Oregon Form 440 2570 – Fill Out and Use This PDF

Important: Read the application instructions before completing this form. Please complete all steps before submitting your application and refer to the checklist at the end of this form.

Your Social Security number is required for BCD licenses, certifications, and registrations according to ORS 25.785, ORS 305.385, 42 USC § 405 (c)(2)(C)(i), and 42 USC § 666(a)(13). Failure to provide this information will be basis for application refusal. Your SSN may be shared with other authorities only for tax-administration purposes and child-support enforcement (including identification).

List all individual or contractor electrical licenses you hold or have held in any state. Submit a copy of all out-of-state licenses with your application.

List license(s):

Please select a license type from the list below. Fees are nonrefundable.

The application instructions list the requirements and scope of each license.

Please refer to the enclosed list or our Web site to choose a test location.

Reciprocal applicants do not test.

Preferred testing location:

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List your experience in order, beginning with your present or most recent position. If more space is needed, attach additional sheets.

Please print

Applicant name:

To provide proof of your work experience, submit an Electrical Experience Verification form (440-2570A) from each of your employers.

OR

Applicants relying on military experience must submit the following:

•
 Official documentation from supervising official showing the type and approximate hours of work experience

•
 Other reliable documentation verifying training and experience if supervisor not located

Applicants must submit a 2” x 2” passport-style photo. Write your name on the back of your photo and submit it with your application. This photo will be printed on your license when it is issued. Please do not staple the photo.

1.I hereby certify that, to the best of my knowledge, the information on this application is complete and correct.

2.I understand that my license may be suspended, conditioned, or revoked if I have deliberately falsified my application. ORS 455.125

3.I understand that, if I provide false information on this application or cheat on a licensing examination, my application will be denied and I may not apply for any license or be allowed to take any division-related examination for one year from the date of denial. OAR 918-001-0040

4.I certify that I have read these statements and understand the terms of my license.

Name (print):

Apprentice applicants must provide proof of completion of a recognized apprenticeship program.

Applicant name:

Instructions: You must submit a separate experience verification form for each place of employment. If you are submitting more than one form, do not overlap dates of employment.

Applicants submitting verification of equivalent training and experience under OAR 918-030-0030(1)(c) must provide verification from the following persons:

• A current or previous employer actively involved with the applicant’s work;

• The individual who supervised the work if the current or previous employer is no longer in business, is deceased, or otherwise cannot be located; or

• A co-worker who was directly involved in the work performed, only if both the employer and the supervisor cannot be located. Co-worker verification must be accompanied by supporting documentation, such as employment records, showing that the verifier worked with the applicant and has knowledge of the work performed.

Name of verifier:

ELECTRICAL WORK EXPERIENCE CATEGORIES

To see a detailed list of minimum hourly requirements for each category, go to our Web site, bcd.oregon.gov, “Statutes and Rules,” “Oregon Administrative Rules,” click on 918-282, then scroll down to the desired license type.

LICENSING PROCESS

1.Review the licensing information on Pages 2-4 to determine the scope of work allowed under each license and whether you meet the qualifications for the license.

2.Complete the electrical license application (Form 440-2570) and send all required documentation, your photograph, and fees to the Department of Consumer and Business Services (DCBS). Use the checklist below to ensure your application is complete. Incomplete applications may delay evaluation of your applications.

3.Building Codes Division sends approved applicants a letter of authorization to take an examination. The letter explains the examination procedures and provides the address and telephone number of the test site. The applicant is responsible for scheduling the examination with the test site office.

4.If your application is denied, Building Codes Division will send a denial letter explaining your rights to a hearing.

5.Allow two weeks for Building Codes Division to grade your exam. If you pass the examination, Building Codes Division will issue your license and mail a photo identification card to you.

6.During each three-year license period, all licensees are required to complete continuing education. Go to bcd.oregon.gov to see the continuing education requirements for each license type.

ELECTRICAL LICENSE EXPERIENCE VERIFICATION INSTRUCTIONS

Most applicants are required to submit verification of electrical experience (Form 440-2570A), signed by a verifier, for each place of employment.

1.The person verifying the applicant’s work must be a current or previous employer. If an employer is not available, the person who supervised the work may verify experience. If neither an employer nor supervisor is available, a co-worker who was directly involved may verify experience.

2.The verifier must identify specific categories (e.g., “finishing and fixture hanging,” “commercial installations,” “troubleshooting and maintenance”) from Page 3 of the verification form and list the number of hours worked in each category on the form. A description of duties for each category must be included.

3.The verifier must sign and date the form.

CHECKLIST FOR ELECTRICAL LICENSE APPLICATION

1. Application form completed (Form 440-2570).

2. Affidavit signed and dated (Step 8 on application).

3. Verification of work experience (Form 440-2570A) from each employer.

4. Any additional required documents:

Proof of completion of an Oregon-approved apprenticeship or training program.

Proof of completion of an out-of-state apprenticeship program recognized by the state of Oregon.

Official transcripts of classroom training.

5. Proof of high school diploma, GED, or equivalent. A college degree will substitute.

6. Passport-style photo (2" x 2") with applicant’s name on the back.

7. Payment of fee.

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ELECTRICAL LICENSE REQUIREMENTS AND SCOPE OF WORK

Applicants are required to provide proof of training and work experience equivalent to an Oregon apprenticeship program. If applicants do not have related training classes, they may alternatively submit verification of twice the amount of required work experience. OAR 918-030-0030(2)

“300 percent rule”: For some licenses, no more than three times the number of minimum hours (300 percent) will be allowed for a single category of work experience. Categories of work experience (residential, commercial, industrial, etc.) required for each license type are listed on the Electrical Experience Verification (Form 440-2570A). Example of

“300 percent rule”: If the minimum requirement is 1,000 hours of residential work, the maximum credit allowed in the residential category is 3,000 hours — three times 1,000.

Below is a brief summary of the work a license holder is allowed to perform and the requirements for each license.