NCHALB

Report of Apprenticeship Experience (F3)

Please review 21 NCAC 22A .0401 and 21 NCAC 22F .0305 for current regulations on submitting this form.
Requirements for submitting a report have changed effective 4/1/2014.

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F3-RAE Affidavit
All applicants must print and submit the affidavit to complete the application.
You can also print a blank affidavit from your confirmation email or the "Forms/Applications" section of the website.

You will receive immediate email confirmation with a copy of this submission when you click SUBMIT.
You will also be redirected to a confirmation page.

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Provide email address to receive confirmation of application submission: *

Sponsor License Number *

Sponsor Name *

Sponsor Email Address (for official Board correspondence) *

Apprentice Name *

Apprentice Email Address (for official Board correspondence) *

Apprentice Certificate Number *

Certificate Expiration Date *

Apprentice has held a valid certificate for 365 days. *

Yes
No

Apprentice has worked at least 27 hours per week for a period of 50 weeks since initial certificate was issued. *

Yes
No

The Sponsor has provided training in all areas identified in 21 NCAC 22F .0302(d). *

Yes
No

If you answered “NO” to any question above, provide details below by citing the question number followed by your explanation. If this is an early termination of apprenticeship, be sure to include date of termination as part of the explanation.

Has the application affidavit been signed by Sponsor and Apprentice? *

Yes, both sponsor and apprentice signed application affidavit
Sponsor refused to complete affidavit.
Apprentice refused to complete affidavit.

How will affidavit be submitted? *

Don't know (haven't decided how to submit it)
Affidavit will be scanned and e-mailed to app@nchalb.org.
Original Affidavit will be mailed to the Board office.
Affidavit is attached to this form.

Attach Affidavit:

Who is filling out the electronic form for submission? *

Sponsor and Apprentice are both present and submitting form together.
Sponsor is completing electronic form.
Apprentice is completing form after consultation with Sponsor.
Office staff or other person is completing electronic form under the instruction of the Sponsor.

* Required

701 Exposition Place, Suite 206, Raleigh, NC 27615 - PH: 919-834-3661 - Email: info@nchalb.org