Pesticide Applicator Exam Registration

Pesticide Applicator Exam Registration
Applicant Information
Name*

First NameMiddle NameLast Name
Mailing Address*

Mailing Address

Mailing Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Are you at least 18 years old?*

YesNo
You must be at least 18 years old to complete this registration form.
Employer
Are you currently employed?

I do not have an employerI have an employer
Name of Company/Agency
Mailing Address

Mailing Address

Mailing Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Where will you take the exam?
Select how you will take the exam (check only one)*

OnlinePaper and pencil
Online Proctored Exam (check only one)

AnchorageCordovaDelta JunctionFairbanksHomerJuneauKetchikanKodiakPalmerSitkaSoldotnaValdez
Paper and Pencil Exam (there will be a delay in arranging a location and proctor for these exams)

I acknowledge there will be a delay
Paper and pencil exam in location .
Exams
Core Exam (required unless you have passed the Exam in the last 12 months)*

Core ExamI have passed the Core Exam in the last 12 months
Category Exam (You must select at least one. Check all categories for which you wish to test.)*

1. Regulatory Pest Control2. Pesticide Consultation & Demonstration3. Agricultural Pest Control4. Ornamental and Turf Pest Control5. Antifouling Paint6. Aquatic Pest Control7. Structural Pest Control8. Public Health Pest Control9. Right-of-Way & Industrial Pest Control10. Mosquito and Biting Fly Pest Control11. Aerial Pest Control12. Forest Pest Control13. Restricted-Use Pesticide Dealer14. Pesticide Research15. Soil Fumigation*16. Non-Soil Fumigation17. a. Vertebrate Pest Control17. b. Vertebrate Pest Control - Rodents only17. c. Vertebrate Pest Control - Predators only**18. Oilfield Biocides19. Pesticide Technician20. Seed Treatment
Documentation of EPA-approved soil fumigation training

*You must attach documentation that you have completed EPA approved soil fumigation training prior to being approved for exam.
Cancelof
Documentation of product-specific training

**You must attach documentation that you have completed required product-specific training pior to being approved for exam. This exam is not available online.
Cancelof
I understand that I must provide proof of liability insurance and the $25 licensing fee before certification will be issued.*

Yes, I understand
I understand that I must take all selected exams before certification will be issued.*

Yes, I understand
Website Posting
Would you like to be included on DEC's online list of certified applicators?*

YesNo
Applicant Signature
Signature*

Clear
Please verify that you are human*
Should be Empty:

Pesticide Applicator Exam Registration

Applicant Information

Employer

Where will you take the exam?

Exams

Website Posting

Applicant Signature