Get CA DLSE-ECF3 2015-2023

Dir. ca.gov/dlse/ecu/ElectricalTrade. html Electrician Certification Program Phone 510 286-3900 Application for Electrician Exam Retest Please PRINT or TYPE all information in INK Last Name First Name MI Name must match U. S. Drivers License or State ID Mailing Address City State Day Phone - Zip - Email Retest Exam Language Selection check one English Spanish RETEST of Exam s Taken but Not Passed OR RETEST of Certification RENEWAL Exam Check Exam s not passed G R F V L Date s taken ECP Tracking Nbr s if known Attach Exam Fee of 100 per Exam. You must wait 60 days to retest an examination. G General R Residential F Fire/Life Safety V Voice Data Video L Nonresidential Lighting Date s scheduled Attach a Processing Fee of 75 PLUS an Exam Fee of 100 per Exam. Any retest must be taken within 1 year from the date of notification of eligibility to take the original examination. I certify under penalty of perjury that all statements and attachments are true and correct. Clear State of California DL State Driver s License Payment Amount Date of Birth MM/DD/YYYY // DIR Labor Standards and Enforcement www. Signature Date Submit form with original signature and keep a copy for your records. Incomplete or inaccurately paid forms will NOT be approved* Exact payment by check or money order must be payable to DIR Electrician Certification Fund. Mail this completed form with all required attachments to DIR-Division of Labor Standards Enforcement Attn Electrician Certification Unit PO Box 511286 Los Angeles CA 90051-7841 For Office Use Approved by Print Form DLSE-ECF3 3-2015. Signature Date Submit form with original signature and keep a copy for your records. Incomplete or inaccurately paid forms will NOT be approved* Exact payment by check or money order must be payable to DIR Electrician Certification Fund. Mail this completed form with all required attachments to DIR-Division of Labor Standards Enforcement Attn Electrician Certification Unit PO Box 511286 Los Angeles CA 90051-7841 For Office Use Approved by Print Form DLSE-ECF3 3-2015. .