Drinking Water Certification Application Instructions

Instructions for Completing the Application for Water Treatment Plant and Distribution System Operator Certification

Note: Incomplete Applications Will Be Returned

1. Check one (1) grade of water distribution system or one (1) grade of water treatment plant exam you wish to take. There is a $30 nonrefundable fee for each grade of certification for which you apply.
2. Check "by examination" or "by reciprocity"
3. Indicate at the right side of the application, the PWSID# of the public water supply where you are currently employed.

Section I. General Information

1. Type or print clearly the applicant's name (last, first, middle). Indicate Mr., Mrs., or Ms.
2. Enter mailing address, include county and zip code. Enter both an office phone number and a home phone number.
3. Check whether applicant has applied for Water Works Certification in Indiana before and indicate the date.
4. Check whether applicant is presently a certified operator in Indiana and, if yes, enter certification number and grade.
5. Check whether applicant is a certified operator in another state. If yes, give certification number and grade (attach a copy of certificate or card, if possible).
6. Check whether applicant has ever had a suspended or revoked certification.
7. Social security number is not necessary. (Please note the disclosure statement on application.)

Section II. Education and Training

Note: All applicants must have a high school diploma or GED

1. Check the highest grade completed in Grade School, High School, and College, if applicable.
2. Check whether applicant is a high school graduate or a GED equivalent. Indicate date of graduation or GED completion. (MONTH & YEAR NEEDED AT LEAST)
3. Check whether applicant is a college graduate and enter Degree and Major, Date granted, Name and Location of College. (Attach college transcript if substituting education for experience.)
4. Indicate training courses attended, include short courses and other courses in the water field.

Section III. Experience History

Note: Experience Must Be Obtained Under The Direction Of A Certified Operator

Indicate applicant's current employment first (show dates of employment and position title). List specific duties performed (incomplete applications will be returned) in the day to day operation of water treatment plant or water distribution system. Show percent of time spent in the performance of duties directly related to treatment or distribution if your primary duties are other than direct operation.

Note to Applicant's Supervisor

1. Make sure that name and signature of the "certified operator under whose direction experience is obtained" is entered.
2. Please read the application being submitted completely to verify that the information submitted is true and correct to the best of your knowledge and indicate the number of years you have supervised this individual.
3. Sign your name and print your name on the application in the appropriate box, as well as your title, along with your certification number (if not certified, enter the name and certification number of operator under whose direction applicant obtained experience in the box indicated).
4. Indicate the name of the public water supply, or organization represented, along with the address and telephone number.

Section IV. Signature of Applicant

Note: Incomplete Applications Will Be Returned

Applicant shall read the statement at the bottom of the application attesting to the accuracy of the information being submitted before signing. Enter the date signed.

Note: The application, along with the required fees and attachments should be mailed to:

Indiana Department of Environmental Management
Office of Water Quality Drinking Water Branch MC 66-34
100 North Senate Avenue
Indianapolis, IN 46204-2251

Please make all checks payable to the Indiana Department of Environmental Management. (Please indicate who and what the check is for -- do not send cash)