Pesticide Applicator License Verification Checklist

Ensure compliance & protect your crops! Our Pesticide Applicator License Verification checklist for Agriculture helps you verify credentials, minimize risk, & stay legally compliant. Download now & safeguard your farm!

This Template was installed 5 times.

Applicant Information

1 of 6

Verify the accuracy and completeness of applicant's personal details.

Legal First Name

Legal Middle Name

Legal Last Name

Date of Birth (Year)

Date of Birth

Current Mailing Address

City

State

Zip Code

Phone Number

License Status & Validity

2 of 6

Confirm the applicant's license is currently active and has not expired.

License Status

License Expiration Date

Number of Renewals

Renewal Status

Last Renewal Date

Notes Regarding Status (if applicable)

License Category & Endorsements

3 of 6

Verify the license category matches the intended use and check for required endorsements.

License Category

Applicable Endorsements (Check all that apply)

If 'Other' endorsement selected, please specify:

Applicable Application Method

Date of Last Endorsement Training

Total Endorsement Training Hours

Copy of Endorsement Certificates

Training & Education Records

4 of 6

Review records to ensure required training hours and certifications are documented and up-to-date.

Date of Initial Training Completion

Date of Last Renewal Training Completion

Total Training Hours Completed (Initial)

Total Renewal Training Hours Completed

Training Modules Completed (Select all that apply)

Specific Crop/Pest Training Details (If Applicable)

Copy of Training Certificate(s)

Background Checks & Disqualifications

5 of 6

Check for any disqualifying events or background issues that might affect licensing eligibility.

Criminal Record Check Completed?

Disqualification for Illegal Pesticide Use?

Details of any Disqualifying Events (if applicable)

Number of Disqualifying Events (if applicable)

Supporting Documentation (e.g., court records, agreements)

Previously Revoked License?

Date of Revocation (if applicable)

Explanation of Revocation/Reinstatement (if applicable)

Record Keeping & Documentation

6 of 6

Ensure all relevant records are properly maintained and accessible.

Date of Record Review

Applicator License Number (Verified)

Summary of Record Examination

Copy of License/Certification

Notes on Training Records

Record Completeness

Reviewer Initials

Date of Next Record Review (if applicable)

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