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GOVERNMENT OF TAMILNADU

THE ELECTRICAL LICENSING BOARD.

Thiru.Vi.Ka.Indl.Estate, Guindy, Chennai-600 032.

FORM"S"Application for Supervisor Competency Certificate

(Read the instructions overleaf before filling u the form)

1. Name of the applicant(in block letters)

2. Father's Name

3. Address of the applicant(in block letters)

4. Date of Birth and age .(Proof for date of Birth in original alongwith xerox copy to be enclosed)

5. Details of Technical Qualification passed

by the applicant.(Certificate in originalalongwith xerox copy to be enclosed)

6. Details of Past and Present experience(along with evidence.)

7. Have you made any previousapplication?If so, State reference No. and date.

8. Do you possess Wireman.C.C/WiremanHelper.C.C issued by this Board? If so

furnish the Details and surrender thesame.

9. Demand Draft Details. DD No. Date Value

One photo should be

affixed and attested by

the Gazetted Officer.

I hereby declare that the particulars stated above are correct and true to the best of myknowledge

I request that I may be granted a Supervisor Competency Certificate.

Place : Signature of the applicant.Date :

Signed before me Gazetted Officer Sign, Designation and Seal.

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INSTRUCTIONS:-

1. Fees Issue for Supervisor Competency Certificate = Rs.500/-.

(ii) The fee should be paid by means of Demand Draft obtained from any scheduled Bank or

Co-operative Bank drawn in favour of the Secretary, Electrical Licensing Board,

Chennai 600 032. Payable at Chennai. Remittance by any other method will not be

accepted.

2. The signature of the applicant and the photo to be affixed in the application should be

got attested by a Gazetted Officer. Out of three photos mentioned under item (4) of the

instructions one photo should be affixed in the space provided in the application and the

same should be attested by a Gazetted Officer.

3. The applicant should be a Diploma holder in Electrical Engineering obtained from the

Department of Technical Education or a Degree holder in Electrical Engineering issuedby any University in India or A.M.I.E. Certificate in Electrical Engineering with Part A

& B.

(with)Experience :- Two years experience in erection or operation and maintenance

in High Voltage installation.(or)

The applicant should be an Electrical Supervisor Competency Certificate obtained from

the Department of Technical Education. Chennai.

4. Three copies of Passport size photograph of the applicant (6cm x 4 cm) (taken not

earlier than three months from the date of application) should be sent.

5. Applicaant's signature in triplicate on a separate sheet of paper should be sent.

6. Evidence for age in original and zerox copy should be furnished.

7. All the columns should be answered in words and figures and no columns should be left

blank.

8. Application should be only in the prescribed form .