Form Dlse-Ecf6 Renewal Application For Electrician Certification
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State of California
DL State _____ Driver’s License # __________________
DIR – Labor Standards and Enforcement
Payment Amount $ __________
Date of Birth (MM/DD/YYYY) ______/______/______
Electrician Certification Program
Phone (510) 286-3900
Renewal Application for Electrician Certification
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:
Zip: ______________-________________________
Day Phone: (____)_____-_______
Email: ___________________________________________________
Type of Certification Examination Requested (check one):
|
| General Electrician |
| Residential Electrician
|
| Fire/Life Safety Technician
|
| Voice Data Video Technician |
| Nonresidential Lighting Technician
GENERAL INSTRUCTIONS
Please fill in the information above and complete a section below. Check the appropriate boxes.
A separate renewal application for each classification of certification is required. Keep a copy of this signed
application with all documents for your records. ECU will respond to your application within 30 days upon
receipt. Please make checks payable to DIR-Electrician Certification Fund. Payment must be included for
the Certification to be renewed. Mail this completed form and payment to:
DIR-Division of Labor Standards and Enforcement
Attn: Electrician Certification Unit
PO Box 511286
Los Angeles, CA 90051-7841
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 and attach a $200.00 fee)
School Name(s):________________________________________City:______________________________________
School Name(s):________________________________________City:______________________________________
School Name(s):________________________________________City:______________________________________
(3) Check here to verify that you have worked at least 2,000 hours in the industry in previous 3 years.
(If you do not have 2,000 hours, you do not qualify to RENEW timely and must retake the exam by marking box
#4 and 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 and attachments are true and correct.
Signature:
Date:
(For Office Use) Tracking Nbr:
Page 1 of 1
Form DLSE-ECF6 (10/2015)
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