Resume Form - Supervisory Level Exam Requirement Page 3
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4NEW HAMPSHIRE DEPARTMENT OF AGRICULTURE, MARKETS AND FOOD
Division of Pesticide Control
PO Box 2042, 25 Capitol Street
Concord, NH 03302-2042
(603) 271-3550
RESUME FORM – SUPERVISORY LEVEL EXAM REQUIREMENT
All applicants for a Commercial Applicator For Hire Supervisory Level License must complete
this form in full and submit it prior to admittance to the supervisory level exam.
NAME___________________________________________________________________________
MAILING ADDRESS_______________________________________________________________
STREET ADDRESS___________________________________________ PHONE______________
CITY/STATE__________________________________________________ZIP_________________
FIRM NAME______________________________________________________________________
FIRM ADDRESS______________________________________________ PHONE______________
CITY/STATE__________________________________________________ZIP_________________
1.
Check category(ies) you wish to become licensed in:
___ (A1) Agricultural Pest Control – Fruit
___ (F2) Mosquito and Black Fly
___ (A2) Agricultural Pest Control – Herbicides
___ (F3) Termites and Wood Destroying Insects
___ (A3) Agricultural Pest Control – Field Crops
___ (F4) Fumigation
___ (A4) Agricultural Pest Control – Animals
___ (F5) Pole Treating and Wood Preservation
___ (B) Right-of-Way, and Commercial Weed & Brush Control
___ (G1) Shade and Ornamental Pest Control
___ (C1) Forest Pest Control and Timber Treatment
___ (G2) Turf Pest Control
___ (C2) Christmas Tree
___ (G3) Indoor Foliar Pest Control
___ (D) Aquatic Pest Control
___ (J) Aerial Pest Control
___ (F1) General Pest Control
___
_______________________________
2.
What is your license history?
Years licensed______________________________________________________
States licensed in____________________________________________________
Category(ies) of licensing_____________________________________________
This information must be verified. Enclose copies of all licenses held. If old licenses are
not available, a letter from the State Pesticide Agency verifying the necessary information
will be acceptable.
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