Form FDACS-13607 "Pest Control Examination Application" - Florida

Form FDACS-13607 is a Florida Department of Agriculture and Consumer Services form also known as the "Pest Control Examination Application". The latest edition of the form was released in October 1, 2015 and is available for digital filing.

Download an up-to-date Form FDACS-13607 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

ADVERTISEMENT

Download Form FDACS-13607 "Pest Control Examination Application" - Florida

287 times
Rate
(4.3 / 5) 20 votes
Florida Department of Agriculture and Consumer Services
Remit Fee Online at:
Division of Agricultural Environmental Services
www.FreshFromFlorida.com
- or -
PEST CONTROL EXAMINATION APPLICATION
Check or Money Order Payable to
FDACS:
Rule 5E-14.117, F.A.C.
Bureau of Licensing and Enforcement
Telephone: (850) 617-7997
P. O. Box 6710
ADAM H. PUTNAM
Tallahassee, FL 32314-6710
COMMISSIONER
I wish to apply for the following PEST CONTROL EXAMINATION category(s):
General Household Pest
$300.00
& Rodent Control
- 001362
Termite Control
$300.00
- 001364
Lawn & Ornamental
$300.00
Pest Control
- 001363
Special ID Card
$200.00
- 001360
Fumigation
$300.00
- 001361
TOTAL FEES ENCLOSED
$
Make check or money order payable to “Florida Department of Agriculture and Consumer Services” (FDACS). All questions
MUST be answered if applicable. MAKE CERTAIN YOU QUALIFY - FEES WILL NOT BE REFUNDED IF YOU ARE
REJECTED! DO NOT SEND ORIGINAL DOCUMENTS WITH APPLICATION.
1.
Name of Applicant
(Last)
(First)
(Middle)
2.
Mailing Address
(Street or P.O. Box)
(
City)
(State)
(Zip Code)
3.
Daytime Telephone Number
(Area code)
(Number)
FL Driver’s License Number (or State ID)
4.
5.
Email Address
6.
Name of Employer
Address
(Street location)
(City)
(State)
(Zip Code)
6.
Have you previously been examined and failed in the category(s) now applied for?
Yes
No
If yes, give month and year FIRST examined in category(s):
FUM.
GHP
L & O
TERMITE
(Mo.) (Yr.)
(Mo.) (Yr.)
(Mo.) (Yr.)
(Mo.) (Yr.)
If previously examined in ALL of the categories being applied for - Go to Line 10. Otherwise complete A or B.
7.
A.
If applying for examination in a category OTHER than Special ID card, provide documentary proof of high school
graduation or equivalent education with this application.
B.
Do you hold a degree with advanced training, or a major in entomology or horticulture from a recognized college or
university?
Yes
No If yes, answer the following:
Degree earned
with major in
Date
(Copies of college transcript(s) and evidence of degree conferred MUST accompany this application if not already on file.)
DO NOT FILL IN
APPROVED
DISAPPROVED
DATE
BY
FDACS-13607 Rev. 10/15
Page 1 of 2
Florida Department of Agriculture and Consumer Services
Remit Fee Online at:
Division of Agricultural Environmental Services
www.FreshFromFlorida.com
- or -
PEST CONTROL EXAMINATION APPLICATION
Check or Money Order Payable to
FDACS:
Rule 5E-14.117, F.A.C.
Bureau of Licensing and Enforcement
Telephone: (850) 617-7997
P. O. Box 6710
ADAM H. PUTNAM
Tallahassee, FL 32314-6710
COMMISSIONER
I wish to apply for the following PEST CONTROL EXAMINATION category(s):
General Household Pest
$300.00
& Rodent Control
- 001362
Termite Control
$300.00
- 001364
Lawn & Ornamental
$300.00
Pest Control
- 001363
Special ID Card
$200.00
- 001360
Fumigation
$300.00
- 001361
TOTAL FEES ENCLOSED
$
Make check or money order payable to “Florida Department of Agriculture and Consumer Services” (FDACS). All questions
MUST be answered if applicable. MAKE CERTAIN YOU QUALIFY - FEES WILL NOT BE REFUNDED IF YOU ARE
REJECTED! DO NOT SEND ORIGINAL DOCUMENTS WITH APPLICATION.
1.
Name of Applicant
(Last)
(First)
(Middle)
2.
Mailing Address
(Street or P.O. Box)
(
City)
(State)
(Zip Code)
3.
Daytime Telephone Number
(Area code)
(Number)
FL Driver’s License Number (or State ID)
4.
5.
Email Address
6.
Name of Employer
Address
(Street location)
(City)
(State)
(Zip Code)
6.
Have you previously been examined and failed in the category(s) now applied for?
Yes
No
If yes, give month and year FIRST examined in category(s):
FUM.
GHP
L & O
TERMITE
(Mo.) (Yr.)
(Mo.) (Yr.)
(Mo.) (Yr.)
(Mo.) (Yr.)
If previously examined in ALL of the categories being applied for - Go to Line 10. Otherwise complete A or B.
7.
A.
If applying for examination in a category OTHER than Special ID card, provide documentary proof of high school
graduation or equivalent education with this application.
B.
Do you hold a degree with advanced training, or a major in entomology or horticulture from a recognized college or
university?
Yes
No If yes, answer the following:
Degree earned
with major in
Date
(Copies of college transcript(s) and evidence of degree conferred MUST accompany this application if not already on file.)
DO NOT FILL IN
APPROVED
DISAPPROVED
DATE
BY
FDACS-13607 Rev. 10/15
Page 1 of 2
8.
EMPLOYMENT-EXPERIENCE QUALIFICATIONS.
(1) Those qualifying by college education MUST have one year of employment as a service employee of a licensee that
They must attach substantiating employer’s form(s) from each employer.
The following
performs pest control.
information in 2(a), (b), and (c) should also be completed.
(2) Those qualifying by experience MUST have been employed for at least three (3) years as a service employee of a licensee
that performs pest control in the category or categories in which the applicant seeks certification. At least one (1) year must
have been completed in Florida during the year immediately preceding application. Complete the information below and
attach substantiating employer’s form(s) (FDACS-13627 Rev. 10/15) from each employer. (Not required for Special ID card
applicants.)
(a)
Name
From
(Month)
(Year)
Complete address
To
(Month)
(Year)
(b)
Name
From
Complete address
To
(c)
Name
From
Complete address
To
USE ADDITIONAL SHEET IF NECESSARY
Total time as service employee in each category(ies) applied for is as follows:
FUM.
GHP
L & O
TERMITE
(Yrs.) (Mos.)
(Yrs.) (Mos.)
(Yrs.) (Mos.)
(Yrs.) (Mos.)
9.
REQUIRED FOR ALL APPLICANTS, INCLUDING SPECIAL ID CARD EXAM APPLICANTS. You must have performed within
Florida, and under the supervision of a certified operator, at least forty-five (45) jobs (fifteen – 15 – for SPID only) in each
category for which you wish to be examined. Attach a separate job form (FDACS-13653, Rev 10/15) for each category or
Special ID card exam.
10. Are you currently on suspension, revocation or probation by the Florida Department of Agriculture and Consumer Services?
Yes
No
If yes, furnish details on separate sheet.
I do hereby declare that all entries herein, attached hereto and made a part of this application are true and correct
statements.
MO
DAY
YEAR
Date of Birth
Applicant’s Signature
Org. Code: 42 13 06 04 001
EO B7
Object Code:
001361
$ 300.00
001362
$ 300.00
001363
$ 300.00
001364
$ 300.00
001360
$ 200.00
FDACS-13607 Rev. 10/15
Page 2 of 2
ADVERTISEMENT
Page of 2