Form FDACS-13662 "Identification Cardholder Training Verification" - Florida

Form FDACS-13662 is a Florida Department of Agriculture and Consumer Services form also known as the "Identification Cardholder Training Verification". The latest edition of the form was released in October 1, 2015 and is available for digital filing.

Download an up-to-date fillable Form FDACS-13662 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

ADVERTISEMENT

Download Form FDACS-13662 "Identification Cardholder Training Verification" - Florida

289 times
Rate
(4.3 / 5) 20 votes
Florida Department of Agriculture and Consumer Services
Respond to:
Division of Agricultural Environmental Services
Bureau of Inspection and
Incident Response
3125 Conner Blvd, Suite N,
IDENTIFICATION CARDHOLDER TRAINING VERIFICATION
Tallahassee, FL 32399-1650
Section 482.091(10), F.S. and Rule 5E-14.1421, F.A.C.
ADAM H. PUTNAM
Telephone: (850) 617-7997; FAX (850) 617-7967
COMMISSIONER
LAST NAME
FIRST
MIDDLE
IDENTIFICATION CARD NUMBER
MAILING ADDRESS
DATE OF BIRTH
4 DIGIT PIN #
CITY
STATE
ZIP CODE
HOME PHONE NUMBER
PEST CONTROL LICENSEE NAME
BUSINESS LICENSE NUMBER
BUSINESS PHONE NUMBER
SEMINAR OR TRAINING PROGRAM NAME
LOCATION OF PROGRAM
NAME AND ADDRESS OF SPONSORING ORGANIZATION (OR TRAINER IF INHOUSE PROGRAM)
DATE OF ATTENDANCE
SIGN-IN TIME
SIGN-OUT TIME
TRAINING TOPICS COVERED - NOTE -- PROVIDE SPECIFIC SUBJECT MATTERS SUCH AS LABEL SAFETY, INTEGRATED PEST
MANAGEMENT AND OTHER TOPICS AS AUTHORIZED BY 482.091(10), F.S.
I certify, by my signature below, that I personally attended the
I certify that the above named individual completed the described
above training class.
training class.
SIGNATURE OF IDENTIFICATION CARDHOLDER
SIGNATURE OF TRAINER
FDACS-13662 Rev. 10/15
Florida Department of Agriculture and Consumer Services
Respond to:
Division of Agricultural Environmental Services
Bureau of Inspection and
Incident Response
3125 Conner Blvd, Suite N,
IDENTIFICATION CARDHOLDER TRAINING VERIFICATION
Tallahassee, FL 32399-1650
Section 482.091(10), F.S. and Rule 5E-14.1421, F.A.C.
ADAM H. PUTNAM
Telephone: (850) 617-7997; FAX (850) 617-7967
COMMISSIONER
LAST NAME
FIRST
MIDDLE
IDENTIFICATION CARD NUMBER
MAILING ADDRESS
DATE OF BIRTH
4 DIGIT PIN #
CITY
STATE
ZIP CODE
HOME PHONE NUMBER
PEST CONTROL LICENSEE NAME
BUSINESS LICENSE NUMBER
BUSINESS PHONE NUMBER
SEMINAR OR TRAINING PROGRAM NAME
LOCATION OF PROGRAM
NAME AND ADDRESS OF SPONSORING ORGANIZATION (OR TRAINER IF INHOUSE PROGRAM)
DATE OF ATTENDANCE
SIGN-IN TIME
SIGN-OUT TIME
TRAINING TOPICS COVERED - NOTE -- PROVIDE SPECIFIC SUBJECT MATTERS SUCH AS LABEL SAFETY, INTEGRATED PEST
MANAGEMENT AND OTHER TOPICS AS AUTHORIZED BY 482.091(10), F.S.
I certify, by my signature below, that I personally attended the
I certify that the above named individual completed the described
above training class.
training class.
SIGNATURE OF IDENTIFICATION CARDHOLDER
SIGNATURE OF TRAINER
FDACS-13662 Rev. 10/15
ADVERTISEMENT