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GEORGIA DEPARTMENT OF PUBLIC HEALTH (DPH)

SOIL CLASSIFIERS CERTIFICATION COMMITTEE

Reference Form

________________________________________________________________________

To be completed by applicant and mailed to individuals who are references:

Applicant’s Name:_______________________________________________________________________

Last

First

Middle

Address:_______________________________________________________________________________

_______________________________________________________________________________

I agree that this reference shall remain confidential.

Yes

(circle one)

______________________________________________________________________________________

To the Reference:

You have been named as a reference by the applicant listed above. The Soil Classifiers Certification

Advisory Committee requests that you provide answers to the following questions with regard to the

character of the applicant in order that the Committee might better assess the applicant’s qualifications.

Please return the completed form in a sealed enveloped to the following address:

Soil Classifiers Certification Advisory Committee

DPH, Environmental Health Branch

2 Peachtree Street, NW, 13

Floor

Atlanta, Georgia 30303-3186

Please describe in detail your relationship (business/personal, etc.) to the applicant.

______________________________________________________________________________

Number of years you have known the applicant________________________________________

Are you aware of anything that may make the applicant ineligible for certification?____________

If yes, please explain on the back of this sheet.

How long have you known the applicant to be engaged in soil classification and mapping?

_____________________________________.

In you professional opinion, has this applicant demonstrated competence and knowledge in the

profession of soil classification and mapping? __________________ Please explain___________

______________________________________________________________________________

Would you entrust the applicant with the responsibility for an important soils project involving the

welfare and safety of the public? _________________

Reference form 1.2

Reference Form 1.2 - Soil Classifiers Certification Committee - Georgia Department Of Public Health