COUNTY COMPLETE REVERSE SIDE IMPORTANT NOTICE This / ILLINOIS DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH / Forms Management Center / Authority of the State / Illinois Department of Public Health / GED CERTIFICATE Year NAME & ADDRESS OF SCHOOL / /
Position
technician / STRUCTURAL PEST CONTROL TECHNICIAN / certified technician / /
ILLINOIS DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH 525 W. JEFFERSON ST. SPRINGFIELD, IL[removed]APPLICATION FOR CERTIFICATION AS A STRUCTURAL PEST CONTROL TECHNICIAN GENERAL USE PESTICIDES