Work History Template

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 LICENCEFormsWork History Template 2015.docx

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Parent category: Business