PI-232 (5/17)

Michigan Department of Agriculture and Rural Development

P.O. Box 30776, Lansing, MI 48909-8276 • 517-284-5653
In accordance with 1994 Public Act 451, Part 83

Pesticide Applicator Certification/Registration Application

Applicant (Applicator) Information (Please print)
Name:____________________________________________________________________
First, middle initial, last
Home Address:_____________________________________________________________
Include apartment number if applicable

City:__________________________________________________ State: ______________

County:________________________________________________ Zip:_______________
Phone: (_____)_______________ Cell Phone: (_____)______________________________
Email:_____________________________________________________________________
Date of Birth: ____/____/______ Social Security Number:_______-____-____________
MM DD YYYY
1a. Are you applying for reciprocity?: Yes What state __________________ No Blank Space
1b. Are you certified in, and a resident of, that state?: Yes No For Official Use Only

Employer Information
Employer Name: ____________________________________________________________________________________________

Street Address of Employer:____________________________________________________________________________________

City:______________________________________________ State: _______ County: _____________________Zip:_____________

Phone: (_____)_____________ Fax: (_____)_______________ Email:_________________________________________________

Exams/Categories (Please check all that apply for certification)

1A 1B 1C 1D 2 2A 3A 3B
Private Commercial Registered Field Vegetable Fruit Livestock Forest Wood Turfgrass Ornamental
Core Core Core Crops Crops Crops Pest Mgmt. Pest Mgmt. Preservation Pest Mgmt. Pest Mgmt.

4 5 5A 5B 5C 6 7A 7B 7D 7E 7F
Seed Aquatic Swimming Microbial Sewer Line Right-of-Way General Wood Vertebrate Interior Plant Mosquito
Treatment Pest Mgmt. Pools Pest Mgmt. Pest Mgmt. Pest Mgmt. Pest Mgmt. Destroying Pest Mgmt. Pest Mgmt. Mgmt.
Pest Mgmt.

Application Fees (Non-refundable) 7G

Domestic
8 9 10
Demo &
Public Health Regulatory Fumigation Aerial
Animal Research
Commercial Applicator $75 AOBJ: 0188 Pest Mgmt. Pest Mgmt. Pest Mgmt. Pest Mgmt.

Private Applicator $50 AOBJ: 0343

Application Fees Exemption for honorably discharged veterans of the Armed Forces of the United States (private
pesticide certified applicators only). A copy of your DD-214 must be submitted along with your application.
Commercial Registered Applicator $45 Private Registered Applicator $50 AOBJ: 0187
I am adding categories to my current certification. Certification Number:________________________
Application fee for adding categories is same as above.

By signing below I certify that the foregoing is true and accurate to the best of my knowledge and belief and that I will comply
with the provisions of 1994 Public Act 451, Part 83, as amended, and all regulations promulgated thereunder.

Payment Method: Check/Money Order No. _________________________________________ Amount enclosed: _____________

Please make check/money order payable to the State of Michigan (see instructions on back of form).

Signature:_________________________________________________ Date:___________________

Please print your name here:__________________________________________________________ Instructions on the

back of this form
This certification will NOT be issued without the above signature and date! www.michigan.gov/mdard-licensing
Pesticide Applicator Application Instructions
Be advised, it is a violation of the Natural Resources and Environmental Protection Act, 1994 Public Act 451, Part 83 to
purchase or apply restricted use pesticides, or, to apply pesticides for a commercial purpose or during a work assignment,
without a valid certification credential. Applicators not subject to the business license requirement and who use a general-
use pesticide directly from its original container (ready-to-use) are exempt from certification requirements.
Commercial and Registered Applicator - This certification is intended for use by individuals who apply a pesticide in the
course of their employment or other business activity. Commercial and registered applicators or firms that intend to apply
pesticides for hire must also obtain a Commercial Pesticide Applicator License.
Private Applicator - This certification is intended for use by individuals or their employees who apply or supervise the
application of restricted use pesticides for the purpose of producing any agricultural commodity on property:
A. Owned or rented by an individual or his/her employer, or
B. On property of another for no compensation other than trading of personal services between producers.

To Qualify For Certification/Registration Credential

1. Must be 18 years of age or older.
2. Submit appropriate fee and a completed application.
3. Commercial applicators must pass the commercial core exam and a minimum of one category exam in the
applicant’s area of pesticide application. If the applicator applies for more than one category, all exams must be
passed before a credential will be issued. An additional standard is required for individuals who intend to use fumigant
pesticides or apply pesticides by aircraft.
Registered applicators must pass the commercial core exam, and complete a Michigan Department of Agriculture
and Rural Development (MDARD) approved training program coordinated by an MDARD approved trainer. The
training program must be verifiable and category-specific. A Registered Applicator Verifiable Training form must be
completed and returned to MDARD.
Private applicators must pass the private core exam. An additional exam is required for individuals who intend to use
fumigant pesticides or apply pesticides by aircraft.
4. All exams must be passed with a score of 70% or better before a credential will be issued.
5. Applicants who fail their exam(s) may schedule to retake the exam(s) without an additional application fee within six
months after the initial application date. (Note: Computer-based exams have an additional fee per test).

Instructions for Completing the Application

1. Type or print in pen.
2. You must complete all the requested information on the application form.
3. Check yes if you are applying for reciprocity by another state. Indicate which state and if you are certified and a
resident there. Reciprocity is only available for residents of Indiana, Minnesota, Ohio, and Wisconsin.
4. Check type of applicator certification/registration required.
5. Check if you are adding category(ies) to your current credential.
6. Check the category(ies) in which you are seeking certification/registration.
7. Check aerial or fumigation standards if you intend to apply pesticides by aircraft or use fumigant pesticides.
8. Sign and date the application form.
9. Schedule online at www.michigan.gov/pestexam or call 1-800-292-3939 for paper-based exams. Schedule online at
www.metrosignup.com for computer-based exams. (Note: Computer-based exams have an additional fee per test).
10. Take this application with a check or money order payable to the “State of Michigan” in the appropriate amount to a
paper-based exam site. Credit cards and cash are not accepted. If you are testing exclusively at computer-based
exam sites, mail the application and fee to the address at the top of the application. The application fee is non-
refundable.
11. You must pass all the exams for the pesticide applicator categories you designate on your application within six
months after the initial application date.
A certification/registration card will be issued within six weeks to each person who completes the requirements for
certification/registration. The applicator must have the card in his/her possession when purchasing restricted use
pesticides or applying any pesticides. The fee for a replacement credential is $10.00.
An applicator’s credential expires December 31 of every third year. Individuals will receive a renewal application
and information approximately three months prior to the expiration of their credential. Renewal may be obtained by
accumulation of seminar credits or by taking renewal examination(s). More information about renewing and certification
may be found on our website at www.michigan.gov/mdardpestcert.