Profession 317 - Crane Operator License - Practical Exam
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Name: _________________________________________ Address: _______________________________________ City: __________________ State: _____ Zip: ______ Driver’s License #: _______________________________ Email: _________________________________________ Phone: _______________ Date of Birth: ____________ Present Occupation: _____________________________ Social Security Number: __________________________ Employer’s Name: ______________________________ Employer’s Name: ______________________________ Address: _______________________________________ Address: _______________________________________ City: __________________ State: _____ Zip: ______ City: __________________ State: _____ Zip: ______ Period of Employment From: _________ To: _______ Period of Employment From: _________ To: _______ Equipment Type: Crane ___ Derrick (stiffleg or guy) ___ Equipment Type: Crane ___ Derrick (stiffleg or guy) ___ Describe: _______________________________________ Describe: _______________________________________ Length of Boom: _____________________________ Length of Boom: _____________________________ Hrs. worked as Apprentice Crane Operator(oiler): ____ Hrs. worked as Apprentice Crane Operator(oiler): ____ Select the license classification for which you are applying: Tower Crane Mobile Crane Drum Hoist Have you ever held an Apprentice Crane Operator certificate? YES _____ NO _______ If YES, what was the time period? From: _____________________ To: ____________________________ Have you ever taken the City of Chicago’s Crane Operator License Exam? YES ______ NO _______ If YES, when did you most recently take the exam? Date: _____________________________________________ This box is reserved for City use. ____________________________ (Approval – Board Member) Mail Forms To: City of Chicago Trade Licenses & Examinations P.O. BOX 388249 Chicago, IL 60638-8249 CTS -2014 Profession 317 - Crane Operator License - Practical Exam * For manual entry, the applicable fee can be found on (www.continentaltesting.net). Fee*: _______________
Transcript of Profession 317 - Crane Operator License - Practical Exam
Name: _________________________________________ Address: _______________________________________
City: __________________ State: _____ Zip: ______ Driver’s License #: _______________________________
Email: _________________________________________ Phone: _______________ Date of Birth: ____________
Present Occupation: _____________________________ Social Security Number: __________________________
Employer’s Name: ______________________________ Employer’s Name: ______________________________
Address: _______________________________________ Address: _______________________________________
City: __________________ State: _____ Zip: ______ City: __________________ State: _____ Zip: ______
Period of Employment From: _________ To: _______ Period of Employment From: _________ To: _______
Equipment Type: Crane ___ Derrick (stiffleg or guy) ___ Equipment Type: Crane ___ Derrick (stiffleg or guy) ___
Describe: _______________________________________ Describe: _______________________________________
Length of Boom: _____________________________ Length of Boom: _____________________________
Hrs. worked as Apprentice Crane Operator(oiler): ____ Hrs. worked as Apprentice Crane Operator(oiler): ____
Select the license classification for which you are applying:
Tower Crane Mobile Crane Drum Hoist
Have you ever held an Apprentice Crane Operator certificate? YES _____ NO _______
If YES, what was the time period? From: _____________________ To: ____________________________
Have you ever taken the City of Chicago’s Crane Operator License Exam? YES ______ NO _______
If YES, when did you most recently take the exam? Date: _____________________________________________
This box is reserved for City use.
____________________________
(Approval – Board Member)
Mail Forms To: City of Chicago Trade Licenses & Examinations
P.O. BOX 388249
Chicago, IL 60638-8249 CTS -2014
Profession 317 - Crane Operator License - Practical Exam
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* For manual entry, the applicable fee can be found on
(www.continentaltesting.net).
Fee*: _______________
