HomeMy WebLinkAbout4/4/2002Gingerich, Preston L. Y OF IOWA CITY, IOWA -
A PPLICA TION FOR AN ELECTRICIAN'S LICENSE
This application must be filled out completely and in detail
and shall be on file with the Building Official. With $20.00.
CITY OF I0 WA CITY
'pe of license for which you are applying:
I~Journeyman
[] Master's
[] Restricted
[] Maintenance
:_SIDENCE ADDRESS
TY ~'e~/¢ ;o
-~LEPHONE NUMBER
:IESENT EMPLOYER
DDRESS OF EMPLOYER
GE Jo
STATE
ZiP
SOCIAL SECURITY NO. z_/,,~
DATE OF BIRTH C~g-- ~-- 7~ BIRTHPLACE _~-o,.~ rS,, dj ,-~j Z-//4-
City State
ave you ever had an electrical license revoked?
nd if so, give reasons:
AJ o By whom?
~ave you previously been examined for an Electrical License by this Board?
f so, state type and results of examination:
.,Vas it approved?
-lave you previous made an application for a City of Iowa City Electrical License?
(over)
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.'tlVl£ (":.FNTI::R · 410 EART WASHINGTON STREET · IOWA CITY, IOWA 52240 · (319) 356-5000
:LECTRICIAN'S LICENSE APPLICATION - CITY OF IOWA CITY Page
ELECTRICAL EMPLOYMENT RECORDS
(Give previous and present employers and complete address.)
:MPLOYER
COMPLETE ADDRESS
DATES EMPLOYED' From ~'A~ /5'
ype of Electrical Work
~e_5', ~..~,-,o /~l ec~-,E
:MPLOYER
~ATES EMPLOYED: From /~_~ /5. ~'?
ype of Electrical Work
.COMPLETE ADDRESS
to 3'r~ /~
~MPLOYER
~ATES EMPLOYED: From
ype of Electrical Work
COMPLETE ADDRESS
to %'~,/P' ~'7
iMPLOYER
~ATES EMPLOYED: From
'ype of Electrical Work
COMPLETE ADDRESS
to d~ ~- _~ ~
If this application is approved by the City, you will be notified as to when you will take your examination.
-he foregoing statements are true and correct to the best of my knowledge and belief.
~ignature of Applicar~'~-'"~
Date
~st~lg~electlic.ap¢