| New query |
| (1) Type of certification desired. |
| (2) Full name of the applicant and any other names the applicant has used to work as an electrician within five years previous to the date of the application. |
| (3) Date of Birth and Driver's license or state identification card number. |
| (4) Mailing Address. |
| (5) Telephone Number (Day and Evening). |
| (6) Request for Spanish language examination if applicable. |
| Note: Authority cited: Sections 3099 and 3099.4, Labor Code. References: Sections 3099-3099.4, Labor Code. |
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| The above information is provided free of charge by the Department of Industrial Relations from its web site at www.dir.ca.gov. |