TERMINATION OF REGISTERED EMPLOYEE AND / OR CERTIFIED APPLICATOR Details
TERMINATION OF REGISTERED EMPLOYEE AND / OR CERTIFIED APPLICATOR
General Info - Statewide Registration
This application is used to notify the MDA of any person that have been terminated.
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Approval time
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Average completion time
Obtaining the Registration
Ready to get your registration? - Steps, Requirements, and Documents
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Provide business/public agency name and address.
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Provide business license/ public agency permit number.
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Provide telephone number.
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List terminated employee name, social security number, indicate if employee is REGISTERED or PROVIDE CERTIFICATION number, date of termination, indicate if ID is returned.
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If ID card is returned, please mail it to Pesticide Regulation.
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Provide name of Authorized Individual.
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Authorized Individual signature and date required.
Apply for the Registration
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Download form
Download the application .PDF file
Agency/Contact
Registration Issuer - Information
Who issues the registration?
Contact Information
Address