Qualified Applicator License Packet

1 STATE OF CALIFORNIA Qualified Applicator License Packet (REV. 03/18) DEPARTMENT OF PESTICIDE REGULATION PEST MANAGEMENT A ND LICENSING BRANCH LICENSING AND CERTIFICATION PROGRAM 1001 I STREET SACRAMENTO, CALIFORNIA 95814-2828 (916) 445-4038 Web site: < > Qualified Applicator License Packet Contains t he following documents: Licensing Requirements Application & Instructions Pest Control Category Descriptions Study Material Source List Visa/Mastercard Transaction FormSTATE OF C ALIFORNIA DEPARTMENT OF PESTICIDE REGULATION PEST MANAGEMENT AND LICENSING BRANCH Qualified Applicator License REQUIREMENTS (REV. 8/17) Qualified A PPLICATOR LICENSING REQUIREMENTS Do you need this License ? You must possess a valid Qualified Applicator License (QAL) if you do any of the following: Apply or supervise the application of federally restricted use pesticides orstate restricted materials for any purpose or on any property other than thatprovided by the definition of a private applicator1 (Title 3 of CaliforniaCode of Regulations [3 CCR], section 6000) Supervise the pesticide applications made by a licensed pest controlbusiness and are responsible for its safe and legal operation.

2 The QALshall include the categories of pest control activities they supervise(Food and Agricultural Code [FAC] sections 11701-11709)Dealer designated agent privile ge Under this License , you may al so act as a licensed pest control dealer designated ag ent, which allows you to actively supervise all operations at a pest control dealer location. Basic lic ensing requirements You may obtain a QAL by submitting the applicati on, appropriate fees, and passing the required e xaminati ons. Examinations You must pass the Laws, Regulations, and Basic Principles examination and at least one pest control category examination with a score of 70 percent or higher (3 CCR section 6504). The pest control categories for this License are as follows: A Residential, Industrial, and Institutional B Landscape Maintenance C Right-of-Way D Plant Agriculture E Forest F Aquatic G Regulatory H Seed Treatment I Animal Agricu lture J Demonstration and Research K Health Related L Wood Preservative M Antifouling Tributyltin N Sewer Line Root Control O Field Fumigation P Microbial Pest Control Exam schedule/ processing time The DPR Exam Schedule is posted on our web site at Your application must be postmarked by the final filing date listed in the examination schedule in order for your requested month, location, and type of examination(s) to be processed.

3 Continued on next page 1 An individual who uses or supervises the use of a pesticide to produce an agricultural commodity on property owned, leased or rented by him/her or his/her employer; OR a householder who uses or supervises the use of a pesticide outside a residential dwelling to control ornamental, plant or turf pests on residential property owned, leased, or rented by that householder. Page 2 Valid licenses License duration List of valid licenses and certificates may be viewed at Refer to the table above for expiration date. Qualified Applicator License Licensing Requirements (Rev. 8/17)Preparing for examinatio ns To prepare for the examination, you should read the appropriate study materials listed on the Suggested Study Material Source List included in this Packet . Many of the study materials have practice test questions at the end of each chapter that can help you evaluate whether you know the material well enough to pass the exam.

4 For some categories, DPR has Knowledge Expectations on our web site that outline the type of information you will be expected to know when you take the examination. Application fee The application fee is $80 for this License (3 CCR section 6502). This fee allows an applicant a 12 month period to become licensed. Examination fees Second -year fee The examination fee is $50 (3 CCR section 6505) for each examination requested, including: adding categories; and rescheduling due to failure to appear or to obtain a passing new applicant passing the required examinations may be required to pay a Second-year Fee. In order to issue your 2-year License , an additional $60 is required. The 2-year cycles are illustrated in the table below. If your last name begins Then your License A through L Expire on December 31 of even-numbered years ( 2018, 2020, 2022, etc.) M through Z Expire on December 31 of odd numbered years ( 2017, 2019, 2021, etc.)

5 Continuing education Once you pass the examination(s) and receive your License , you must accumulate a determined amount of approved continuing education (CE) hours. DPR will inform you of the number of approved CE hours you are required to After your first renewal, you are required to accumulate at least 20 hours of approved continuing education (CE) every two years before License renewal. Four of the 20 hours must cover the topic of pesticide laws and regulations (3 CCR section 6511). Continued on next page 2 Some new License holders may require fewer CE hours for their first renewal depending on when the License was issued. The number of required CE hours will be specified on your transmittal card when you receive your new License . Qualified Applicator License Licensing Requirements (Rev. 8/17) Page 3 Continuing education (con't) QAL holders who have category M, N, or P are required to complete eight hours of approved CE after their first renewal.

6 QAL holders who have category H only are required complete four hours of approved CE after their first renewal. Two of the hours must cover pesticide laws and regulations (3 CCR section 6511). It is your responsibility to ensure that you complete the number of hours required in each CE category prior to renewal of your QAL. For more information, you can find the following on our website: CE requirements: DPR-approved CE courses: fee The renewal fee is $120 for the 2-year cycle (3 CCR section 6502). Late renewal fee A late fee of 50 percent of the total renewal fee will be charged for e ach License or certificate postmarked after December 31 of your expiration year. Continued on next page Type Details Name change $20 You must immediately notify the Licensing and Certification Program in writing (3 CCR section 6508). You must submit legal documents certifying the namechange. A new License will be automatically issued for all namechanges.

7 The Address Change/Name Change/Replacement CardForm is available on our website change $20 You must immediately notify the Licensing andCertification Program in writing (3 CCR section 6508). This fee is only required if you request a new License . The Address Change/Name Change/Replacement CardForm is available on our website $20 This fee applies to requests for a duplicate orreplacement License . The Address Change/Name Change/Replacement Form is available on our website following chart lists possible miscellaneous fees. Name and/or address change fees are waived when adding a pest control category or at renewal. Page 4 Qualified Applicator License Licensing Requirements (Rev. 8/17) Common mistakes The m ost common application errors are Incorrect fe es Missing the final filing date Not specifying your preferred month, location, and type of examinati on(s)You can avoid these errors by reading the appli cation instructions carefully and by mailing your application before the final filing date.

8 Our physical address Department of Pesticide Regulation Pest Management and Licensing Branch Licensing and Certification Program 1001 I Street Sacramento, CA 95814-2828 Our mailing address Department of Pesticide Regulation Pest Management and Licensing Branch Licensing and Certification Program Box 4015 Sacramento, CA 95812-4015 For more information You may contact us between the hours of 8 to 5 at (916) 445-4038, or e-mail us at This page intentionally left blank for double sided printing. STATE OF CALIFORNIAQUALIFIED Applicator License APPLICATIONPR-PML-001 (REV. 05/10)Page 1 of 2 The mailing address you indicate on this application is your address of record for your License /certificate. Therefore it is public information. You may wish to use a post office box in lieu of the physical address as an address of OF PESTICIDE REGULATIONPEST MANAGEMENT AND LICENSING BRANCHLICENSING AND CERTIFICATION PROGRAM1001 I STREET, BOX 4015 SACRAMENTO, CALIFORNIA 95812-4015(916) 445-4038 FAX - (916) 445-4033 Web site: CDB(R) Laws, Regulations and Basic Principles $50(I) Animal AgricultureREQUIRED FOR ALL NEW APPLICANTS$50(A) Residential, Industrial, and Institutional $50(J) Demonstration and Research $50 Health Related (B) Landscape Maintenance $50(K)$50(C) Right-of-Way $50(L) Wood Preservation $50(D) Plant Agriculture $50(M) Antifouling-Tributyltin$50(E) Forest Sewer Line Root Control $50(N)$50(F) Aquatic $50(O) Field Fumigation$50(H) Seed Treatment E.

9 (G) Regulatory $50(P) Microbial $50$50 Examination complete this section, see Examination Schedule for the monthand location. DPR will assign the exam MONTHEXAMINATION SITE LOCATIONF. Reasonable if you need reasonable accommodation to take a written Fees. All fees are non-transferable and # of ExamsTotal AmountNew Applicant Fee (First Time Applicant Only)$80---$Examination Fee (New, Adding, and Reexamination)$50=XTotal Fees Due/Enclosed$$---H. Read Before the last three years have you had any administrative, civil, or criminal action taken against you for violation of any State orfederal laws or regulations relating to the application or use of pesticides that resulted in disciplinary or in which any disciplinary action is pending?YES (State explanation below or attach separate page.)NOI. I declare under penalty of perjury, under laws of the State of California, that the above information is true and SIGNATUREDATE SIGNEDFOR OFFICIALPROBLEMCOMPUTER ENTRY DATEUSE ONLYA.

10 Application Type. Check the appropriate box(es).NEW APPLICATION - FIRST TIME APPLICATION ADDING PEST CONTROL CATEGORY(IES)OTHER - Specify REEXAMINATION - FAIL OR NO SHOW ON PREVIOUS EXAMS B. Applicant Information. Please print or (Last)(First)(Middle Initial)QAL NUMBER/EXAM ID NUMBERHOME TELEPHONE NUMBERAILING ADDRESS (Number and Street)City)(County)(State)(ZIP Code)WORK TELEPHONE NUMBERCELL TELEPHONE NUMBERCURRENT EMPLOYER (Check only one box)EMAIL ADDRESSCityCountyStateFederalPest Control BusinessMaintenance GardenerPrivate BusinessOtherEMPLOYER NAME AND MAILING ADDRESS (If Applicable) (Name, Number and Street, City, State, Zip Code). Laws, Regulations and Basic Principles Examination. Exemption. See instructions on - Check this box and enter the number from your current License or certificate if you are exempt from this CONTROL ADVISER License NUMBERJOURNEYMAN PILOT CERTIFICATE NUMBERAPPRENTICE PILOT CERTIFICATE NUMBER.