Form Mde/wma/bwd/res - Application For License Reinstatement Page 3
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3AGREEMENT TO SUPERVISE APPLICANT'S TRAINING and WORK PERFORMANCE
Note:
Complete only if the applicant is applying for reinstatement of a Journeyman Well Driller, Well Rig Operator,
or an Apprentice license.
I hereby affirm that _______________________________________________, who is applying for license reinstatement
(Name of Applicant)
is and has been employed by ___________________________________________ since _________________________.
(Company)
(Date)
As a _____ Master Well Driller _____ Water Conditioner Installer ____ Pump Installer licensed in Maryland and the
designated sponsor of this applicant, I submit that the applicant is a likely candidate for training and advancement in the
practice of well drilling, and I fully endorse this application.
In consideration of this application for license reinstatement, I agree to and pledge cooperation in the following:
1.
That while employed by the Company, the applicant will be provide with the opportunity to frequently operate all
well drilling machinery, equipment, and apparatus used by me in the practice of well drilling, and perform any
associated work only while under the supervision and responsibility required in the Maryland State Board of Well
Drillers' Regulations, COMAR 26.05.01-.04, for the class and category of license sought.
2.
That all practice of well drilling done by this applicant shall be in accordance all applicable regulations, and shall
be covered by the bond of the designated sponsor and liability insurance of the Company.
3.
That I will make every effort to provide the applicant, while an employee of the Company, with the opportunity to
obtain additional training and experience in the practice of well drilling.
4.
That written reports on the applicant's progress will be submitted to the Board, upon request.
5.
That should the applicant's employment be terminated, either voluntarily or otherwise, I will notify the
Board, in writing, within 10 days after termination.
_________________________________________________ MSBWD License No. _____________
(Name of Designated Sponsor, Printed)
(6 characters)
_________________________________________________
(Signature of Sponsor)
_________________________________________________
(Signature of Applicant)
_________________________
(______)_______-____________
(Date)
(Business Telephone Number)
AOBJ: 5364
MDE/WMA/BWD/RES
3 of 3
Revision Date (11/04)
Recycled Paper
TTY Users 1-800-735-2258
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