"Application for Certification as a Pesticide Applicator Under the Delaware Pesticide Law" - Delaware

This fillable "Application for Certification as a Pesticide Applicator Under the Delaware Pesticide Law" is a document issued by the Delaware Department of Agriculture specifically for Delaware residents.

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APPLICATION FOR CERTIFICATION AS A PESTICIDE APPLICATOR UNDER THE
DELAWARE PESTICIDE LAW
 
 
I, _______________________________, hereby apply for certification as a Pesticide Applicator in 
accordance with provisions of 3 DEL C., Part II, Chapter 12, Sections 1215‐1223. 
 
 
 
1. 
Your current home address: 
 
 
                                                          Street 
 
 
 
 
        City                                                                                               State                                                                  Zip 
 
 
 
 
        Email address                                                                              Certification Number                                       Telephone Number                     
 
 
 
2. 
Who are you currently employed by? 
 
                                                                                                  Firm Name 
 
 
 
 
        Street                                                                                      City                                                           State                           Zip 
 
 
 
 
        County                                                                                    Telephone Number   
 
 
3. 
Check the type of certification requested:    
 Initial   
 Recertification    
 Category Addition  
 
Check:   
 Private   
 Government   
 Commercial  
Category Applied For:        
 Core   
 Private Applicator              EXAM DATE: __________________________ 
1A 
AGRICULTURAL ‐ PLANT 
 
7A  GENERAL PEST CONTROL 
 
 
 
 
 
 
 
 
1B 
AGRICULTURAL ‐ ANIMAL 
 
7B 
WOOD DESTROYING 
 
 
 
 
 
FUMIGATION OF SOILS AND AG. 
 
1C 
 
7C 
FUMIGATION (NON‐AG) 
COMMODITIES 
 
 
 
 
 
 
 
02 
 FOREST 
 
7D 
WOOD PRESERVATIVES 
 
 
 
 
 
 
 
03 
ORNAMENTAL & TURF 
 
7E 
INSTITUTIONAL AND MAINTENANCE 
 
 
 
 
 
 
 
04 
SEED TREATMENT 
 
7F 
COOLING TOWER 
 
 
 
 
 
 
 
5A 
AQUATIC  
 
7G 
MISCELLANEOUS  
 
 
 
 
 
 
 
5B 
ANTIFOULING PAINT 
 
08 
PUBLIC HEALTH 
 
 
 
 
 
 
 
5C 
MOSQUITO 
 
09 
REGULATORY 
 
 
 
 
 
 
 
06 
RIGHT‐OF‐WAY 
 
10 
DEMONSTRATION & RESEARCH 
 
 
4. 
FEE: $30.00 ‐ Make check or money order payable to Delaware Department of Agriculture. 
 
 
 
    Applicant Signature                                                                                    Date                                                                 
        
 
 
 
Government agency employees who apply or supervise the application of pesticides are exempt from fee requirements if pesticide use is related to official duties. 
 
 
 
APPLICATION FOR CERTIFICATION AS A PESTICIDE APPLICATOR UNDER THE
DELAWARE PESTICIDE LAW
 
 
I, _______________________________, hereby apply for certification as a Pesticide Applicator in 
accordance with provisions of 3 DEL C., Part II, Chapter 12, Sections 1215‐1223. 
 
 
 
1. 
Your current home address: 
 
 
                                                          Street 
 
 
 
 
        City                                                                                               State                                                                  Zip 
 
 
 
 
        Email address                                                                              Certification Number                                       Telephone Number                     
 
 
 
2. 
Who are you currently employed by? 
 
                                                                                                  Firm Name 
 
 
 
 
        Street                                                                                      City                                                           State                           Zip 
 
 
 
 
        County                                                                                    Telephone Number   
 
 
3. 
Check the type of certification requested:    
 Initial   
 Recertification    
 Category Addition  
 
Check:   
 Private   
 Government   
 Commercial  
Category Applied For:        
 Core   
 Private Applicator              EXAM DATE: __________________________ 
1A 
AGRICULTURAL ‐ PLANT 
 
7A  GENERAL PEST CONTROL 
 
 
 
 
 
 
 
 
1B 
AGRICULTURAL ‐ ANIMAL 
 
7B 
WOOD DESTROYING 
 
 
 
 
 
FUMIGATION OF SOILS AND AG. 
 
1C 
 
7C 
FUMIGATION (NON‐AG) 
COMMODITIES 
 
 
 
 
 
 
 
02 
 FOREST 
 
7D 
WOOD PRESERVATIVES 
 
 
 
 
 
 
 
03 
ORNAMENTAL & TURF 
 
7E 
INSTITUTIONAL AND MAINTENANCE 
 
 
 
 
 
 
 
04 
SEED TREATMENT 
 
7F 
COOLING TOWER 
 
 
 
 
 
 
 
5A 
AQUATIC  
 
7G 
MISCELLANEOUS  
 
 
 
 
 
 
 
5B 
ANTIFOULING PAINT 
 
08 
PUBLIC HEALTH 
 
 
 
 
 
 
 
5C 
MOSQUITO 
 
09 
REGULATORY 
 
 
 
 
 
 
 
06 
RIGHT‐OF‐WAY 
 
10 
DEMONSTRATION & RESEARCH 
 
 
4. 
FEE: $30.00 ‐ Make check or money order payable to Delaware Department of Agriculture. 
 
 
 
    Applicant Signature                                                                                    Date                                                                 
        
 
 
 
Government agency employees who apply or supervise the application of pesticides are exempt from fee requirements if pesticide use is related to official duties. 
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