Electrical Training Center

May 2019

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Important Links

Local 697 Business Office

Benefits Office

Credit Union

EPRI Part B Renewal Request

Name:

Street Address:

City, State, Postal Code

Phone Number:

Email:

SS#:

Card#:

Certification Expiration Date:

Today's Date:

A maximum difference of two years between today's date and the certification expiration date is allowed for part B recertification.

IBEW Local:

Location of your Part B Exam:

Please supply a record of work history totaling no less than 1200 hours within your certification period. Attach necessary reports and records as needed. Include employer contact information for all applicable employers within the certification period. Submit this form with all attached documents to the Host Facility where you completed your Part B Exam (Performance Exam) or to your local JATC for review. Supply a copy of your current certification card.

Contractor	Dates Worked	Hours Worked	Supervisor	Phone #

Training Director of Local JATC

Enter the text shown in the image above.