State of California
Qualified Applicator License Application Instructions
LIC-001 (Rev. 07/23) Page 2 of 2
Failure to complete or provide the requested information may delay the processing of your application.
DPR will only disclose personally identifiable information, such as home phone number and personal email address,
to third parties as required by state or federal law or regulation and consistent with the Information Practices Act
(Civ. Code, sections 1798-1798.78).
A. Application Type: Check the appropriate box(es).
New
Application: If you:
Are applying for a Qualified Applicator License for the first time. *
Failed to obtai
n your license within 12 months from the first date you scheduled your examination.
Failed to meet the renewal requirements.
*Applications for a new license shall include
an attached copy of valid government-issued documentation verifying that the
applicant will meet the required minimum age of 18 years old prior to admission to the examination. The applicant’s name
included on the submitted application shall match the name stated on the valid government-issued documentation submitted.
Reexamination: Schedul
ing an examination on which you failed to obtain a passing score or failed to appear for a
previously scheduled examination.
Add Pest Control Category(ies): Requesting to take pest control category examinations not yet taken. If passed, the
category(i
es) will be added to your existing license.
B. Applicant Information: Enter your name (name shall match the submitted valid government-issued documentation); Qualified
Applicator License or Application Number (if applicable); date of birth; mailing address; E-Mail address; cell or
home and work
phone numbers; employment type; and current employer (if applicable).
C. Examination – Laws, Regulations, and Basic Principles:
This examination is required of all new QAL applicants. Exemption:
(Check the appropriate box, if appl
icable). No fee or examination is required if you: have a current Pest Control Adviser License
(PCA), Journeyman Pilot Certificate (JPC), Apprentice Pilot Certificate (APC), or Qualified Applicator License (QAL). To qualify for
this exemption, you must
enter the number from your current license or certificate next to the (1) exemption, or (2) have passed
the Laws, Regulations, and Basic Principles
exam within the past 12 months. A Qualified Applicator Certificate (QAC) does not
meet the exemption requirements.
D. Examination – Categories: Indicate the category(ies) y
ou want to take by checking the appropriate box(es). In addition to the
Laws, Regulations, and Basic Principles examination, each new applicant must successfully pass at least one of the pest control
categories (A-M) before a Qualified Applicator
License is issued. You may only select a maximum of four examinations per
application, including the Laws, Regulations, and B
asic Principles examination. You may only apply once per month
, exceptions
to this are evaluated on a case by case basis. See Qualified Applicator License category descriptions and suggested study
material source list in the Qualified
Applicator License Application Packet.
E. Examination Schedule: Provide your first
and second choice for taking your exam(s). Indicate the exam month and location for
each choice in the appropriate boxes. Your exam date and location choices are not guaranteed. Go to DPR’s Web site to find
current exam information. If you selected an exam date, your application must be postmarked by the final filing date for the
earliest choice you provided. DPR will
assign your exam date.
F. Reasonable Accommodation: Reasonable accommodation will be provided to
applicants who need assistance to take an
exam. If you check “Yes”,
you will be contacted.
G. Fees: All fees are non-transferable and non-refundable.
New Application Fee: $80………………………………………………….(See Section A)
Laws, Regulations, and Basic Principles Examination Fee: $50………..(See Section C)
Category Examination Fee(s): $50
per exam …………………………………..(See Section D)
H. Read Before Signing: Check appropriate box and provide explanation on separate page, if necessary.
I. Declaration/Signature Block: Sign here to indicate that all of the information submitted is true and correct.
Mailing Instructions: Enclose a check, money order, or credit card information payable to “Cashier, DPR” and mail to:
Department of Pesticide Regulation
Attn: Cashier MS-4A
PO Box 4015
Sacramento, CA 95812-4015