Verification Electrician Form PDF Details

Navigating the pathway to becoming a licensed electrician involves significant steps, one of which is the completion of the Verification Electrician form, an essential document for those seeking licensure in the electrician field. Accessible via the cca.hawaii.gov/pvl website, this form serves a dual purpose by helping to establish an applicant's experience in the field under the supervision of a licensed electrician. The form is divided into two parts where the first part requires basic information from the applicant, including their name and address, while the second part mandates detailed input from either the supervisor or employer, or from the applicant if they are self-employed. This detailed section seeks to verify the applicant's experience by asking for specifics about the nature of the work performed, adherence to the National Electric Code, and a thorough description of tasks along with hours spent on each. Notably, if the supervisor in charge does not operate under a specific electrician license due to state regulations but holds a contractor's license, they are still required to complete this form and provide verification of their ability to perform electrical work. Furthermore, this form must be notarized and returned to the applicant to attach to their application, making it a critical step in the verification process. By completing this form, supervisors and employers assist in providing credible evidence of an applicant's experience and capabilities in the electrical trade, showcasing the practical, hands-on skills gained over the course of their employment.

QuestionAnswer
Form NameVerification Electrician Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesLic, licensee, hawaii experience verification, experience verification electrician

Form Preview Example

EXPERIENCE VERIFICATION - ELECTRICIAN ONLY

Access this form via website at : cca.hawaii.gov/pvl

PART I. TO BE COMPLETED BY APPLICANT

Fill in your NAME and ADDRESS only. Your supervisor/employer must complete the other sections and have the form notarized. After it is completed, ATTACH it to your application form.

NAME OF APPLICANT (First, Middle)

(Last)

Mailing Address of Applicant

Date

PART II. TO BE COMPLETED BY LICENSED ELECTRICIAN SUPERVISOR OR CONTRACTOR EMPLOYER OF APPLICANT OR APPLICANT IF SELF-EMPLOYED

Your assistance as a licensed electrician is necessary to provide valid and accurate verification of experience. Acceptable verification is from a licensed electrician working with and/or responsible for the applicant. NOTE: If self-employed, please provide verification of a valid contractor's or other appropriate license that allowed you to contract to perform electrical work. NOTE: If the state in which you supervised the applicant does not require licensure as a journey worker, supervising, or master electrician and only requires a contractor's license, you may complete the form and attach verification of licensure that shall include the effective date of the license that allowed you to perform electrical work. Please sign before a Notary Public. Please return this completed "Experience Verification" form to the APPLICANT who must attach it to the application form.

Please indicate your license before verifying the applicant's experience:

Name and Address of Supervisor

Title:

Years of Experience:

Electrician Lic. No.: (Required)

Years Licensed:

Employer's Name and Address

Type of Business:

License No.:

Applicant's Employment Information:

Employment Date

Termination Date

 

 

Total Length of Employment

yrs.mos.

Average Hours Per Week

EXPERIENCE:

1.

Is applicant's work performed in compliance with the National Electric Code?

 

2.

Describe work performed in detail.

Yes

No

(CONTINUED ON PAGE 2 - NOTARIZED SIGNATURE REQUIRED)

EP-03 1214R

PART II. TO BE COMPLETED BY SUPERVISOR/EMPLOYER OF APPLICANT OR APPLICANT IF SELF-EMPLOYED (Continued)

Beside describing the applicant's experience, please indicate the total hours for each work process/task as listed below:

ELECTRICIAN

Specific Work Process/Task

Total Hours Per Task

Residential wiring (Installation of meter sockets; rough in wires; and installation and

maintenance of receptacles, switches, light fixtures, signal and other work). . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Commercial wiring (Conduit installation; installation of metal moldings and cables;

and installation and maintenance of panel boards and other work). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Industrial wiring (Installation and maintenance of substation equipment, switchboards, bus

ducts automatic controls, and other work; and cable splicing). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Specialized wiring (Installation of temperature and refrigeration controls; fabrication of electrical panels, motor starters, etc.; assembly and wiring of custom job fixtures for special jobs;

and installation and maintenance of neon sign). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General wiring (Installation and maintenance of motor generators; appliance repairs;

and other wiring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOTAL HOURS

OF EXPERIENCE. . . . . .

AFFIDAVIT:

I swear that the information provided is true and correct. I understand that any misrepresentation is grounds for refusal to grant or possible disciplinary action against the licensee.

Signature of Supervisor, Employer, or Applicant if Self-Employed in front of Notary Public

Date

Subscribed and sworn to before me this

 

 

 

 

 

day of

A.D. 20

 

.

 

 

 

 

 

Notary Public, State of Hawaii

My commission expires:

Print Name:

 

Doc. Date:

No. of Pages:

 

 

 

 

 

 

 

 

 

 

 

 

 

Notary Name:

 

Circuit Court:

 

 

 

 

 

 

 

 

 

 

 

 

Doc. Description

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notary Signature:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This material can be made available for individuals with special needs. Please call the Licensing Branch Manager at (808) 586-3000 to submit your request.

-2-

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Step number 1 in submitting hawaii experience verification

2. After finishing the previous step, go on to the next stage and fill in the essential details in these fields - Electrician Lic No Required, Years Licensed, Applicants Employment Information, License No, Employment Date, Termination Date, Total Length of Employment, Average Hours Per Week, EXPERIENCE, Is applicants work performed in, Yes, yrs, mos, and Describe work performed in detail.

Completing section 2 in hawaii experience verification

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4. The following section requires your input in the following parts: Signature of Supervisor Employer, Date, Subscribed and sworn to before me, day of, Notary Public State of Hawaii, My commission expires, Print Name, Doc Date, Notary Name, Doc Description, Notary Signature, Date, No of Pages, Circuit Court, and This material can be made. Ensure that you fill in all of the needed details to move onward.

hawaii experience verification completion process clarified (portion 4)

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