Form 700-010-50 "Proctor Request for Fdot's Construction Training Qualification Program" - Florida

What Is Form 700-010-50?

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

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Florida Department of Transportation;
  • 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 700-010-50 by clicking the link below or browse more documents and templates provided by the Florida Department of Transportation.

ADVERTISEMENT
ADVERTISEMENT

Download Form 700-010-50 "Proctor Request for Fdot's Construction Training Qualification Program" - Florida

Download PDF

Fill PDF online

Rate (4.4 / 5) 57 votes
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
700-010-50
CONSTRUCTION
PROCTOR REQUEST
12/17
FOR FDOT’S CONSTRUCTION TRAINING QUALIFICATION
PROGRAM
Submit To: FDOT State Construction Training Administrator
605 Suwannee St., Mail station 31
Tallahassee, Florida 32399-0450
Or email to:
Susan.Robeson@dot.state.fl.us
Contact Details to post on website
Name:
Proctor name:
Driver’s License No:
Provider:
Address:
Address:
Email address:
Phone number:
Phone number:
Email address:
(see CTQM 1.12 for details)
Website:
I request approval to act as a Proctor for examinations given as a part of the Florida Department of Transportation’s
(FDOT’s) Construction Training Qualification Program (CTQP). If approved, I request that contact information for me on
the FDOT’s State Construction Office internet website is as shown above.
I have read and I am familiar with the current version (as of today’s date) of Chapter one of the Construction Training Qualification
Manual (CTQM) including the Proctoring Responsibilities show in CTQM Attachment 1-1 as published on the FDOT’s State
http://www.dot.state.fl.us/construction
Construction Office internet website.
I agree to be bound by and to comply with any conditions set for CTQP examinations by the State Construction Training
Administrator (SCTA) and any conditions set for CTQP examinations in the CTQM both as now published and as it may be amended by
the FDOT in the future. I agree that if my performance as a Proctor is called into question for any reason the SCTA may revoke my
approval as a Proctor for CTQP examinations.
(I have)
(I do not have) additional experience which may assist in the consideration of my request
(Please check one of the phrases in above. When “I have” is checked attach a separate signed dated sheet with any information which may be helpful
in considering your request. For example: state if you have proctored CTQM exams before and state the Provider you did this for)
____________________________________________________
Signature
Date
NOTE: THIS REQUEST MUST HAVE THE ENDORSEMENT OF AN APPROVED CTQP PROVIDER
Provider Endorsement
As a representative of the currently approved CTQP Provider shown below, I certify that the individual named above, who is requesting approval as a
proctor, is personally known to me to be of good character and knowledgeable in the reference materials described above regarding CTQP
examinations.
____________________________________________________
Signature of entity’s principal officer (see CTQM 1 for details)
Date
Print Name
Provider Name
Provider Number
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
700-010-50
CONSTRUCTION
PROCTOR REQUEST
12/17
FOR FDOT’S CONSTRUCTION TRAINING QUALIFICATION
PROGRAM
Submit To: FDOT State Construction Training Administrator
605 Suwannee St., Mail station 31
Tallahassee, Florida 32399-0450
Or email to:
Susan.Robeson@dot.state.fl.us
Contact Details to post on website
Name:
Proctor name:
Driver’s License No:
Provider:
Address:
Address:
Email address:
Phone number:
Phone number:
Email address:
(see CTQM 1.12 for details)
Website:
I request approval to act as a Proctor for examinations given as a part of the Florida Department of Transportation’s
(FDOT’s) Construction Training Qualification Program (CTQP). If approved, I request that contact information for me on
the FDOT’s State Construction Office internet website is as shown above.
I have read and I am familiar with the current version (as of today’s date) of Chapter one of the Construction Training Qualification
Manual (CTQM) including the Proctoring Responsibilities show in CTQM Attachment 1-1 as published on the FDOT’s State
http://www.dot.state.fl.us/construction
Construction Office internet website.
I agree to be bound by and to comply with any conditions set for CTQP examinations by the State Construction Training
Administrator (SCTA) and any conditions set for CTQP examinations in the CTQM both as now published and as it may be amended by
the FDOT in the future. I agree that if my performance as a Proctor is called into question for any reason the SCTA may revoke my
approval as a Proctor for CTQP examinations.
(I have)
(I do not have) additional experience which may assist in the consideration of my request
(Please check one of the phrases in above. When “I have” is checked attach a separate signed dated sheet with any information which may be helpful
in considering your request. For example: state if you have proctored CTQM exams before and state the Provider you did this for)
____________________________________________________
Signature
Date
NOTE: THIS REQUEST MUST HAVE THE ENDORSEMENT OF AN APPROVED CTQP PROVIDER
Provider Endorsement
As a representative of the currently approved CTQP Provider shown below, I certify that the individual named above, who is requesting approval as a
proctor, is personally known to me to be of good character and knowledgeable in the reference materials described above regarding CTQP
examinations.
____________________________________________________
Signature of entity’s principal officer (see CTQM 1 for details)
Date
Print Name
Provider Name
Provider Number