in each type of work. The total percentage should add up to 100%.

REFERENCES: - Provide 3 persons or firms, preferably in the electrical industry, to be used as references

REMARKS: - Space provided for comments or additional information that would assist the board in evaluating your application.

Part 7 - VERIFIABLE ELECTRICAL WORK EXPERIENCE

Name of Current/ Previous Employer – Provide names of present and previous employers. If self employed, list company name and indicate self- employed.

Mailing Address – (Mailing Address, City, State, Zip Code) – Mailing Address of Employer

Reason for Leaving – Indicate reason for leaving (i.e. Better Opportunity, Resigned, Laid Off, Fired, etc.)

Duties– Provide an explanation of the nature of work that the applicant performed during employment (i.e. 3 months installing residential wiring or 15 months installing commercial wiring)

Part 8- APPLICANT SIGNATURE– Sign and date the application

Please remember that the application must be completed in blue or black ink and all attachments must be submitted on separate pieces of single- sided, 8½‖ x 11‖ paper. Please use a paperclip to fasten all pages together. Do not use staples. Any deviation from these instructions may delay the

processing of your application.

Documents submitted with the application will not be returned. Keep a copy of the completed application, all attachments and your check. Do not submit forms that you did not have to complete.

Before you sign, carefully read the statement at the bottom of the application. Be aware that information provided on this application and any attachments are subject to audit. Providing false information may result in revocation of this license and imposition of administrative penalties.

Part 9- ELECTRICAL CONTRACTOR - This portion of the application to completed by those applying for an Electrical Contractor license. A Master Electrician license is required for an electrical contractor.

Name of Responsible Master Electrician – Print the name of the Responsible Master Electrician that is required to be or be employed by the Electrical Contractor

Name of Contractor Representative – Print the name of the Contractor Representative (i.e. owner, officer of corporation, etc.).

Have you completed and attached a Certificate of Responsible Licensed Master? – Check the appropriate box. A Certificate of Responsible Master Electrician is required to obtain an Electrical Contractor License.

Business Name of Contractor – Enter the business name of contractor as it appears on the Contractor Registration Form issued by the Iowa Division of Labor, except for an individual (sole proprietor) or a partnership making application using the individual’s or all partners’ own full true

name(s) as the contractor name. Examples of business names:

An individual without an assumed name – John Doe or John Doe Electric

An individual with an assumed name – John Doe dba Assumed Name

A partnership with an assumed name – John Doe and Jane Doe dba Assumed Name

A corporation – Company Name, Inc.

A corporation with an assumed name – Company Name Inc. dba Assumed Name

A limited liability company – Company Name, LLC or LLP

Business Address – Address of the business

Mailing Address – Required if different from business address

Are you registered as a contractor with the state of Iowa? – Check the appropriate box. An electrical contractor is required to be registered as a contractor with the state of Iowa before they can receive an electrical contractor license. To check on the status of registration follow the web link: http://www.iowaworkforce.org/labor/contractor.htm

Iowa Division of Labor Contractor Registration # - Provide the registration number of the electrical contractor as provided by the Iowa Division of Labor. To check the requirements of the Iowa Division of Labor go to their web site at http://www.iowaworkforce.org/labor/contractor.htm

Federal Tax ID# or Employer Identification # - Provide the federal tax identification number or employer identification number assigned to the business by the U.S. Department of Treasury – Internal Revenue Service. Sole proprietorships and partnership should provide their social security number(s) in lieu of the employer identification number. All employer identification numbers and social security numbers will be not be part of the public record and will be kept confidential.

Signature of Contractor Representative – Contractor Representative to sign and date application

Signature of Responsible Master or Master Applicant – Responsible Master Electrician or Master Electrician Applicant to sign and date application

CLASS B AFFADAVIT FORM – This form is used to verify that you have been practicing as an electrician on or before 1990.

Print Name of Qualifying Party – Print name of applicant applying for Class B license

Signature of Qualifying Party – Signature of applicant applying for Class B license

Name of Business- Print Name of Business that applicant works for/ owns

Date – Print date that the form was filled out.

THIS FORM IS REQUIRED TO BE NOTARIZED – The bottom of this form is required to be filled out by a notary of the public. A notary of the public is required to witness that the person signing this document is authentic.

A notary of the public in your area can be found at the following web site: http://www.sos.state.ia.us/notaries/index.html This website contains a searchable database of notaries of the public in your area.

CERTIFICATE OF RESPONSIBLE MASTER – This form is to designate a master electrician that is responsible for the electrical contractor

THIS FORM IS REQUIRED TO BE NOTARIZED – The bottom of this form is required to be filled out by a notary of the public. A notary of the public is required to witness that the person signing this document is authentic.

A notary of the public in your area can be found at the following web site: http://www.sos.state.ia.us/notaries/index.html This website contains a searchable database of notaries of the public in your area.

APPLICATION FOR ELECTRICIAN'S LICENSE	SUBMIT TO:
IOWA ELECTRICAL EXAMINING BOARD	ELECTRICAL EXAMINING BOARD
	215 EAST 7TH STREET
	DES MOINES, IA 50319

*APPLICABLE LICENSE FEE MUST ACCOMPANY THIS APPLICATION.

Please Type or Print Legibly

Part 1- LICENSE TYPE

1.DESIGNATE TYPE OF LICENSE DESIRED:

2.APPLICATION FOR LICENSE BY:

ELECTRICAL CONTRACTOR – (See Fee Schedule)

EXAMINATION

MASTER - (See Fee Schedule)

CLASS A or

CLASS B

or

RESIDENTIAL MASTER - (See Fee Schedule)

RECIPROCAL

RESIDENTIAL CONTRACTOR - (See Fee Schedule)

or

RESIDENTIAL ELECTRICIAN - (See Fee Schedule)

PROOF OF WORK EXPERIENCE (Class B or

JOURNEYMAN - (See Fee Schedule)

CLASS A or

CLASS B

Special Electrician Endorsements)

SPECIAL ELECTRICIAN - (See Fee Schedule)

or

Special Electrician Endorsements: (Check the appropriate endorsement that you

EXISTING CITY LICENSE IN IOWA (Provide copy of

would like to receive. You may check multiple endorsements.)

existing license and testing results)

Irrigation System Wiring

Disconnect/ Reconnect Existing Air Conditioning or

Refrigeration Equipment

Sign Installation

APPRENTICE ELECTRICIAN - (See Fee Schedule)

UNCLASSIFIED PERSON - (See Fee Schedule)

All licenses valid for three years, except apprentice and unclassified

licenses. Apprentice licenses and unclassified persons are valid for one

year.

Part 2- PERSONAL INFORMATION

Name (Last, First, Middle)

Social Security Number

Date of Birth

Telephone

(

)

Mailing Address (Street or P.O. Box)

Email Address

City

County

State

Zip Code

Part 3 - EDUCATIONAL RECORD

TYPE

YES

NO

DATES ATTENDED

NAME & LOCATION OF SCHOOL OR

DATE DIPLOMA OR

FROM

TO

TRADE ASSOCIATION

DEGREE RECEIVED

(Attach copy of degree)

Have you completed a two-year post

high school course in electrical wiring

from which you received a Degree in

Electrical Technology?

Have you completed a four-year or

five-year apprentice electrician

program?

Part 4 -CURRENT ELECTRICAL LICENSES IN FORCE

(If needed, attach an additional sheet in the same format)

TYPE OF

ISSUING JURISDICTION

LICENSE #

YEAR

EXPIRATION

IS THIS LICENSE

WAS THE LICENSE

LICENSE

LICENSED

DATE

CURRENT/

OBTAINED BY

ISSUED

ACTIVE?

EXAMINATION?

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

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