Employee List

*** IF NO EMPLOYEES ARE DOING ELECTRICAL WORK, PLEASE INDICATE "NONE" IN BOTH FIELDS -- IF RECEIVED WITH BLANKS, YOUR LICENSE WILL NOT BE RENEWED.

Basic Information

This information is required to verify this submission to the Electrical Board.
License Type
Master
Class B
Last 4 Digits of Social Security Number
License Number (Digits Only)

Employee Information

Please enter the name and registration\license number of all employees doing electrical work below. If you have more than 10, the fields will increase each time you fill in the last row.
NameRegistration / License Number
Example:
John Doe
M 5555