Florida Application Pest Control Details

If you are in the market for a new home, you will likely need to fill out the Fdacs 13606 form. This form is used to determine whether or not you are eligible for a mortgage. In order to complete the form, you will need to provide information about your income and assets. Completing the form accurately is important, as it will help you get the best possible interest rate on your mortgage.

This page includes information regarding fdacs 13606 form. It might be beneficial to know its length, the typical time to complete the form, the fields you should fill in, and so forth.

QuestionAnswer
Form NameFdacs 13606 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesfdacs form pdf, fdacs 13606, pest control card, fdacs form search

Form Preview Example

Florida Department of Agriculture and Consumer Services Division of Agricultural Environmental Services

APPLICATION FOR PEST CONTROL

EMPLOYEE-IDENTIFICATION CARD

ADAM H. PUTNAM

Rule 5E-14.142, F.A.C.

COMMISSIONER

Telephone: (850) 617-7997

Remit Fee Online at: www.FreshFromFlorida.com

- or -

Check or Money Order Payable to

FDACS:

Bureau of Licensing and Enforcement

Revenue Processing Section

407 S. Calhoun Street, Room 121

Tallahassee, FL 32399-0800

OFFICE USE ONLY – DO NOT FILL IN

JE# -_____________ JB# - ____________________ Issue Date:

 

 

IMPORTANT DIRECTIONS -- INCOMPLETE APPLICATIONS WILL BE RETURNED --

This application must be legible and completely filled out. Copy this form as needed, but you must submit original signatures and the following:

(1)A CURRENT, clearly recognizable, full-faced head and shoulders photograph.

(2)A check or money order in the amount of $10.00 for each ID card made payable to “DACS”.

(3)A “Special Training to Perform Wood-Destroying Organism Inspections” affidavit (Form DACS-13642) MUST ACCOMPANY this application for applicants trained to perform Wood-Destroying Organism inspections and/or provide termite treatment(s) or re-inspection(s) for contractual purposes.

(4)A NEW applicant must submit his/her date of birth and a 4 digit Personal Identification Number (PIN) of His/Her choice. This combination creates a unique identifier for each person that cannot be changed. THE APPLICANT IS RESPONSIBLE FOR REMEMBERING HIS/HER PIN NUMBER.

_____ ID card application submitted AT THE TIME OF business license issuance 002241 ($10)

_____ ID card application submitted with a BUSINESS LICENSE CHANGE 001371 ($10)

(Change of Address, Change of Name or Change of Owner)

ATTACH RECENT 1 1/2 x 1 1/2 INCH CLEAR, FULL-FACE PHOTO HERE EVEN IF ALREADY ON FILE

DO NOT STAPLE

_____ ID card application submitted DURING the valid business license period 002251 ($10)

Please issue a Pest Control Identification Card to the employee-applicant named below in accordance with Chapter 482.091, F.S., and Rule 5E-14, F.A.C.

Per Chapter 482.091(1)(b), F.S., the licensee and the certified operator in charge are jointly responsible for obtaining an identification card for employees within 30 days of employment. The postmark date of this application will be used to document and verify the employee’s work experience

for exam purposes.

1.NAME OF BUSINESS: ___________________________________________________________________JB Number: _____________________

BUSINESS LOCATION: ________________________________________________________________________________________________

(Street)

(City)

(Zip code)

2.COMPLETE NAME OF EMPLOYEE: _______________________________________________________________________________________

--Please print or type--

(Last)

(First)

(Middle)

HOME ADDRESS: ____________________________________________________________________________________________________

(Street)

(City)

(Zip code)

DATE OF BIRTH: month _____________

day ___________ year ____________ 4 digit PIN #: ________________________________________

 

 

 

(Reference Memorandum #823 for explanation)

This applicant began performing pest control services for this licensee on (DATE:) ___________________________________________

The primary pest control duties assigned to this employee are: __________________________________________________________

3.CHECK AND SIGN ONE STATEMENT ONLY:

(A)I am not currently employed at any other pest control licensee in Florida. If previously employed by a Florida licensee, please provide the

TERMINATION DATE: month _______ day ______ year _____ and your JE number: ____________________________________

(B)I am not currently employed at any other Florida pest control licensee and I will be a full time employee of the licensee performing the duties of the certified operator in charge of:

[circle all that apply]

F

G

L

T

EFFECTIVE DATE: ________________________ CPO home/cell phone #: ______________________

(C)I am a certified operator currently employed at _________________________________________________________________

applying for a SECOND ID CARD for exam experience in [circle the appropriate category] F G L T

Original Signature of Applicant for ID card: _______________________________________________________ Date: ____________________

4.I DO HEREBY CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF. I ALSO CERTIFY THAT THE APPLICANT HAS RECEIVED AT LEAST 5 DAYS OF FIELD TRAINING UNDER THE DIRECT SUPERVISION OF A CERTIFIED OPERATOR AS REQUIRED BY SECTION 482.091(3), F.S.

______________________________________________________ JB/JF Number: _______________

Original Signature of Licensee or Certified Operator in Charge

_____________________________________________

___________________________________________________

(Please print Name)

(Date)

(Contact Phone number)

FDACS-13606 Rev. 07/14

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Florida Department of Agriculture and Consumer Services

Division of Agricultural Environmental Services

 

APPLICATION FOR PEST CONTROL

 

EMPLOYEE-IDENTIFICATION CARD

ADAM H. PUTNAM

Rule 5E-14.142, F.A.C.

COMMISSIONER

Telephone: (850) 617-7997

Remit Fee Online at: www.FreshFromFlorida.com

- or -

Check or Money Order Payable to

FDACS:

Bureau of Licensing and Enforcement

Revenue Processing Section

407 S. Calhoun Street, Room 121

Tallahassee, FL 32399-0800

NAME OF BUSINESS: ___________________________________________________________________JB Number: ___________________

COMPLETE NAME OF EMPLOYEE: _______________________________________________________________________________________

(Last)

(First)

(Middle)

This page must be included with application submittal.

Org. Code: 42 13 08 02 060

 

 

EO B7

 

 

Object Code: 002251

$

10.00

002241

$

10.00

001371

$

10.00

FDACS-13606 Rev. 07/14

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