Pesticide Forms

Certificate of Surety Bond for WDO, General Pest and Rodent, Bird, and Fumigation Structural
Certificate of Surety Bond for all other categories
Application: Pest Control Applicator License and Charter (companies a-k)
Application: Pest Control Applicator License and Charter (companies l-z)
Application to Take License Exam
Application to Take Certification Exam
Application for Commercial Recertification Exam
UT Order Form for Study Materials
Commercial Certification Applicator Information Sheet
Points Required to Maintain Certification
Application for the Registration of Pesticides in Tennessee
How to Complete the Product Registration Application
Application for Duplicate or Replacement Certification Card
Application for Reciprocity in the State of Tennessee
Pesticide Investigation Request Form and its separate Instruction Sheet
Application for Restricted Use Pesticide Dealer License
Application for Aerial Applicator License
Aerial Applicator Verification Form
How to Obtain an Aerial Applicator License and Aircraft Decal
Application For Points
Roster Form
Apprentice Termite Technician School Registration Form - March
Apprentice Termite Technician School Registration Form - June
Apprentice Termite Technician School Registration Form - September

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: Gerry Mires - 615-837-5232 - gerry.mires@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. Contact: Mary Borthick - 615-837-5310 - Mary.Borthick@TN.gov

Aerial Issuance – For aerial requirements and issuance of decals. Contact Robert Lawton – 615-837-5148 – robert.lawton@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 Rich Strickland 615-837-5523 or richard.strickland@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: Jacquetta Bryant - 615-837-5131 - jacquetta.bryant@TN.gov

For all other questions regarding the Pesticides or Pest Control program, contact Kathy Booker, Administrator - 615-837-5133 - kathy.booker@TN.gov.