pesticide_applicator_cert_reg_app.pdf

Blank Space For Official Use Only

Payment Method: Check/Money Order No. _________________________________________ Amount enclosed: _____________

Please make check/money order payable to the State of Michigan (see instructions on back of form).

Signature:_________________________________________________ Date:___________________

Please print your name here:__________________________________________________________

Michigan Department of Agriculture and Rural Development P.O. Box 30776, Lansing, MI 48909-8276 • 517-284-5653

Name:____________________________________________________________________

Home Address:_____________________________________________________________

City:__________________________________________________ State: ______________

County:________________________________________________ Zip:_______________

Phone: (_____)_______________ Cell Phone: (_____)______________________________

Email:_____________________________________________________________________

Date of Birth: ____/____/______ Social Security Number:_______-____-____________

1a. Are you applying for reciprocity?: Yes What state __________________ No

1b. Are you certified in, and a resident of, that state?: Yes No

Employer Information Employer Name: ____________________________________________________________________________________________

Street Address of Employer:____________________________________________________________________________________

City:______________________________________________ State: _______ County: _____________________Zip:_____________

Phone: (_____)_____________ Fax: (_____)_______________ Email:_________________________________________________

Application Fees (Non-refundable)

Pesticide Applicator CERTIFICATION Application

In accordance with 1994 Public Act 451, Part 83 www.michigan.gov/mdard-licensing

PI-232.1 (9/22)

Exams/Categories (Please check all that apply for certification)

Instructions on the back of this form

By signing below I certify that the foregoing is true and accurate to the best of my knowledge and belief and that I will comply with the provisions of 1994 Public Act 451, Part 83, as amended, and all regulations promulgated thereunder.

First, middle initial, last

Include apartment number if applicable

MM DD YYYY

Public Health Pest Mgmt.

Regulatory Pest Mgmt.

Demo &

Research Pest Mgmt.

Commercial Core

Commercial Applicator $75

Private Applicator $50

AOBJ: 0188

AOBJ: 0343

This certification will NOT be issued without the above signature and date!

Private Core

I am adding categories to my current certification. Certification Number:________________________ Application fee for adding categories is same as above unless you are adding category(ies) at renewal.

1D Livestock

Pest Mgmt.

Forest

Pest Mgmt.

2A Wood

Preservation

3A Turfgrass

Pest Mgmt.

7B Wood

Destroying Pest Mgmt.

Fumigation

3B Ornamental Pest Mgmt.

Seed

Treatment

Aquatic

Pest Mgmt.

5A Swimming

Pools

5B Microbial

Pest Mgmt.

5C Sewer Line Pest Mgmt.

Right-of-Way Pest Mgmt.

7A General

Pest Mgmt.

7D Vertebrate Pest Mgmt.

7E Interior Plant Pest Mgmt.

7F Mosquito

Mgmt.

Aerial

7G Domestic Animal

Pest Mgmt.

1C Fruit

Crops

1B Vegetable

Crops

1A Field Crops

Applicant (Applicator) Information (Please print)

Application Fees Exemption for honorably discharged veterans of the Armed Forces of the United States (private pesticide certified applicators only). A copy of your DD-214 must be submitted along with your application.

Be advised, it is a violation of the Natural Resources and Environmental Protection Act, 1994 Public Act 451, Part 83 to purchase or apply restricted use pesticides, or, to apply pesticides for a commercial purpose or during a work assignment, without a valid certification credential. Applicators not subject to the business license requirement and who use a general-use pesticide directly from its original container (ready-to-use) are exempt from certification requirements.

Commercial Applicator - This certification is intended for use by individuals who apply a pesticide in the course of their employment or other business activity. Commercial applicators or firms that intend to apply pesticides for hire must also obtain a Commercial Pesticide Applicator Business License (PABL).

Private Applicator - This certification is intended for use by individuals or their employees who apply or supervise the application of restricted use pesticides for the purpose of producing any agricultural commodity on property:

A. Owned or rented by an individual or his/her employer, or B. On property of another for no compensation other than trading of personal services between producers.

To Qualify For Certification Credential

1. Must be 18 years of age or older.

2. Submit appropriate fee and a completed application.

3. Commercial applicators must pass the commercial core exam and a minimum of one category exam in the applicant’s area of pesticide application. If the applicator applies for more than one category, all exams must be passed before a credential will be issued. An additional standard is required for individuals who intend to use fumigant pesticides or apply pesticides by aircraft.

Private applicators must pass the private core exam. An additional exam is required for individuals who intend to use fumigant pesticides or apply pesticides by aircraft.

4. All exams must be passed with a score of 70% or better before a credential will be issued.

5. Applicants who fail their exam(s) may schedule to retake the exam(s) without an additional application fee within six months after the initial application date. (Note: Computer-based exams have an additional fee per test).

Instructions for Completing the Application

1. Type or print in pen.

2. You must complete all the requested information on the application form.

3. Check yes if you are applying for reciprocity by another state. Indicate which state and if you are certified and a resident there. Reciprocity is only available for residents of Indiana, Minnesota, Ohio, and Wisconsin.

4. Check type of applicator certification required.

5. Check if you are adding category(ies) to your current credential.

6. Check the category(ies) in which you are seeking certification.

7. Check aerial or fumigation standards if you intend to apply pesticides by aircraft or use fumigant pesticides.

8. Sign and date the application form.

9. Take and pass core or standards exams (2 options): (1) Schedule online at www.metrosignup.com for computer-based exams (Note: Computer-based exams have an additional fee per test). (2) Schedule MDARD In-Person Core Paper-Based Testing & Core Review at https://www.canr.msu.edu/news/michigan-pesticide-applicator-review-sessions-recertifications-credits-and-testing-options

10. Take and pass all category exams with Metro Institute. Schedule online at www.metrosignup.com for computer-based exams (Note: Computer-based exams have an additional fee per test).

11. Mail MDARD paper application with a check or money order payable to the “State of Michigan” in the appropriate fee amount ($50-private, $75-commercial) to the address on top of application. The application fee is non-refundable.

12. You must pass all the exams for the pesticide applicator categories you designate on your application within six months after the initial application date.

General Information A certification card will be issued within six weeks to each person who completes the requirements for certification. The applicator must have the card in his/her possession when purchasing restricted use pesticides or applying any pesticides.

The fee for a replacement credential/card is $10.00.

An applicator’s credential expires December 31 of every third year. Individuals will receive a renewal application and information approximately three months prior to the expiration of their credential. Renewal may be obtained by accumulation of seminar credits or by taking renewal examination(s). More information about renewing and certification may be found on our website at www.michigan.gov/mdardpestcert.

Pesticide Applicator Application Instructions