CITC HVAC Apprentice Request for Electrical Affidavits of Experience

First Name(Required)

Middle Initial

Last Name(Required)

am/was a registered CITC HVAC apprentice.

My WA State Apprentice ID is:(Required)

Please Enter with 6 Digits.

Click here to lookup your WA State Apprentice ID.

My WA Electrical Trainee License number is:(Required)

Please Enter with 12 Digits.

Click here to lookup your WA State Electrical Trainee License.

I am requesting affidavit(s) of experience for the following time period:

From(Required)

To(Required)

I attest that I have not requested affidavits from my employer for the time period above. While I am a CITC apprentice, I will not, and cannot, request HVAC (06A) affidavits from my employer(s). I understand that I cannot submit duplicate or overlapping affidavits for the same time periods to L&I Electrical Licensing. I authorize the WA Dept of L&I, Electrical Program, permission to release any information pertaining to my electrical records to CITC for the purposes of issuing my affidavits.

Reason for requesting an affidavit:(Required)

I have enough OJT hours to apply for the journeyman 06A electrician exam

I have suspended, withdrawn, or transferred from the CITC apprenticeship program

I am renewing my electrical trainee card, which expires on

License Expiration Date:(Required)

Select One:(Required)

Mail the affidavit(s) to this address

Call me to pick up the affidavit(s) at the Bellevue office at this number

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Signature:(Required)

Today's Date(Required)

Email(Required)

Please enter email to receive a copy of your submission.

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Time of Submission(Required)