CITC HVAC Apprentice Request for Electrical Affidavits of Experience

I(Required)

am/was a registered CITC HVAC apprentice. I am requesting affidavit(s) of experience for the following time period:

My WA HVAC Trainee License number is:

I attest that I have not requested affidavits from my employer for the time period above. I understand that I cannot submit duplicate or overlapping affidavits for the same time periods to L&I Electrical Licensing, and that while I am a CITC apprentice, I will not and cannot request HVAC (06A) affidavits of experience from my employers. 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 of experience.

From

Please:

Mail the affidavit(s) to my home address on file

Call me to pick up the affidavit(s) at the CITC main office in Bellevue

Signed:

Date: