Form 47289 - Application For Wastewater Treatment Plant Operator Certification Examination - Indiana Page 2

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III. EXPERIENCE HISTORY
List your current assignment first. Show all experience in the wastewater treatment field. Positions of responsible charge should be listed separately. Show
any related experience you feel is applicable.
DATE
POSITION TITLE
NAME OF FACILITY, CLASSIFICATION OF FACILITY,
(Month and Year)
AND
TYPE OF TREATMENT AND AVERAGE FLOW
JOB DUTIES
FROM:
TO:
Position title
Name of facility
Job duties
Classification of facility
Type of treatment
Average flow
Position title
Name of facility
Job duties
Classification of facility
Type of treatment
Average flow
Position title
Name of facility
Job duties
Classification of facility
Type of treatment
Average flow
Position title
Name of facility
Job duties
Classification of facility
Type of treatment
Average flow
Position title
Name of facility
Job duties
Classification of facility
Type of treatment
Average flow
IV. RESPONSIBLE CHARGE EXPERIENCE (to be completed by Class III, IV, C, and D applicants only)
List specific duties for positions of responsible charge. Additional sheets may be attached as necessary.
(2)

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