Operator License Exam Application

Pest and Weed Control

Mississippi Department of Agriculture & Commerce • Bureau of Plant Industry

Applicant Information

Name	#field(13103) #if(#field(13104))#field(13104) #endif#field(13105)
Phone	#field(13117)
Email	#field(13118)

Physical Address

#field(13106)
#if(#field(13107))#field(13107)
#endif#field(13108), #field(13109) #field(13110)

Mailing Address

#if("#text(#field(13111))" == "Mailing address is same as physical address")Mailing address is same as physical address.#endif#if("#text(#field(13111))" != "Mailing address is same as physical address")#field(13112)
#if(#field(13113))#field(13113)
#endif#field(13114), #field(13115) #field(13116)#endif

Examination Qualification

#if(#field(13133))#endif

Examination Method	#field(13121)
Qualifying based on	#field(13122, ; )
Additional Notes	#field(13133)

Commercial Certification Status

#if(#field(13130))#endif #if(#field(13131))#endif #if(#field(13132))#endif

Commercial Certification Status	#field(13129)
Commercial Certification State	#field(13130)
Commercial Certificate Number	#field(13131)
Commercial Certification Card Front and Back	#field(13132)

Examination Categories

Selected Categories

#field(13137, "")

#if("#text(#field(13122))" != "Education")

Employment History

#section_rows_start(2189)

Employment History #section_row_number

Company	#field(13141)
Company Address	#field(13142) #if(#field(13143))#field(13143) #endif#field(13144), #field(13145) #field(13146)
Company Phone	#field(13147)
Employment Dates	#field(13148) to #field(13149)
Job Title	#field(13150)
Applicant ID Card	#field(13151) #if(#field(13152))(#field(13152))#endif
Categories on Applicant ID Card	#field(13153)
Supervisor	#field(13154)
Supervisor ID Card #	#field(13155)
Supervisor Affirmed Category(ies)	#field(13156)

#section_rows_end #endif

Document Checklist

#if(#field(13124))#endif #if(#field(13125))#endif #if(#field(13126))#endif #if(#field(13127))#endif

College Transcripts	#field(13124)
High School Diploma or GED	#field(13125)
Employment History Documentation	#field(13126)
Other Supporting Documentation	#field(13127)

Submission ID: #submit_id
Page: #post_title
URL: #post_url