NOTE: TO ASSURE THIS APPLICATION IS MAILED ON TIME IT IS RECOMMENDED THAT YOU MAIL IT YOURSELF.
STATE OF MISSOURI
DEPARTMENT OF NATURAL RESOURCES
APPLICATION: FOR EXAMINATION FOR A WATER TREATMENT, WATER DISTRIBUTION,
WASTEWATER OPERATOR or CONCENTRATED ANIMAL FEEDING OPERATIONS (CAFO) CERTIFICATE
INSTRUCTIONS TO APPLICANT
Ã FORM CONTINUES ON BACK
FORM CONTINUES ON BACK
DRINKING WATER TREATMENT
DRINKING WATER DISTRIBUTION
CONCENTRATED ANIMAL FEEDING OPERATIONS
1. Please print in ink or type. Give complete and detailed answers. You will be credited only with drinking water treatment, distribution,
wastewater and CAFO related education and experience shown in this application. If more space is needed, attach additional sheets or a
resume. Be sure and list all water, wastewater and CAFO experience regardless of which certificate examination you are applying for.
2. Complete a separate application for each certificate examination level and type that you are applying for.
3. A Forty Five dollar ($45.00) fee is required for an initial examination or a twenty ($20.00) fee for the reexamination for the same type
and level of certificate. Payment should be made by check or money order payable to: Department of Natural Resources. (Cash will not be
4. The applicant must sign and date the original application and submit fee to the address listed below. Incomplete applications will be
5. The completed original application must be returned at least 30 days prior to date of exam to the following address: Missouri Department
of Natural Resources, Receipts and Reporting, PO Box 477, Jefferson City, MO 65102-0176.
7. FIRST NAME
8. MIDDLE INITIAL
9. LAST NAME
10. HOME ADDRESS (STREET OR P.O. BOX NO.)
13. ZIP CODE
14. SOCIAL SECURITY NUMBER
15. HOME TELEPHONE NUMBER
16. PRESENT CERTIFICATION NUMBER
AREA CODE (
GENERAL - PLEASE PRINT
EXAMINATION TYPE AND LEVEL
DECLARATION OF AGE ELIGIBILITY
I certify that I am at leas