commercial structural pest control - Kentucky Department of ...

EDUCATION: Name of High School: _________________________________________________________
Address: _______________________________________ City: ______________________ State: _______
Did you graduate? ______YES ______NO ______GED
COLLEGE: Name of school: _______________________________________________________________
Address: _______________________________________ City: ______________________ State: _______
Major Subject: _______________________________________________ Years Attended: _____________
Did you graduate? ______YES ______NO, Degree(s): __________________________________________
Have you ever failed a Structural Pest Control Examination? ______NO ______YES
If YES, when and where: __________________________________________________________________
Have you ever been convicted of a felony or misdemeanor, in any state? ______NO ______YES
If yes, when and where: ___________________________________________________________________
NOTARY: Please impress your seal on BOTH the signature and edge of photo. Do not deface the photo.
STATE OF KENTUCKY or (_______________________) ********************
* *
COUNTY OF ___________________________, * *
* *
Subscribed and sworn to before me this ____day of ___________ 20___. * *
* Photo *
____________________________ ______________ * *
Notary Public Expiration Date * *
* *
* *
* *
********************
By signing this application I affirm that the statements and answers contained herein
are true and correct. _______________________________________ _____________
(Applicant’s Signature)
Date
As part of your application you must submit a comprehensive state wide criminal record check
which must be obtained from the Kentucky State Police. (See below for details on how to obtain
the background check).
You must also obtain a letter signed by the license holder of the pest control company, on
letterhead stationary, which verifies that you have at least two (2) year’s experience for the
Applicators Examination or at least one (1) year experience for the Manager’s Examination. (If
letterhead stationary is unavailable, the letter must be notarized). If your verification is from a
license holder from a state other than Kentucky, the KDA will contact that state’s licensing
agency and verify the license holder.
IS YOUR APPLICATION COMPLETE?
All information must be submitted. Incomplete applications will not be
considered and will be returned.
ONLY COMPLETE APPLICATIONS POSTMARKED THIRTY (30) DAYS
PRIOR TO THE TESTING DATE WILL BE PRESENTED TO THE PEST
CONTROL ADVISORY BOARD FOR CONSIDERATION.
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