
YOU MUST COMPLETE THIS SECTION IN ITS ENTIRETY FOR THIS APPLICATION TO BE PROCESSED Course Subject DOH-352 11/12 Page 1 of 2 Dates Contact Hours Location Sponsor Signature. NEW YORK STATE DEPARTMENT OF HEALTH Center for Environmental Health Bureau of Water Supply Protection Empire State Plaza Corning Tower Room 1110 Albany New York 12237 Application for Renewal of Certification Water Treatment Plant or Distribution System Operator Instructions To avoid your application being rejected please read and follow these instructions carefully. 1. Complete ALL items in SECTION I and II ONLY. PRINT IN PEN OR TYPE ALL INFORMATION* 2. Include copies of all course completion certificates. 3. BE SURE TO SIGN AND DATE YOUR APPLICATION* FAILURE TO COMPLETE THIS APPLICATION FULLY WILL CAUSE IT TO BE REJECTED AND RETURNED AS INCOMPLETE* I. Applicant Information Phone No* Work Home Email Address Employer Name Employer Address PLEASE ENTER ANY ADDRESS CORRECTIONS IN THE SPACE BELOW County of Employment II....
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How to fill out the DOH-352 online
The DOH-352 form is essential for the application of renewal of certification for water system operators in New York State. This guide provides clear, step-by-step instructions to help you successfully complete the form online, ensuring that your application is processed efficiently.
Follow the steps to complete the DOH-352 online
- Press the ‘Get Form’ button to access the DOH-352 form and open it in the editor.
- Begin by filling out SECTION I, which includes your applicant information. This consists of your home phone number, home email address, employer name, and employer address. Ensure all information is clear and accurately entered.
- In SECTION I, provide any address corrections in the designated space. Fill in your work phone number, work email address, the county of employment, and indicate whether you are a veteran or a contract operator by selecting 'yes' or 'no' as applicable.
- Proceed to SECTION II, titled 'Renewal Training Credits.' Summarize all training received for renewal over the last three years. For each course taken, enter the course title, the dates of attendance, the contact hours, and the approved training course number.
- Continue filling out the details for any additional courses, ensuring that all spaces are filled completely as required to avoid rejection of your application.
- After completing both sections, review your entries for accuracy. Sign and date your application at the bottom of the last page.
- Once all information is correctly filled out and reviewed, proceed to save any changes, and download or print the completed form for submission.
Take the next step in your career by completing the DOH-352 online today!
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