REQUIREwlENTS FOR ELECTRICAL EXAMINATION/LI CENSURE 
APPLICATION FOR EXAMINATION 
1.
Must be a resident of the Virgin Islands for at least 30 days immediately prior to submitting 
application for examination.
2.
Must submit 2 .letters of professional reference from persons with knowledge of applicant's work 
in the electrical field and 1 letter of favorable character testimony.
3.
Provide evidence of at least 5 years experience in the electrical trade.
4.
Copy of current registrntion/licensure.
5.
Copy of certification from Trade School (if applicable).
6.
· Fees: $150.00 (Expedited fee of $100.00 & Application fee of ,i50.00). 
APPLICATION FOR LICENSURE 
Upon successful completion of the electr:ica1 examination, an applicant must select the level of licensure 
he/she wishes to pursue. 
An applicant for a Master Electrician's License must provide the.following information to the Board. 
1.
Completed business application 8.pr,roved by DPNR, FIRE & POLICE.
?... 
Favorable tax clearance letter Lom·-the \!.J Bure::iu of Internal Revenue. 
3.
Certificace of Trade N.:ime Registi-ation froar the Lieutenant Governor's Office (jf applicable).
4.
Letter from a fin:rncial institution stating that the applicant is in good standing.
5.
License fee of $130.00, which covers licensure for one (1) year from date of issuance.
*
A holder of a Master Electrician's License shall not employ more than one full or part-time
apprentice or journeyman.
An applicant for an Electrical Contractor's License must provide the following information to the Board. 
1.
Completed business application .:ipproved by DPNR, FIRE & POLICE.
2.
Employer Identification Number (EIN).
3.
Favorable tax clearance letter from the V.I. Bureau of Internal Revenue.
4.
Certificate of Trade Name Registration from the Lieutenant Governor's Office (if applicable).
5.
Letter from a financial institution stating the applicant 1s in good st.:inding.
6.
Proof of Public Liability Insurance.
7.
Workman's Compensation Insur:rnce (if applico.ble).
8.
License fee of $130.00, which covers licensme for one (l) ye.:ir from date of issuance.
LAW: Title 27 V.I.C. Chapter 7, Section 275 states," Whoever violates or refuses to comply with any 
provisions of this chapter or any rules or regulation thereunder shall be fined not more than $500 for each .
and every violation or act ot· non-compliance." 
Part I 
VIRGIN ISLANDS ELECTRICIANS' 
LICENSING BOARD 
Department of Licensing and Consumer Affairs 
3000 Golden Rock Shopping Center, Ste. 9 
Christiansted, VI 00820-4311 
(340) 773-2226
(340) 713-8308 (Fax)
APPLICATION FOR EXA1Y1INATI0N 
Attach 3 
2x2 photos of 
Applicant here 
In accordance with the provisions of Chapte1- 7 Title 27, Virgin Islands Code, which regulates Trades & 
Crafts in the U.S. Virgin Islands, I hereby apply for the following examination: 
Electrical Examination 
Non-Refundable Application Fee 
$ 200.00 
$ 50.00 
•
Only the application fee ,viii be accepted at the time application is submitted.
Part Il
I 
1.
Full Name
First 
Middle 
Last 
2.
Physical Address
3.
Mailing Address
4.
Business Address
S. 
Business Telephone ( 
) 
6. Home Telephone ( 
7. 
Birth Date 
8. BirthPlace ___________ _
9.
Citizenship
10. Naturalized: 
(
) yes 
) no 
11.
Social Security Numbe(-
12.
Virgin Islands Resident? (
) yes 
( 
) no 
If yes, how long? _______
_
_ _ 
13.
Present Business Activity
Email Address: _________________________
14. 
In which state(s) do you currently hold registration/licensure:
 
_ 
15, 
Has your license ever been revoked? ( 
) yes ( 
) no 
If yes, please explain: 
_ 
16, 
Have you ever been censured for unprofessional conduct') 
) yes ( 
) no 
.If yes, please explain: 
~ 
_ 
17, 
Have you ever been convicted ofa felony? 
If yes, please explain: 
_ 
) yes ( 
) no 
_._----,---
----,----
---------------------.---
Part III 
18,
 
REFERENCES: Please provide two (2) professional refecences from licensed electncians in the, 
industry and one (1) character reference in the space provided below. Please note that the reference 
letters mLlst correspond with the names listed below and should be persons other than Board 
Members and relatives of the applicant. 
Name 
Address 
Telephone Number 
1. 
2, 
3. 
Name and Address of Institution 
Attendance 
From 
To 
Technical Course 
, 
Graduation 
., 
Degree Recei ved 
, 
Part IV 
EDUCATIONffECHNICAL TRAINING: (PI 
. I 
I
 
der. b 
20.
 
El\1PLOYMENTIE:J..'"PERlENCE: (Please list in chronological order your electrical expelience for at least 5 years). Use an 
f necessary. followiM: the same format or ·attacl 
, 
From 
To 
Name, Address and Phone # of Employer 
Name of Immediate 
Supervisor 
Job Title and Description 
All information must be verifiable. Any false informatjon may be reason for denial of application. 
Part V 
AFFIDAVIT 
(Must be cOmpleted by all applicants) 
State of 
Terri tory of 
Country of 
_ 
_ 
_ 
I, 
, being duly sworn, depose and say that I am the 
person who ex.ecuted the foregoing instrument; that I have read the same and know the contents thereof; that 
the m~ltters stated therein are true to my knowledge; that I have not suppressed any information that might 
affect this application; and that I have read and understand this affidavit. 
Applicant's Signature
 
Sworn and Subscribed before me this _~ 
day of 
, 20 
_
 
Notary 
Seal 
Notary Publtc 
My Commission ex.pires on 
_ 
Do not write below this line: 
BOARD DISPOSITION: 
Application Approved: 
(__) YES 
(__) NO 
Signature, Chairman of the Board 
Member 
Member 
Date 
Member 
Member 
SIGN
Form Lie lA 
Affidavit 
United States Virgin Islands 
) 
SSN: 
_ 
St. Croix, St. Thomas, St. John 
) 
1, 
after first being duly swom, hereby 
depose and say: 
1. That I am a resident 01 
_ 
2. That during the period from 
to 
I have 
been residing in 
and have filed 
my Federal Income Tax Returns l..J..lith and paid any taxes due to the United 
States Federal Government at the Internal Revenue Service Office in 
and to the State of 
_ 
Or 
3. That during the period from 
to 
_ 
[ have been residing in 
and I was 
unemployed or did not have sufficient income to file an Income Tax Return 
(mark out the one that does• not apply.) If I was a full or part-time student, I 
attended 
...!.-
_ 
Signature 
Subscribed and Sworn before me on this 
day 0/ 
_ 
Notary Public 
I I 
SIGN
'-OI<.\ll.1ll 
GOVfUNMENTOF
 
HIE VIRGIN ISlANDS OFTHE UNITEDSfATES
 
VIRGIN IStANDS BUREAU OF INTERNAl- REVENUE
 
APPLICAnON FOR
 
TAX flUNG AND PAYMENT STATUS REPORT-LICENSING
 
The applicant identified befOH' !lereby relJuests a letter certifying !lis or !ler tax filing ami l'ayll1e11t status 
for tlIe I'urpose of receiving a I/ew or rellelPal license from tlIe Department of Licensing and Consumer 
Affllirs pursuant to Section JOl of Act 5060, codified as Title 27, Section 304, Subcl,apter (j), Virgin Islands 
Code. TI,e applicant authorizes tI,e Virgin Islands Bureau of Intt'nral Revenue to disc/ost' any taxpayer 
illfonnatio" related to tlIis application to the Department of Licensing and Consumer Affairs, who may 
make sud, further disc/osures as are necessanJ to carry out the requirements ofAct 5060. 
1. 
BUSINESS NAME: 
2. 
BUSINESS EIN: 
_ 
3. 
OWNERS SSN: 
SPOUSE S5N: 
_ 
4. 
PLEASE INDICATE: ______ NEW LICENSE 
__________ RENEWAL 
5. 
_____ SELF-EMPLOYED 
CORPORATION 
PARTNERSHIP 
l.LC 
LLP 
6. 
DO YOU HA VE EMPLOYEES? 
_ 
7. 
PLEASE CIRCLE FORMS THAT YOU USE: 
(1040/8689,1065,1120,941 VI, 720VI, 720B VI, 722 VI, OTHER(1isO 
_ 
8. 
DATE BUSINESS STARTED: 
LICENSE EXPIRATION DATE: 
_ 
9. 
PERSON REPRESENTING APPLICANT: 
__ 
ZO. 
POSITION OF REPRESENTATIVE: 
_ 
11. 
SIGNATURE: 
_ 
13. 
PHYSICAL ADDRESS: 
_ 
14. 
DAfE: 
_ 
fELEPHONE: 
. 
.__.. 
. 
_ 
HEPl. Y 10: (1601 ESTATE fHOMAS, ST TlIOM.-\S, VIHGIN ISLANDS 00802
 
OH 4008 ESTA fE Dl;\MOND, Pl.O f ?HI C[(HIS riA NSTED, VIHGI.'J ISLANDS 00820··1421