NEW/REPLACEMENT CARD - ESP Nevada Electrical Qualifications Card

Nevada Electrical Qualifications Card

New or Replacement Card Request
Name:*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Business Phone Number
Cell Phone Number*
Examination Passed:*
Date Passed:*

MonthDayYear
I have passed an Electrical Qualifications examination through ICC and wish to obtain an ID card*
Are you currently participating in an apprenticeship program in the State of Nevada?*
If YES, Program Name*
Apprenticeship Program Name (If None, Use N/A)f
Important Notes:
- Only passing candidates may obtain an ID card
- Application must be completed in with all required fields in this form addressed
- Fees are NON-REFUNDABLE
- Requests for an ID card may take 4-8 weeks for processing and verification of candidate records
* Submissions are ONLY accepted via this webform or through regular mail or courier mail.
Please submit one passport-sized digital photo (in .jpg format)*

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Please submit a photo of your driver's license (in .jpg format)*

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Please submit a copy of your Pass Letter (.pdf or .jpg format accepted)*

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Please submit proof of 2,000 hours of apprenticeship hours or work in the electrical field (in .jpg format)*

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Please Choose:

Exam ID # G16Y/#T16Y - ICC Master Electrician Exam$100.00

Exam ID # G17Y/#T17Y - ICC Journeyman Electrician Exam$85.00

Exam ID # G18Y/#T18Y - ICC Residential Electrician Exam$85.00

Exam ID # G21-N - ICC Low Voltage Electrician Exam$85.00

I need a replacement card$45.00

Total $0.00

I hereby certify that I am the person indicated above, that all the information I have given herein is true and complete to the best of my knowledge, and that any false statement will be cause for voiding this application. Please sign in the box below:

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PLEASE NOTE: Submissions are accepted via this webform or through regular mail or courier mail. Please call for an in-office appointment. If you print this form to submit via mail, do not attach any payment information. Payment for mailed applications will take place via phone.
Electrical Safety Professionals

PO Box 46257

Las Vegas, NV 89114

Phone: 725-214-6004

www.electricalsafetypro.org
Revised 11/21/2024
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