8 Ill. Adm. Code 220.ILLUSTRATION A
A Application for Weed Control Superintendent Certification
Section 220
Section 220.ILLUSTRATION A
Application for Weed Control Superintendent Certification
STATE
OF ILLINOIS
DEPARTMENT
OF AGRICULTURE
Bureau
of Environmental Programs
P.O.
Box 19281
Springfield,
Illinois 62794-9281
APPLICATION
FOR WEED CONTROL SUPERINTENDENT CERTIFICATION
Please typewrite or print.
1.
Name of Applicant
2.
County in which you live
Telephone
Number
3.
Home Address
City
State
Zip
Code
4.
Business Name and Address
Telephone
Number
5.
Please list all the previous
employment for the last five positions. (List most recent job first.)
Employer
(Name
and Address)
Date
Started
Date
Terminated
Reason
for Leaving
A.
B.
C.
D.
E.
6.
Education
High School
Graduated
College
Graduated
Major
Minor
Other Advance Training
Additional Information:
I certify the above
information to be true.
Signature
Date
Date Approved:
Approved:
Director
Illinois Department of
Agriculture