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Get CA DLSE-ECF6 (Formerly DAS-ECF6) 2012

Keep a copy of this signed application with all documents for your records. ECU will respond to your application within 30 days upon receipt. ECU accepts payment only by check or money order payable to DIR Electrician Certification Fund. Payment must be included for certification to be renewed. Mail this completed form and payment to Attn Electrician Certification Unit ECU PO Box 420603 San Francisco CA 94142-0603 Section I - ALL Timely Certification Renewals must have first 3 boxes checked and proof of CE 1 Enclose 100. Dir. ca.gov/dlse/ecu/ElectricalTrade. html Electrician Certification Program Phone 415 703-4919 RENEWAL APPLICATION FOR ELECTRICIAN CERTIFICATION Please PRINT in Ink or TYPE Name Last Sfx First Initial Name must match U. S. Drivers License or State ID Drivers License or State ID D/L State Birthdate MM DD YYYY Mailing Address City County State Zip Day Phone Certificate Type General Electrician E-Mail Evening Phone Residential Electrician Voice Data Video Technician Fire/Life Safety Technician Non-residential Lighting Technician GENERAL INSTRUCTIONS Please fill in the information above and complete a section below. State of California Department of Industrial Relations Division of Labor Standards Enforcement www. Check the appropriate boxes. Please fill out a separate renewal application for each classification of certification you are renewing. Keep a copy of this signed application with all documents for your records. ECU will respond to your application within 30 days upon receipt. ECU accepts payment only by check or money order payable to DIR Electrician Certification Fund* Payment must be included for certification to be renewed* Mail this completed form and payment to Attn Electrician Certification Unit ECU PO Box 420603 San Francisco CA 94142-0603 Section I - ALL Timely Certification Renewals must have first 3 boxes checked and proof of CE 1 Enclose 100. 00 renewal fee. Required for timely submissions and card will be received within 2 weeks. 2 Check here to verify that you have completed 32 hours of further electrical education from an educational provider relevant to the type of certification being renewed and attach a copy of your completion hours. If not you do not qualify to RENEW timely and must retake the exam by marking box 4 attach a 200 fee. School Name s City If you do not have 2 000 hours you do not qualify to RENEW timely and must retake the exam by marking box 4 attach a 200. 00 fee. Section II - Renewal of EXPIRED Certification or Retake of Exam 4 Enclose 200. 00 exam fee to retake exam due to lapsed card or due to not meeting the first 3 requirements above. Please check language choice when retaking the exam* ECU will notify you in writing of the next step* Language choice for RENEWAL EXAM English Spanish I certify under penalty of perjury that all statements are true and correct. Check the appropriate boxes. Please fill out a separate renewal application for each classification of certification you are renewing. Keep a copy of this signed application with all documents for your records. ECU will respond to your application within 30 days upon receipt. .

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