FW&PCOA SYSTEMS OPERATORS
SYSTEMS OPERATORS APPLICATION FORM
WATER DISTRIBUTION
Class “3”
Location of School: Suncoast Public Works Academy - Sarasota Date/s of School: Sept.10-14 2012 ________
NAME: Last 4 digits of SS#:
MAILING ADDRESS:
(House Number) (Street/Ave) (Apt.)
(City) (County) (State) (Zip)
Email Address: _______________________________________________________________________________________
Work Phone: ( ) Fax: ( )
Employer: Job Title:
PLACE AND “X” NEXT TO THE APPROPRIATE LEVEL OF TRAINING AND/OR EXAM:
Water Distribution Level 3: _____ course & exam _____ course only _____ exam only* _____ CEU (DW/DS28096, 3.0 CEU’s)
Water Distribution Level 2: _____ course & exam _____ course only _____ exam only* _____ CEU (DW/DS28097, 3.0 CEU’s)
Water Distribution Level 1: _____ course & exam _____ course only _____ exam only* _____ CEU (DW/DS2304, 3.0 CEU’s)
* YOU MUST ATTACH A COPY OF YOUR ATTENDANCE CERTIFICATE FOR THE APPROPRIATE LEVEL TECHNOLOGY TRAINING COURSE.
STUDENTS ARE RESPONSIBLE FOR PURCHASING THEIR OWN TEXTBOOK! All students will use “Water Distribution System Operation and Maintenance.” Level 1 will also use “Manage for Success: Effective Utility Leadership Practices.” Textbooks may be purchased from Dr. Kenneth Kerri:
Office of Water Programs, CSU - Sacramento Phone: 1-916-278-6142
6000 J Street Fax: 1-916-278-5959
Sacramento, CA 95819
To receive a “Certificate-of-Completion”:
LEVEL 3: (A) Must be at least 18 years of age. (B) Must furnish evidence of having completed the FW&PCOA Level 3 Technology Training course. (C) Must pass the Level 3 written exam with a score of 70% or higher.
LEVEL 2: (A) Must furnish evidence of having completed the FW&PCOA Level 2 Technology training course. (B) Must pass the Level 2 written exam with a score of 70% or higher.
LEVEL 1: (A) Must furnish evidence of having completed the FW&PCOA Level 1 Technology training course. (B) Must pass the Level 1 written exam with a score of 70% or higher.
Please note that while the FW&PCOA does not require evidence of a high school diploma or equivalent for its water distribution operator training programs, applicants for Florida Department of Environmental Protection (FDEP) licensure must provide proof that they hold a valid high school diploma or equivalent issued by an FDEP approved institution. Contact the FDEP Operator Certification Program office (850-245-7500) for details.
Request for an Oral Exam: Medical documentation that is in agreement with the Americans with Disabilities Act (ADA) must be attached. Please place an “X” below to indicate your request for an oral exam.
_____YES: I request to take an oral exam, documentation attached.
Applicant’s Signature: Date:
FEES: FW&PCOA Members: $300.00 for course and exam or for course only (Indicate Region #________). FW&PCOA Non-members: $330.00 for course and exam or for course only. Members and Non-members: $90.00 for exam only.
MAIL: Fees, payable to Region XII FW&PCOA, with original application (all documentation attached) to: Region XII FW&PCOA, c/o Karen Johnson,
3305 Gulf Watch Court, Sarasota, FL 34231. Phone (941) 922-4647, kdjohn33@, .
-----------------------
[pic]
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.