Before filling out this form

You must be able to verify a minimum 8000 hours of field experience to qualify!

Applicant Information

First Name*

Last Name*

Middle Initial

Address*

City*

State*

Zip Code*

Primary Phone*

Alternate Phone

E-mail Address*

Business Information (Optional information that would appear on your license certificate)

Business Name (if applicable)

Business Address

City

State

Zip Code

Business Phone

Business Fax

Web Site

Type of License and Date Applied For

Type of Exam*

Class A (Com./Ind./Res.) Class B (Residential Only)

Date of Exam*

Wed., December 19, 2018 Wed., February 20, 2019 Wed., April 17, 2019 Wed., June 19, 2019 Wed., August 21, 2019 Wed., October 16, 2019 Wed., December 18, 2019

Payment

After you click on "Submit" or "Submit and Print", you will be redirected to the credit/debit card payment page. From this page choose "Make a One-Time Payment". At the next screen select "Electrical Exam" from the Payment Category drop-down box. You will be officially registered when we receive verification of your payment.

Within 4 business days you will receive an email confirmation with details of your exam date. If you do not receive an email, first check your Spam folder, then call our office at 847-918-2020.

Please Note: If you choose "Submit and Print", you must click the "Continue" button on the next page.