"Work History Template"

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Member #:
Date:
Work History Relating to the ‘M’ Licence
Members Name:
Employer Name
Position
Start Date
Finish Date
Relevant hands on experience related to
Voltage
% of Time
‘M’ Licence
Note: Only one Employer Per Sheet
Signature of Current Supervisor required on Current Job Work History
Supervisor:
M or H Licence Number:
Date:
*** If Supervisor has a Licence Include a Copy of the Licence with Application
S:\M LICENCE\Forms\Work History Template 2015.docx
Member #:
Date:
Work History Relating to the ‘M’ Licence
Members Name:
Employer Name
Position
Start Date
Finish Date
Relevant hands on experience related to
Voltage
% of Time
‘M’ Licence
Note: Only one Employer Per Sheet
Signature of Current Supervisor required on Current Job Work History
Supervisor:
M or H Licence Number:
Date:
*** If Supervisor has a Licence Include a Copy of the Licence with Application
S:\M LICENCE\Forms\Work History Template 2015.docx