Application for Nutrient Application Technician Licence

The information contained in this document is derived from the Nutrient Management Act, 2002 and O. Reg. 267/03 as amended. Every effort has been made to make it as accurate as possible, but is is not authoritative. Please refer to www.e-laws.gov.on.ca or the official volumes printed by Publications Ontario for the authoritative text of the act.

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Application for Nutrient Application Technician Licence

Section 1 - Applicant Information

Company Name: ____________________________________________

Name of Applicant (First, Middle, Last): __________________________

Mailing Address (include 911, RR#):

_____________________________________________________

City/Town/Village: _______________________Postal Code: ______

County/Regional Municipality: ________________________________

Telephone: (        ) __________________ Fax:(        )_________

Email Address: ___________________________________________

Name of Trainer (COMPLETE PAGE 2 OF APPLICATION):

______________________________________________________

Section 2 – Requirements for Certification

• View DVD
• Complete Workbook
• Complete Test

Training Date(s): ________________________________________

Training Location: ____________________________

Exam Date(s): __________________________________________

Exam Location: _________________________________________

Grade Received: ________

______________________________ Date: _________________
Applicant's Signature

Please complete next page of application form

Trainer Information (please indicate if your trainer was an OMAFRA staff person)

Name: __________________________________________________

Title: ___________________________________________________

Company: ___________________________________________

Date of Training Session(s): _______________________________

1. Please describe your qualifications to be a trainer (tick all that apply) (*required):

*Possess a Prescribed Materials Application Business Licence. Provide licence number ______________________________

Day to day managerial responsibility for field operations

Extensive knowledge of company standard operating procedures

Knowledge of equipment used in land application

Other. Provide details:

___________________________________________________

___________________________________________________

2. In training the applicant(s) at the company, I followed Ontario Ministry of Agriculture, Food and Rural Affairs guidelines for course delivery, such as:

______________________________ fully completed the course under my supervision
(Name of applicant)

The applicant viewed all chapters of the Nutrient Application Technician DVD/Video with me

I worked with the applicant to review and complete the Nutrient Application Technician Workbook. For each chapter, we reviewed and discussed the following until the technician had a thorough understanding and mastery of the subject matter:

All topics included in the chapter

All exercises

All questions in the "Talk to Your Trainer" section

All module review questions

The applicant completed the sample test questions and we reviewed the answers to make sure the participant understood the concepts covered by the questions

3. Employer/Trainer Declaration

I hereby warrant all the information in this application is accurate, and that the applicant has completed the course requirements as outlined by OMAFRA.

Trainer Signature: ___________________ Date:_______________

4. Nutrient Application Technician Declaration

I hereby warrant that all the information in this application is accurate and that I have completed the training and testing requirements as outlined by OMAFRA for this course.

Applicant Signature: ___________________ Date:______________