Operator License Exam Application

Pest and Weed Control

Mississippi Department of Agriculture & Commerce • Bureau of Plant Industry

Applicant Information

Name	#field(16199) #if(#field(16200))#field(16200) #endif#field(16201)
Phone	#field(16213)
Email	#field(16214)

Physical Address

#field(16202)
#if(#field(16203))#field(16203)
#endif#field(16204), #field(16205) #field(16206)

Mailing Address

#if("#text(#field(16207))" == "Mailing address is same as physical address")Mailing address is same as physical address.#endif#if("#text(#field(16207))" != "Mailing address is same as physical address")#field(16208)
#if(#field(16209))#field(16209)
#endif#field(16210), #field(16211) #field(16212)#endif

Examination Qualification

#if("#field(16218)" *= "Paper-based")#endif #if(#field(16232))#endif

Examination Method	#field(16218)
Requested Session	#field(16226)
Qualifying based on	#field(16219, ; )
Additional Notes	#field(16232)

Commercial Certification Status

#if(#field(16229))#endif #if(#field(16230))#endif #if(#field(16231))#endif

Commercial Certification Status	#field(16228)
Commercial Certification State	#field(16229)
Commercial Certificate Number	#field(16230)
Commercial Certification Card Front and Back	#field(16231)

Examination Categories

Selected Categories

#field(16237, "")

#if("#text(#field(16219))" != "Education")

Employment History

#section_rows_start(2666)

Employment History #section_row_number

Company	#field(16242)
Company Phone	#field(16248)
Company Address	#field(16243) #if(#field(16244))#field(16244) #endif#field(16245), #field(16246) #field(16247)
Employment Start Date	#field(16249)
Employment End Date	#field(16250)
Job Title	#field(16251)
Applicant ID Card	#field(16252) #if(#field(16253))(#field(16253))#endif
Categories on Applicant ID Card	#field(16254)
Supervisor	#field(16255)
Supervisor ID Card #	#field(16256)
Supervisor Affirmed Category(ies)	#field(16257)

#section_rows_end #endif

Document Checklist

#if(#field(16221))#endif #if(#field(16222))#endif #if(#field(16223))#endif #if(#field(16224))#endif

College Transcripts	#field(16221)
High School Diploma or GED	#field(16222)
Employment History Documentation	#field(16223)
Other Supporting Documentation	#field(16224)

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