Form DMM-BMME-3 "Application for Renewal" - Virginia

What Is Form DMM-BMME-3?

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-3 by clicking the link below or browse more documents and templates provided by the Virginia Department of Mines, Minerals and Energy.

ADVERTISEMENT
ADVERTISEMENT

Download Form DMM-BMME-3 "Application for Renewal" - Virginia

Download PDF

Fill PDF online

Rate (4.5 / 5) 94 votes
Division of Mineral Mining
Fontaine Research Park
900 Natural Resources Drive, Suite 400
Charlottesville, VA 22903
(434) 951-6316
Application for Renewal
You may apply for renewal online at
https://www.dmme.virginia.gov/DMM/divisionmineralmining.shtml
or
complete this form for each certification you want to renew. Type or complete the form in ink. Include a check or
money order for $10 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 non-refundable fee must be received by DMM at least five working days prior to
the date of the renewal class or examination.
DMM ID:
1.
Full Name:
Address:
City
State
Zip Code
Street or P.O. Box
(
)
Work Phone:
(
)
2.
Home Phone:
3.
Certificate No.:
Expiration Date:
Date of Birth:
4.
Requesting to renew the following certifications (Check all that apply):
 Surface Foreman – Open Pit
 Surface blaster
Surface Foreman
 Underground Foreman
 Underground Blaster
Mineral Mining Electrician
Mine Inspector (DMME employee only)
5.
Check the statement that applies to you:
a. I have worked a cumulative minimum of 24 months in the last five years in the area
for which I am currently certified and am requesting the examination or refresher class
covering changes in regulations and laws and other important information.
b. I have not worked in the area for which I am certified for a total of 24 months in the
last five years, so I am requesting the full examination (see 4 VAC 25-35-20 of
certification requirements).
c.
I have uncorrected violations (described in 8 below), so I am requesting the full
examination (see 4 VAC 25-35-20 of certification requirements).
6.
If you checked a (above), mark your choice for renewal:
examination
refresher course
7.
Specific location
and date
(see enclosed schedule)
8.
If you checked c (in #5 above), describe any uncorrected violations issued to you by DMME since
you were certified.
9.
Attach a copy of your Verification of Work Experience form (DMM-BMME-2) and valid first aid
certificate/card, as applicable to your certification, and the $10 fee (if paying by check or money
order).
10. E-Mail Address: ___________________________________________
I hereby certify that the above answers are true and accurate to the best of my knowledge.
Signed:
Date:
DMM-BMME-3 (Revised 03/17)
Division of Mineral Mining
Fontaine Research Park
900 Natural Resources Drive, Suite 400
Charlottesville, VA 22903
(434) 951-6316
Application for Renewal
You may apply for renewal online at
https://www.dmme.virginia.gov/DMM/divisionmineralmining.shtml
or
complete this form for each certification you want to renew. Type or complete the form in ink. Include a check or
money order for $10 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 non-refundable fee must be received by DMM at least five working days prior to
the date of the renewal class or examination.
DMM ID:
1.
Full Name:
Address:
City
State
Zip Code
Street or P.O. Box
(
)
Work Phone:
(
)
2.
Home Phone:
3.
Certificate No.:
Expiration Date:
Date of Birth:
4.
Requesting to renew the following certifications (Check all that apply):
 Surface Foreman – Open Pit
 Surface blaster
Surface Foreman
 Underground Foreman
 Underground Blaster
Mineral Mining Electrician
Mine Inspector (DMME employee only)
5.
Check the statement that applies to you:
a. I have worked a cumulative minimum of 24 months in the last five years in the area
for which I am currently certified and am requesting the examination or refresher class
covering changes in regulations and laws and other important information.
b. I have not worked in the area for which I am certified for a total of 24 months in the
last five years, so I am requesting the full examination (see 4 VAC 25-35-20 of
certification requirements).
c.
I have uncorrected violations (described in 8 below), so I am requesting the full
examination (see 4 VAC 25-35-20 of certification requirements).
6.
If you checked a (above), mark your choice for renewal:
examination
refresher course
7.
Specific location
and date
(see enclosed schedule)
8.
If you checked c (in #5 above), describe any uncorrected violations issued to you by DMME since
you were certified.
9.
Attach a copy of your Verification of Work Experience form (DMM-BMME-2) and valid first aid
certificate/card, as applicable to your certification, and the $10 fee (if paying by check or money
order).
10. E-Mail Address: ___________________________________________
I hereby certify that the above answers are true and accurate to the best of my knowledge.
Signed:
Date:
DMM-BMME-3 (Revised 03/17)