Beruflich Dokumente
Kultur Dokumente
**FEES
$50
Furnish
two (2)
identical full
front facing
photos
1" x 1 1/2"
in size
Photos MUST
be placed and
MUST fit in
these boxes
NO
EXCEPTIONS
EXAMINATION/GRADED
DATE
GRADE %
Name: / /
Last First Middle SS #
Address:
City: State: Zip Code:
Home Phone #: Work Phone #:
Date of Birth:
yrs.
mos.
(rev. 7/12)
Page 1 of 3
EDUCATIONAL BACKGROUND
NAME & LOCATION
OF SCHOOL
EDUCATION/
EXPERIENCE
YEARS
ATTENDED
DATE
GRADUATED
RELATED ELECT
SUBJECT
HIGH SCHOOL
COLLEGE
TRADE SCHOOL,
CORRESPONDENCE
SCHOOL OR
APPRENTICE
PROGRAM
No personal information will be released to persons seeking to compile a list
EMPLOYMENT BACKGROUND
POSITION
NAME OF EMPLOYER
ADDRESS
(rev. 7/12)
Page 2 of 3
In what jurisdiction?
I, THE UNDERSIGNED, CERTIFY THAT I HAVE READ AND FULLY COMPREHEND THIS FORM IN ITS
ENTIRETY AND THAT THE INFORMATION HEREIN PROVIDED IS TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE. I UNDERSTAND THAT SHOULD ANY STATEMENT I HAVE MADE PROVE FALSE, MISLEADING OR
ERRONEOUS, IT MAY RESULT IN THE REJECTION OF MY APPLICATION. I FURTHER UNDERSTAND THAT IT
BECOMES THE PROPERTY OF PRINCE GEORGES COUNTY GOVERNMENT AND WILL NOT BE RETURNED.
Date Signature
SUBSCRIBED AND SWORN TO ME THIS DAY OF ,20
Commission Expires: Notary Public
(rev. 7/12)
Page 3 of 3
Completed application MUST be signed by applicant and notarized. Check which type of license applicant is
applying for. A Limited License must indicate work performed. Examples include: HTG & A/C, elevators, signs, gas
dispensers, x-ray, voice communications, cable TV, 50 volts, remote control, alarms and lawn sprinklers and burglar
alarms.
Please note: Fees vary and are NON-REFUNDABLE. All fees MUST be paid by Money Order or Cashiers Check
payable to Prince Georges County.
Two (2) identical full front-facing photographs, 1"x 1 1/2" in size, MUST be able to fit in the boxes and MUST be
submitted with your application.
Documentation of your experience must be submitted on official company letterhead with your application:
Master Electrician: Must show seven (7) years of experience
Master Electrician Limited: Must show four (4) years of experience
Journeyman Electrician: Must show four (4) years experience
Apprentice Electricians must submit a letter from a licensed Prince Georges County Electrical
Contractor with signature of the Master Electrician or proof of enrollment in an Apprentice Program
Proof of your hands-on practical field experience MUST be submitted on company letterhead, signed by the Master
Electrician or Master Electrician Limited with whom you worked under and MUST include their license number
and licensing jurisdiction. Letters of verification must indicate specific dates of employment and account of pertinent
experience.
If employment with Government or Military, attach affidavits from qualified supervisory personnel.
Two (2) years of your experience can be substituted with formal course study or professional training. Attach copies
of school records, transcripts, diploma, certificates, etc. (Only Master Electrician or Master Electrician Limited may
substitute this type of proof).
Upon receipt of your application it will be submitted to the Board of Registration for Master Electricians and Contractors
for their review and approval. The Boards business meetings are held on the second Thursday of every odd-numbered
month of the year. If your application is approved by the Board, notice will be sent for your attendance for the examination.
The examination is given in every even-numbered month of the year. Please be advised that exams will not be graded on
the date of your examination.
(rev. 7/12)