Pesticide Forms
Certification and Licensing Forms
2022 January thru June Registration CEU Classes
1. Certificate of Surety Bond for WDO, General Pest and Rodent, Bird, and Fumigation Structural
2. Certificate of Surety Bond for all other categories
3. Application: Pest Control Applicator License and Charter
4. Application to Take License Exam
5. Application to Take Certification Exam
6. Candidate Information Bulletin to Take the Certification Exam
7. Application for UT Pesticide Testing
8. UT Order Form for Study Materials
9. Commercial Certification Applicator Information Sheet
10. Application for the Registration of Pesticides in Tennessee
11. Points Required to Maintain Certification
12. How to Complete the Product Registration Application
13. Application for Duplicate or Replacement Certification Card
14. Application for Reciprocity in the State of Tennessee
15. Pesticide Investigation Request Form and its separate Instruction Sheet
16. Application for Restricted Use Pesticide Dealer License
17. Application for Aerial Applicator License
18. Aerial Applicator Verification Form
19. How to Obtain an Aerial Applicator License and Aircraft Decal
20. Application For Points
21. Roster Form
22. Apprentice Termite Technician School Registration Form - March
23. Apprentice Termite Technician School Registration Form - June
24. Apprentice Termite Technician School Registration Form - September
25. Application for Removal of Employee(s) from the Charter 2018
Contacts
Pesticide Product Registration - For making general-use and restricted-use pesticide products available for sale in Tennessee. Contact: Heather Kirby - 615-837-5187 - heather.kirby@TN.gov
Pesticide Dealer Licensing - For selling restricted-use pesticide products in Tennessee. Contact: John Ewell - 615-837-5340 -john.ewell@TN.gov
Pesticide Applicator Testing - For commercial certification testing. Contact: Kathy Booker - 615-837-5148 – kathy.booker@tn.gov
License Issuance - For establishing and maintaining the right to apply pesticides for a fee in Tennessee. Contact: John Ewell - 615-837-5340 - john.ewell@TN.gov
Pesticide Issues - For pesticide enforcement, including consumer related complaints concerning a pesticide application. Contact: Jim Endsley - 615-837-5138 - jim.endsley@TN.gov
Certification and Licensing - For use of any general-use and restricted-use pesticides as either a private or commercial applicator, schools approved for points, license exams. Kathy Booker - 615-837-5148 – kathy.booker@tn.gov
Aerial Issuance – For aerial requirements and issuance of decals. Contact John Ewell – 615-837-5340 – John.Ewell@tn.gov
Structural Issues – For structural issues pertaining to the application of termiticides. Contact Jerry Seabolt – 615-837-5178 – jerry.seabolt@tn.gov
EPA Programs and Pesticide Disposal - For Endangered Species, Groundwater, Pesticide Disposal and Worker Protection including the requirements to train agricultural employees and pesticide handlers. Contact Jim Endsley – 615-837-5138 – jim.endsley@tn.gov
Worker Protection Training Verification Cards - For verification of training or to obtain Worker Protection training verification cards to show that training has occurred. Contact: Wilnetia Williams / 615-837-5188 / wilnetia.willimas@tn.gov
For All Other Questions
For all other questions regarding the Pesticides or Pest Control program, contact Kathy Booker, Administrator - 615-837-5133 -kathy.booker@TN.gov.