Form DMM-BMME-1 "Application for Certification Examination" - Virginia

What Is Form DMM-BMME-1?

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

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Virginia Department of Mines, Minerals and Energy;
  • 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 printable version of Form DMM-BMME-1 by clicking the link below or browse more documents and templates provided by the Virginia Department of Mines, Minerals and Energy.

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Download Form DMM-BMME-1 "Application for Certification Examination" - Virginia

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Division of Mineral Mining
Fontaine Research Park
900 Natural Resources Drive, Suite 400
Charlottesville, VA 22903
(434) 951-6316
Application for Certification Examination
Applicants for certification may apply online at
https://www.dmme.virginia.gov/DMM/divisionmineralmining.shtml
or complete and submit this form with a $10 non-refundable fee for each exam. Type or complete the form in
ink. Include a check or money order made payable to the Treasurer of Virginia. Cash is accepted if paid in
person at DMM’s Charlottesville office (DO NOT MAIL CASH). You may also pay the fee with a credit card by
calling the DMM office. The application and fee must be received by DMM at least five working days prior to
the examination date.
1.
Full Name:
DMM ID
2.
Address:
Street or P.O. Box
City
State
Zip Code
3.
Date of Birth:
Phone #:
(
)
Month/Day/Year
4.
Total years employed at a mineral mine:
Surface
Underground
5.
List your current employer:
Company Name:
Address:
Street or P.O. Box
City
State
Zip Code
Job Title:
From:
To:
Month/Day/Year
Month/Day/Year
6.
I have attached a copy of my valid first aid card, the degrees to be used for credit toward the
experience requirements, and payment for the exam.
7.
Certification Examination Requested (Check one of the following):
 Surface Foreman – Open Pit [for a person whose
Surface Foreman (for a person whose
duties may include overseeing drilling
duties will not include overseeing areas where
and blasting activities or areas where
blasting activities or hazards occur (e.g., sand and
blasting hazards occur)
gravel mine)]
 Underground Foreman
 Underground Blaster
Surface Blaster
Mine Inspector (DMME employee)  Mineral Mining Electrician
8.
Exam requested at
on
(refer to exam schedule)
Location
Date
9. E-Mail Address: ___________________________________________
I hereby certify that the above answers are true and accurate to the best of my knowledge.
Signed:
Date:
DMM-BMME-1 (Revised 03/2017)
Division of Mineral Mining
Fontaine Research Park
900 Natural Resources Drive, Suite 400
Charlottesville, VA 22903
(434) 951-6316
Application for Certification Examination
Applicants for certification may apply online at
https://www.dmme.virginia.gov/DMM/divisionmineralmining.shtml
or complete and submit this form with a $10 non-refundable fee for each exam. Type or complete the form in
ink. Include a check or money order made payable to the Treasurer of Virginia. Cash is accepted if paid in
person at DMM’s Charlottesville office (DO NOT MAIL CASH). You may also pay the fee with a credit card by
calling the DMM office. The application and fee must be received by DMM at least five working days prior to
the examination date.
1.
Full Name:
DMM ID
2.
Address:
Street or P.O. Box
City
State
Zip Code
3.
Date of Birth:
Phone #:
(
)
Month/Day/Year
4.
Total years employed at a mineral mine:
Surface
Underground
5.
List your current employer:
Company Name:
Address:
Street or P.O. Box
City
State
Zip Code
Job Title:
From:
To:
Month/Day/Year
Month/Day/Year
6.
I have attached a copy of my valid first aid card, the degrees to be used for credit toward the
experience requirements, and payment for the exam.
7.
Certification Examination Requested (Check one of the following):
 Surface Foreman – Open Pit [for a person whose
Surface Foreman (for a person whose
duties may include overseeing drilling
duties will not include overseeing areas where
and blasting activities or areas where
blasting activities or hazards occur (e.g., sand and
blasting hazards occur)
gravel mine)]
 Underground Foreman
 Underground Blaster
Surface Blaster
Mine Inspector (DMME employee)  Mineral Mining Electrician
8.
Exam requested at
on
(refer to exam schedule)
Location
Date
9. E-Mail Address: ___________________________________________
I hereby certify that the above answers are true and accurate to the best of my knowledge.
Signed:
Date:
DMM-BMME-1 (Revised 03/2017)