Pesticide Forms

Certification and Licensing Forms

2022 January thru June Registration CEU Classes

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
Application to Take License Exam
Application to Take Certification Exam
Candidate Information Bulletin to Take the Certification Exam
Application for UT Pesticide Testing
UT Order Form for Study Materials
Commercial Certification Applicator Information Sheet
Application for the Registration of Pesticides in Tennessee
Points Required to Maintain Certification
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
Application for Removal of Employee(s) from the Charter 2018


Pesticide Product Registration - For making general-use and restricted-use pesticide products available for sale in Tennessee. Contact: Heather Kirby - 615-837-5187 -

Pesticide Dealer Licensing - For selling restricted-use pesticide products in Tennessee. Contact: John Ewell - 615-837-5340

Pesticide Applicator Testing - For commercial certification testing. Contact: Kathy Booker - 615-837-5148 –

License Issuance - For establishing and maintaining the right to apply pesticides for a fee in Tennessee. Contact: John Ewell - 615-837-5340 -

Pesticide Issues - For pesticide enforcement, including consumer related complaints concerning a pesticide application. Contact: Jim Endsley - 615-837-5138 -

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 –

Aerial Issuance – For aerial requirements and issuance of decals. Contact John Ewell – 615-837-5340 –

Structural Issues – For structural issues pertaining to the application of termiticides. Contact Jerry Seabolt – 615-837-5178 –

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 –

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 /

For All Other Questions

For all other questions regarding the Pesticides or Pest Control program, contact Kathy Booker, Administrator - 615-837-5133