Form DP-30 "Application for an Individual Commercial Applicator License" - Arkansas

What Is Form DP-30?

This is a legal form that was released by the Arkansas Agriculture Department - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the Arkansas Agriculture Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DP-30 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

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Download Form DP-30 "Application for an Individual Commercial Applicator License" - Arkansas

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Form DP-30 (Rev.4/18)
APPLICATION FOR AN
INDIVIDUAL COMMERCIAL APPLICATOR LICENSE
Issued Under the authority of Act 389 of 1975,
Pesticide Use and Application Act
For the Year Ending December 31, 20___
INSTRUCTIONS: Complete and submit with appropriate fees to the Arkansas State Plant Board, Pesticide Division, P.O. Box 1069,
Little Rock, Arkansas 72203. Upon approval, your license will be issued for the year indicated. Incomplete application will delay
processing. PRINT OR TYPE ONLY.
PERSON APPLYING
Name: Last ______________________________ First _____________________________ Middle _______________________
Date of Birth
_____________________________
FAA Pilot=s Authorization Number
(Required if applying for pilot=s authorization)
Mailing Address
City
State
Zip Code _____________
County ______________________ Home Phone # (
) _______ - __________ Work Phone # (
) _______ - __________
Fax # (
) ______ - _________ E-mail address
Cell Phone # (
) ______ - _________ (Opt)
Indicate category(s) applied for (must be currently certified in each category indicated):
(1) Agricultural -Plants
(3) Aquatic
(1A) Agricultural - Animals
(4) Right- of Way
(2) Forest Pest Control
(5) Demonstration and Research
(2A) Wood Treatment
(6) Public Health
Category Certifications ........................................................................................................ $35.00 Each
$ ______________
Commercial Pilot Authorization (aerial applicators only) .................................................... $35.00
$ ______________
Custom Pilot’s Authorization (must have passed test)(aerial applicators only) ................... $35.00
$ ______________
Total Enclosed
$ ______________
List the licensed firm(s) that you plan on working for during the year ending December 31, 20_____
___________________________________________
___________________________________________
___________________________________________
___________________________________________
I do hereby attest that I have read and am familiar with the Pesticide Use and Application Act and the Regulations adopted thereunder.
Applicant=s
Signature: ______________________________________________________________ Date: _______________
(Person Applying Only)
This application is considered incomplete unless the second page (Required Confidential Information Form) is completed.
***********************************************************************************************
DO NOT WRITE IN THIS SPACE
________________________
__________________________
License Number
Date of Issuance
Form DP-30 (Rev.4/18)
APPLICATION FOR AN
INDIVIDUAL COMMERCIAL APPLICATOR LICENSE
Issued Under the authority of Act 389 of 1975,
Pesticide Use and Application Act
For the Year Ending December 31, 20___
INSTRUCTIONS: Complete and submit with appropriate fees to the Arkansas State Plant Board, Pesticide Division, P.O. Box 1069,
Little Rock, Arkansas 72203. Upon approval, your license will be issued for the year indicated. Incomplete application will delay
processing. PRINT OR TYPE ONLY.
PERSON APPLYING
Name: Last ______________________________ First _____________________________ Middle _______________________
Date of Birth
_____________________________
FAA Pilot=s Authorization Number
(Required if applying for pilot=s authorization)
Mailing Address
City
State
Zip Code _____________
County ______________________ Home Phone # (
) _______ - __________ Work Phone # (
) _______ - __________
Fax # (
) ______ - _________ E-mail address
Cell Phone # (
) ______ - _________ (Opt)
Indicate category(s) applied for (must be currently certified in each category indicated):
(1) Agricultural -Plants
(3) Aquatic
(1A) Agricultural - Animals
(4) Right- of Way
(2) Forest Pest Control
(5) Demonstration and Research
(2A) Wood Treatment
(6) Public Health
Category Certifications ........................................................................................................ $35.00 Each
$ ______________
Commercial Pilot Authorization (aerial applicators only) .................................................... $35.00
$ ______________
Custom Pilot’s Authorization (must have passed test)(aerial applicators only) ................... $35.00
$ ______________
Total Enclosed
$ ______________
List the licensed firm(s) that you plan on working for during the year ending December 31, 20_____
___________________________________________
___________________________________________
___________________________________________
___________________________________________
I do hereby attest that I have read and am familiar with the Pesticide Use and Application Act and the Regulations adopted thereunder.
Applicant=s
Signature: ______________________________________________________________ Date: _______________
(Person Applying Only)
This application is considered incomplete unless the second page (Required Confidential Information Form) is completed.
***********************************************************************************************
DO NOT WRITE IN THIS SPACE
________________________
__________________________
License Number
Date of Issuance
Required Confidential Information Form
Pesticide Division
Instructions: Please print clearly. This information is confidential and required by Act 1163 of 1997.
The name below should appear the same as on the license application form.
Last Name ____________________________ First Name ________________ Middle Initial ______
Social Security Number _______ - _______ - __________
Do not write below this line
For Plant Board Use Only
Type of License(s) Issued
License Number
Private Applicator License ......................................
........................................................... ________________
Commercial Individual License ..............................
........................................................... ________________
Custom OIC Authorization Permit ..........................
........................................................... ________________
Custom Pilot=s Authorization Permit .......................
........................................................... ________________
Non-Commercial License .......................................
........................................................... ________________
Ginseng Dealer License ..........................................
........................................................... ________________
Ginseng Man License .............................................
........................................................... ________________
Landscape Contractors License ...............................
........................................................... ________________
Pest Control License ...............................................
........................................................... ________________
Ag Consultants License ..........................................
........................................................... ________________
Seed Dealers License ..............................................
........................................................... ________________
Seed Treaters License .............................................
........................................................... ________________
Registered Seed Technologists License ..................
........................................................... ________________
Other .....................................................................
........................................................... ________________
During the Arkansas General Assembly legislators passed Act 1163 of 1997. This Act mandates that on and after
July 1, 1997, all persons, boards, commissions, or other licensing entities issuing any occupational, professional or
business license or marriage licenses will record the name, address and social security number of each person
applying for such licenses on the license application, or on the license if no application is required. The Arkansas
State Plant Board is required to submit this information to the Office of Child Support Enforcement.
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