Application for Operator Certification – Water & Wastewater Operator Certification Program Step 1 of 7 14% Water & Wastewater Operator Certification ProgramPursuant to Section 38 of the Water Resources Act,SNL 2002 cW-4.01. The Newfoundland and Labrador Water and Wastewater Operator Certification Program incorporates the following Levels of Operator Certification: Operator in Training (OIT); Class I; Class II; Class III; Class IV; and Small Systems Information for Supervisors Regarding Submission of Application for Operator Certification Application for CertificationAn operator applying for certification shall submit a completed application form along with all required supporting documentation. The Certifier shall review the application and determine the applicant’s eligibility for examination.Eligibility RequirementsWith the exception of those applying for OIT status, only those operators currently employed at a water distribution facility, water treatment plant, wastewater collection facility, or wastewater treatment plant shall be eligible for certification. Operators must also meet education and experience requirements as stipulated by the department to satisfy eligibility requirements.Before You BeginThis form must be completed by the supervisor of the operator applying for certification.Information You'll NeedPlease be prepared to provide the following details about the operator seeking certification: Operator’s full name Description of job duties Start date of employment Personal contact information Highest level of education achieved, along with proof of completion Information Regarding Documentation of EducationA copy of the Degree, Diploma, Certificate being used to support the educational requirements for certification must be submitted with this Application. High School Transcripts are available without cost from the Department of Education. To obtain a high school transcript or your high school diploma, please contact: High School Certification Department of Education P.O. Box 8700 St. John's, NL A1B 4J6 Telephone: 1-709-729-3001 Fax: 1-709-729-0611 Email: transcripts@gov.nl.ca and email, fax or mail in the following information: Name and address in your last year of high school MCP and/or date of birth Last year of high school (e.g. 1997) and high school attended Address where you would like your transcript to be sent (or fax number) A request for a high school transcript normally takes 3-5 business days to process. Your transcript can either be mailed or faxed to you so you must provide an address or fax number with your request.What to Expect After you Submit the FormUpon completion of the application review, the Certifier will notify the operator of the outcome of their application. Applicants who are deemed eligible and approved for certification examination will be assigned a unique operator number.Confirmation(Required) I read and understood Section A: Employer's InformationSupervisor's Name(Required) First Name Last Name Supervisor’s Title(Required) Supervisor’s Email(Required) Knowingly verifying false information may result in legal action and will invalidate this application.Supervisor Declaration(Required)I confirm that the information regarding employment history and work experience with this employer is true and accurate to the best of my knowledge. I agree to the declarationSupervisor’s Signature(Required)To sign your name, use your finger, mouse or other compatible input device inside the dotted box. To start signing, press or click, hold and move. To stop signing, lift or release. To clear the signature, press or click the arrows icon in the bottom right corner.Date(Required) Year Month Day Section B: Employee's InformationEmployee's Job Title(Required)ForemanMaintenanceManagerOperatorSuperintendentSupervisorSystem(Required)Water DistributionWater TreatmentWastewater CollectionWastewater TreatmentEmployee's Name(Required) First Name Last Name Personal Email Work Phone(Required)Work Email Work FaxWork AddressPO BOX or Street Town or City Province Postal Code Section C1: Present Certification HeldDoes the Employee Hold Any Present Certification?(Required) Yes No Is this a request for Transfer of Certification from another Province or Territory?(Required) Yes No State Province/Territory of Transfer Section C2: Certification Exam RequestedIs the employee requesting to write a certification exam?(Required) Yes No Water DistributionSelect if ApplicableIIIIIIIVWater TreatmentSelect if ApplicableIIIIIIIVWastewater CollectionSelect if ApplicableIIIIIIIVWastewater TreatmentSelect if ApplicableIIIIIIIV Section D: Current Work Experience InformationIndicate employee's experience in the appropriate section: Water Distribution (WD); Wastewater Collection (WWC); Water Treatment (WT); and/or Wastewater Treatment (WWT). Indicate the amount of time spent at each activity in either hours per day, week or month.Employment Start Date(Required) Month Day Year Water Distribution Work ExperienceHoursUnitsHours/DayHours/WeekHours/MonthDescription of Current WD DutiesWastewater Collection Work ExperienceHoursUnitsHours/DayHours/WeekHours/MonthDescription of Current WWC DutiesWater Treatment Work ExperienceHoursUnitsHours/DayHours/WeekHours/MonthDescription of Current WT DutiesWastewater Treatment Work ExperienceHoursUnitsHours/DayHours/WeekHours/MonthDescription of Current WWT DutiesSection E: Details on Direct Responsible Charge (DRC) ExperienceApplying for Class III or Class IV certification?(Required)Complete this section only if applying for Class III or Class IV certification. Yes No Details on Direct Responsible Charge (DRC) ExperienceSystem(Required)Water DistributionWater TreatmentWastewater CollectionWastewater TreatmentSystem Classification(Required)IIIIIIIVDRC Start Date (Year/Month)(Required) Year Month Day To Present ?(Required) Yes No DRC End Date (Year/Month) Year Month Day Section F: Related Work Experience Previous to Present OccupationAdding water and or wastewater operation experience from a previous employer?(Required)Complete this section only if you are adding to water and or wastewater operation experience from a previous employer. Yes No Related Work Experience from Previous OccupationPrevious Supervisor's Name(Required) First Name Last Name Previous Supervisor’s Title(Required) Previous Supervisor’s Email(Required) Previous Job Title(Required)ForemanMaintenanceManagerOperatorSuperintendentSupervisorPrevious Employer(Required) Previous System(Required)Water DistributionWater TreatmentWastewater CollectionWastewater TreatmentStart Date:(Required) Year Month Day Finish Date:(Required) Year Month Day Water Distribution Work ExperienceHoursUnitsHours/DayHours/WeekHours/MonthDescription of Previous WD DutiesWastewater Collection Work ExperienceHoursUnitsHours/DayHours/WeekHours/MonthDescription of Previous WWC DutiesWater Treatment Work ExperienceHoursUnitsHours/DayHours/WeekHours/MonthDescription of Previous WT DutiesWastewater Treatment Work ExperienceHoursUnitsHours/DayHours/WeekHours/MonthDescription of Previous WWT Duties Section G: Education and TrainingIf not already on file, a copy of the High School Diploma or official transcript must be submitted. High School graduation means Grade 12 (Level III) from 1985 onward. To receive credit for Post Secondary courses, operators must submit a copy of the Degree, Diploma, Certificate etc., or transcript of marks for incomplete courses.Please Select Highest Level of Education(Required) High School College, Trades or Other Non-University University High School EducationName of High School Attended Grade CompletedDate Completed (Year/Month) Year Month Day GED or High School Equivalent? Yes No Post Secondary Education – College, Trades or Other Non UniversityName of College, Trades or Other Non University Program Attended Start Date (Year/Month) Year Month Day Date Completed (Year/Month) Year Month Day Certificate/Diploma Awarded? Yes No Journeyman’s Certificate? Yes No Would you like to add another – College, Trades or Other Non University? Yes No 2nd – College, Trades or Other Non-UniversityName of College, Trades or Other Non University Program Attended Start Date (Year/Month) Year Month Day Date Completed (Year/Month) Year Month Day Certificate/Diploma Awarded? Yes No Journeyman’s Certificate? Yes No Would you like to add another – College, Trades or Other Non University? Yes No 3rd – College, Trades or Other Non UniversityName of College, Trades or Other Non University Program Attended Start Date (Year/Month/Day) Year Month Day Date Completed (Year/Month) Year Month Day Certificate/Diploma Awarded? Yes No Journeyman’s Certificate? Yes No Post Secondary Education - UniversityName of University Degree Program Attended Start Date (Year/Month) Year Month Day Date Completed (Year/Month) Year Month Day Degree Awarded? Yes No If No, # of Credits:Would you like to add another University? Yes No 2nd - UniversityName of University Degree Program Attended Start Date (Year/Month) Year Month Day Date Completed (Year/Month) Year Month Day Degree Awarded? Yes No If No, # of Credits:Documentation of EducationSubmit documentation belowMaximum file size per form: 30 MB Drop files here or Select files Accepted file types: bmp, doc, docx, gif, heic, jpg, jpeg, pdf, png, tif, tiff Submitting false information may result in Certification Revocation and legal action by the Department of Environment, Conservation, and Climate Change.Acknowledgement of Application Submission I confirm that the employee has been informed of this application and is aware of the information being submitted.Privacy statement(Required) The personal information collected in this form will be used only for the administration of those programs provided by the Government of Newfoundland and Labrador for which the supplier is a participant. This information is being collected in accordance with section 61(c) of the Access to Information and Protection of Privacy Act, 2015 (ATIPPA, 2015). All information provided will be maintained in a secure manner and confidentiality will be protected, as required by the ATIPPA, 2015. For questions or comments related to the protection of your personal privacy, please e-mail Amanda Clarke, ATIPP Coordinator, at email amandaclarke@gov.nl.ca. For more information or questions about this form, please contact: Department of Environment, Conservation and Climate Change 4th Floor, Confederation Building-West Block, PO Box 8700, St. John's, NL, A1B 4J6 operatorcert@gov.nl.ca (709) 637-2035 I agree to the privacy statement.
