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Pcpnj. org CATEGORY TRAINING VERIFICATION FORM FOR COMMERCIAL PESTICIDE APPLICATORS THIS FORM IS ONLY TO BE USED IF YOU ARE APPLYING FOR A CATEGORY TEST. State of New Jersey Chris Christie Department of Environmental Protection Govenor Bob Martin Commissioner Pesticide Control Program PO Box 420 Trenton NJ 08625-0420 www. FOR THE CORE TEST SUBMIT A BASIC TRAINING COURSE CERTIFICATE* PLEASE CHECK APPROPRIATE BOX BELOW YES I HAVE COMPLETED THE 40 HOURS OF ON THE JOB CATEGORY TRAINING OJT AND HAVE PERFORMED/WITNESSED THE MINIMUM NUMBER OF PESTICIDE APPLICATIONS REQUIRED BY NJAC 7 30-6. 2. LIST CATEGORIES TRAINED IN BELOW NO I HAVE NOT COMPLETED THE 40 HOURS OF ON-THE-JOB-CATEGORY TRAINING BECAUSE IT IS NOT AVAILABLE* Note You may not use this option for categories 3A 3B 7A 7B. You must take a training course in lieu of the 40 hours of OJT. Please see attached CategoryTraining Course list or visit our web site www. pcpnj. org for course listings and information* Please check the line below that best explains why training is not available to you I am currently unemployed I am starting a new business I do not have a qualified trainer available Other APPLICANT S NAME print APPLICANT S SIGNATURE DATE TRAINER By signing below I verify that the above named person completed 40 hours of on-the-jobtraining in the categories listed above as required by N*J*A. C. 7 30-6. 2. TRAINER S NAME print TRAINER S PESTICIDE APPLICATOR LICENSE TRAINER S SIGNATURE DATE Note This form is only for Commercial Pesticide Applicators. Do not submit with Commercial Pesticide Operator application forms. Forty hours of OJT is not required for Categories 10 and 13. FOR THE CORE TEST SUBMIT A BASIC TRAINING COURSE CERTIFICATE* PLEASE CHECK APPROPRIATE BOX BELOW YES I HAVE COMPLETED THE 40 HOURS OF ON THE JOB CATEGORY TRAINING OJT AND HAVE PERFORMED/WITNESSED THE MINIMUM NUMBER OF PESTICIDE APPLICATIONS REQUIRED BY NJAC 7 30-6. 2. LIST CATEGORIES TRAINED IN BELOW NO I HAVE NOT COMPLETED THE 40 HOURS OF ON-THE-JOB-CATEGORY TRAINING BECAUSE IT IS NOT AVAILABLE* Note You may not use this option for categories 3A 3B 7A 7B. 2. LIST CATEGORIES TRAINED IN BELOW NO I HAVE NOT COMPLETED THE 40 HOURS OF ON-THE-JOB-CATEGORY TRAINING BECAUSE IT IS NOT AVAILABLE* Note You may not use this option for categories 3A 3B 7A 7B. You must take a training course in lieu of the 40 hours of OJT. Please see attached CategoryTraining Course list or visit our web site www. You must take a training course in lieu of the 40 hours of OJT. Please see attached CategoryTraining Course list or visit our web site www. pcpnj. org for course listings and information* Please check the line below that best explains why training is not available to you I am currently unemployed I am starting a new business I do not have a qualified trainer available Other APPLICANT S NAME print APPLICANT S SIGNATURE DATE TRAINER By signing below I verify that the above named person completed 40 hours of on-the-jobtraining in the categories listed above as required by N*J*A.

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