"Application for Solid Waste Facility Operator Certification" - New Mexico

Application for Solid Waste Facility Operator Certification is a legal document that was released by the New Mexico Environment Department - a government authority operating within New Mexico.

Form Details:

  • Released on April 1, 2017;
  • The latest edition currently provided by the New Mexico Environment Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New Mexico Environment Department.

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Download "Application for Solid Waste Facility Operator Certification" - New Mexico

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NEW MEXICO ENVIRONMENT DEPARTMENT
Application for Solid Waste Facility Operator Certification
PRINT LEGIBLY
Mr.
Social Security # or
Mrs.
Operator ID #
Ms.
Last Name
First Name
MI
Type of certification sought: (Check only one box)
Processing Facility Operator
Compost Facility Operator
Landfill Operator
Recycling Facility Operator
Transfer Station Operator
Transformation Facility Operator
HOME (MAILING) ADDRESS
FACILITY
Address
Name of the facility where you work:
City
State
Zip
Address
Home phone No.
Cell phone No.
City
State
Zip
Course Name:
(Check one box)
Facility phone No.
Fax No.
Compost Facility Operator Certification Course
Landfill Operator Certification Course
Processing Facility Operator Certification Course
Your current job title:
Recycling Facility Operator Certification Course
Transfer Station/Processing Facility Operator Certification Course
Transformation Facility Operator Certification Course
Course
Course Date:
Location:
OFFICE USE ONLY
CEU's Awarded by
Certification Exam Date:
Department:
* E-mail address:
*You must provide a valid e-mail address, to access your certification information online. Please print clearly!
Revised April 2017
Page 1 of 2
NEW MEXICO ENVIRONMENT DEPARTMENT
Application for Solid Waste Facility Operator Certification
PRINT LEGIBLY
Mr.
Social Security # or
Mrs.
Operator ID #
Ms.
Last Name
First Name
MI
Type of certification sought: (Check only one box)
Processing Facility Operator
Compost Facility Operator
Landfill Operator
Recycling Facility Operator
Transfer Station Operator
Transformation Facility Operator
HOME (MAILING) ADDRESS
FACILITY
Address
Name of the facility where you work:
City
State
Zip
Address
Home phone No.
Cell phone No.
City
State
Zip
Course Name:
(Check one box)
Facility phone No.
Fax No.
Compost Facility Operator Certification Course
Landfill Operator Certification Course
Processing Facility Operator Certification Course
Your current job title:
Recycling Facility Operator Certification Course
Transfer Station/Processing Facility Operator Certification Course
Transformation Facility Operator Certification Course
Course
Course Date:
Location:
OFFICE USE ONLY
CEU's Awarded by
Certification Exam Date:
Department:
* E-mail address:
*You must provide a valid e-mail address, to access your certification information online. Please print clearly!
Revised April 2017
Page 1 of 2
EXPERIENCE:
You must have one year of experience in the operation of a facility of the same type as that for which certification
is sought (i.e., composting, landfill, transfer station, etc.). Beginning with your present position and working back; list and describe at least one year of your experience
relating to the type of certification you are applying for. Be specific in describing your experience as it relates to this certification. Failure to adequately describe
specific experience related to this application will result in denial of your application for certification. (Paragraph 3, Subsection B of 20.9.7.8 NMAC)
Name and address of employer:
Dates of employment: From:
/
/
to:
Present
Your current position title:
Facility name:
Describe your job duties:
(If the same as on other side, so indicate. Include the facility name.)
Name and address of employer:
Dates of employment: From:
/
/
to:
/
/
Your position title:
Facility name:
Describe your job duties:
Name and address of employer:
Dates of employment: From:
/
/
to:
/
/
Your position title:
Facility name:
Describe your job duties:
I hereby certify there are no misrepresentations in the information I am providing. I am aware that if an investigation discloses any discrepancies, my
application may be rejected and any certification received as a result of this application may be revoked. I am also aware that I may be required to provide
the Department with proof of my training and employment experience.
SIGNATURE:
DATE:
THIS SECTION FOR DEPARTMENT USE ONLY
Application received
Initials:
Date
Parental Responsibility Act Verification
Initials:
Date
Education & Training Verification
Exam score:
Initials:
Date
Complete database Entries
Initials:
Date
Certificate Issued
Expires:
Initials:
Date
Notification Letter & Certificate Mailed
Initials:
Date
New Mexico Environment Department, Solid Waste Bureau, 1190 St. Francis Dr.
Return completed and signed application to:
P.O. Box 5469, Room N2150, Santa Fe, NM 87502-5469. Attn: William Schueler
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