I. IMPORTANT TESTING INFORMATION FOR APPLICANTS (Applicants are responsible for knowing the testing policies and procedures. Read and fill out this entire form to avoid a delay in your application.) 1. Please send photocopies of all supporting documents for your testing eligibility to complete your application. Incomplete material

will result in a delay for approval or denial to sit for the exam. (We will not transfer information from old certification applications.) 2. Applicants that are not approved will receive a refund of the application fee minus a $40 administrative fee within 2 weeks of

receiving notification. 3. Applications must be typed or printed neatly in ink. Illegible applications will be returned. 4. Non-Member rate includes one year CWEA membership. If you do not wish to take advantage of the membership, please note

on application. 5. Candidates must meet minimum experience and education requirements at the time that they apply. Applications will not be approved if the candidate does not meet the eligibility requirements. 6. Under no circumstances are candidates allowed to sit for the same exam twice in the same window. Candidates that do not pass

must skip a window before they are eligible to re-test.

II. TECHNICAL CERTIFICATION APPLICATION INFORMATION

VOCATION GRADE LEVEL 1 2 3 4

Member Discounted Rate (for current members only) $165 $180 $195 $210 Non-Member Rate $345 $360 $375 $390

Check test applying for (check only one): Biosolid Land Application Management Collection System Maintenance Environmental Compliance (Industrial Waste) Inspector Laboratory Analyst Operator, Industrial Waste Treatment Plant Mechanical Technologist Electrical/Instrumentation

LAST NAME __________________________________________________________________________________ FIRST NAME ___________________________________________________ MIDDLE INITIAL ________________ (Your name must exactly match your government issued ID to be admitted to testing center) E-MAIL (required):______________________________________________________________________________ (All notifications will be emailed to you) EMPLOYER______________________________________ JOB TITLE_______________________________________ MAILING ADDRESS________________________________________________________________________________ (Street) (Apt/Ste) ______________________________________________________________________________ (City) (State) (Zip) WORK PHONE (_____)__________________________ HOME/CELL PHONE (______)_________________________

Application for Technical Certification CALIFORNIA WATER ENVIRONMENT ASSOCIATION 7677 Oakport Street, Suite 600 Oakland, CA 94621 (510) 382-7800 (510) 382-7810 fax www.cwea.org

Test window (check only one): Test dates in which you will take your test: Application deadline (postmark):

2017 Fall October 1 through December 31 August 31 2018 Winter January 1 through March 31 November 30 2018 Spring April 1 through June 30 February 28 2018 Summer July 1 through September 30 May 31

CWEA USE ONLY

Received___/___/___ By: _______________ Primary Review: Reviewer:____________ Approved: YES NO Date: _______________ SME: Reviewer:___________ Approved: YES NO Date:________________ Application Appeal: Reviewer:____________ Approved: YES NO Date:________________

Name of Applicant:_______________________________ III. EDUCATION AND TRAINING College Graduate? YES NO Degree:________________________ Major:________________________

Date Granted:_________________ Name and Location of School:_____________________________________

ATTACH COPIES OF COLLEGE TRANSCRIPTS OR CERTIFICATES OF COMPLETION AS PROOF OF EDUCATIONAL CREDITS IF APPLYING FOR A GRADE 2 AND ABOVE.

IV. QUALIFYING EXPERIENCE HISTORY – (Complete if you are applying for a Grade 2 and above) Describe detailed work experience related to the vocation for which you are applying. Please attach additional documents with your application. Be sure to adequately describe your job duties to avoid rejection. We do NOT have access to old certification applications.

A. CURRENT EMPLOYER:____________________________________________Phone:__________________

(include area code)

Job Title:_________________________ Date Started: ____________________Date Left:______________ Job Duties (provide detailed description to avoid being rejected):________________________________

_______________________________________________________________________________________ _______________________________________________________________________________________

What portion of your time did these duties take?______________% Total Years:_____________________

EMPLOYER VERIFICATION: I certify that the information stated above is true and correct to the best of my knowledge.

_______________________________________________________________________________________ (Employer/Supervisor’s Name--Please Print) (Title) (Date)

Supervisor’s Signature: __________________________ Supervisor’s Email: ___________________ (Required for grade level 2-4)

B. PREVIOUS EMPLOYER:______________________________________Phone:________________________ (include area code)

Job Title:__________________________ Date Started: ____________________Date Left:_______________

Supervisor’s Name:__________________________________ Supervisor’s Phone Number:_______________

Job Duties (please provide detailed description): ________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________

What portion of your time did these duties take?______________% Total Years:_____________________ C. NEXT PREVIOUS EMPLOYER:______________________________________Phone:__________________ (include area code)

Job Title:__________________________ Date Started: ____________________Date Left:_______________

Job Duties (please provide detailed description): ________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

What portion of your time did these duties take?______________% Total Years:______________________

Name of Applicant:_______________________________

D. Total Qualifying Years of Experience:_______________________ E. Do you currently have valid CWEA certification in this vocation? YES NO If yes, give grade level and estimated years held:____________________________________

V. REASONABLE ACCOMMODATIONS FOR THOSE WITH DISABILITIES Do you have a physical or psychological disability that may affect your ability to successfully complete the exam? YES NO If yes, please state the nature of your disability:__________________________________________________________ Reasonable accommodations will be provided for those individuals who provide CWEA with a physician’s certificate, or the equivalent. Please attach documentations with this application. VI. CODE OF ETHICS

All California Water Environment Association certificate holders and applicants are expected to meet the following standards of professional conduct and ethics:

1. To protect public health, themselves, their co-workers, property, and the environment by performing the Essential Duties of the CWEA certified vocation safely and effectively, and complying with all applicable federal, state and local regulations.

2. To represent themselves truthfully and honestly throughout the entire certification process. 3. To adhere to all test site rules and make no attempt to complete the test dishonestly or to assist any other person in doing so. 4. To refrain from activities that may jeopardize the integrity of the Technical Certification Program. VII. NON-DISCRIMINATION

It is the policy of CWEA that it shall not discriminate among applicants on the basis of age, gender, race, religion, national origin, disability, sexual orientation or marital status VIII. SIGNATURE OF APPLICANT I, the undersigned, certify that I am the above named applicant; that all statements made and information contained in the above application are true and correct to the best of my knowledge and belief; that I understand that any omissions or misrepresentations may result in ineligibility of the examination being applied for or revocation of any certificate granted. I have read and understand the CWEA Technical Certification Program Code of Ethics. I also consent to a thorough investigation of my employment records and other qualifications in related activities for the purpose of verification of my qualifications for the certificate for which I have applied. I understand that the exam to which I applied is confidential and protected by law. I am prohibited by law from disclosing, publishing, reproducing or transmitting the exam content in any form, verbal, written or electronic. I have read and understand the CWEA Technical Certification Program Policy Description attached with this application.

DATE: ___________________________ Signature of Applicant:___________________________________________

SEND YOUR COMPLETED APPLICATION, ALONG WITH THE APPROPRIATE FEE, DIRECTLY TO:

CWEA TCP 7677 Oakport St., STE 600 Oakland, CA 94621-1944

Email applications to: MemberServices@CWEA.org

Fax to: 510-382-7810

Make checks payable to: CWEA Checks must be included with application and mailed to the address listed above.

Technical Certification Program Qualifying Combinations

Credit Card Information: Choose one: Mastercard American Express Visa Discover Card Number: _______________________________________ Exp. Date _____/_____ Total Amount Authorized to Charge: $__________ Card Holder Signature: _______________________________________ Print Name: _______________________________ Type: Agency Personal

Certification Applicant Experience and Education Qualifying Combinations This table shows you combinations of experience and education that qualify for each grade level. Qualifying experience and education

is usually in the same field as your certification and reflects the Knowledge Skills and Abilities (KSAs) for that certification. For more info on the KSAs see the KSA Gap Tool or the appropriate CWEA Study Guide on myCWEA.org.

GRADE 1

Qualifying Combination

EDUCATION/CERTIFICATIONS

EXPERIENCE

NONE REQUIRED TO TAKE TEST

NONE REQUIRED TO TAKE TEST

GRADE 2

Qualifying Combination

EDUCATION/CERTIFICATIONS

EXPERIENCE

A

NONE

4 full-time years in vocation

B

Hold Grade 1 certificate in vocation for 1 year 2 full-time years in vocation

C Associate’s, or higher, degree in a related field 2 full-time years in vocation

D Bachelor’s, or higher, degree in a related field 1 full-time year in vocation

GRADE 3

Qualifying Combination

EDUCATION/CERTIFICATIONS

EXPERIENCE

A

NONE

6 full-time years in vocation

B Hold Grade 2 certificate in vocation for 2 years 4 full-time years in vocation

C Associate’s, or higher, degree in a related field 4 full-time years in vocation

D Bachelor’s, or higher, degree in a related field 3 full-time years in vocation

GRADE 4

Qualifying Combination

EDUCATION/CERTIFICATIONS

EXPERIENCE

A

NONE

8 full-time years in vocation with 1 year supervising others

B Hold Grade 3 certificate in vocation for 2 years 6 full-time years in vocation with 1 year supervising others

C Associate’s, or higher, degree in a related field 6 full-time years in vocation with 1 year supervising others

D Bachelor’s, or higher, degree in a related field 5 full-time years in vocation with 1 year supervising others

CWEA Certification Policies

CWEA Certification Policies

Exam Windows Exams are given in quarterly windows. The deadline to apply for each window is one month before the window begins (see table below). You can change your test window to a future test window if the future window is within a year of your original test window. For example, you can change a test originally in a spring window to any window up to the following winter window. Only two transfers are allowed. There is no fee to transfer once, but the second transfer is subject to a fee of $40. If you do not take your exam in your original window, your exam will be transferred to the next window and you will be notified about 2 weeks after the new window begins. If you do not take your exam and have already transferred once, your exam will not automatically be transferred to the next window.

Exam Windows

Window Date Range

Application Deadlines

Fall October 1 through December 31 August 31

Winter January 1 through March 31 November 30

Spring April 1 through June 30 February 28

Summer July 1 through September 30 May 31

Scheduling an Exam Appointment Date Once your application has been approved, you will be emailed instructions on scheduling your exam with our testing partner Pearson VUE. You need to schedule your exam within the approved testing window. If you need to change a scheduled exam date with Pearson VUE, contact Pearson VUE directly at least 24 hours before your scheduled appointment to change your test appointment. Be sure to contact Pearson VUE at least 24 hours before your scheduled appointment to make changes, otherwise you will be charged $75 to reactivate your application. Please contact CWEA if you miss your scheduled exam date and we will help you reactivate your application. Pearson VUE cannot reactivate your application if you miss your exam date.

Exam Site Admission—Bring Your ID

You will be required to show a valid government issued photo identification (State driver’s license, ID, or

passport) at the test center. You do not need to bring your eligibility letter to the test site. No other personal

belongings are allowed in the testing room. The exam center might have lockers for your personal

belongings. However, it’s best to not bring anything valuable to the exam center, just in case.

Calculators Allowed at the Exam Site

An onscreen calculator (basic and scientific) is available in all CWEA tests. Candidates may bring one of the

following pre‐approved handheld calculators:

Casio: All fx‐115 models; any Casio calculator with fx‐115 in its model is allowed.

Texas Instruments: All TI‐30x and TI‐36x models are allowed.

Sharp: EL models except EL‐W516B and EL‐W535B are allowed.

Retesting Hopefully, you will pass your exam on the first try. If not, you can submit a Retest Application along with the appropriate fees. You’ll need to skip at least one testing window before retesting. To be eligible to use the

CWEA Certification Policies

Retest Application form you must schedule the new test within the same year as the original test. If you will retest more than a year after your original test date, you will need to fill out the regular test application form.

Cancelling Your Certification Application You can cancel your application at any time before you take your exam. However, if your application has already been approved, we will refund your application fees less an administrative fee. You can cancel your application within a year of your original test window. Please cancel exam appointment with Pearson VUE before contacting CWEA to cancel application. If you do not cancel your appointment, you will be charged a $75 No Show fee.

Appealing Your Exam Results

All appeals must be submitted within two weeks, of your test date. Appeals will be reviewed by CWEA staff and/or

subject matter experts and candidates will be kept up to date as to the status of their appeal. Once an appeal has

been processed, candidates cannot submit a new appeal for the same test. You may appeal under the following

justifications (you cannot appeal a test simply because you did not pass the exam)

Test Delivery Appeal:

To appeal conditions at the test center, such as test site issues, test administration issues or computer problems

simply fill out and submit an appeal form. CWEA staff will review your appeal and consult our test administrator,

Pearson VUE, to investigate your appeal if necessary.

Test Question Appeal:

If you wish to appeal specific test questions, you may flag the question during your test using the Flag to Enter a

Comment function. You are allowed to add comments about any question as long as you have time remaining. All

comments are reviewed for feedback, but you must submit an appeal form within two weeks in order for your

comments to be considered for an appeal of your exam results. Non-substantive appeals or appeals without just

cause will be automatically rejected. If you are not satisfied with the outcome of your appeal, you may request a

review by the Technical Certification Committee. Their decision will be final.

The appeal form can be accessed on our website at www.cwea.org

Getting Your Exam Results Immediately after your test, you will see your score on the screen. An Unofficial Score Report is provided before you leave the test site (don’t leave without it). If you need a copy call Pearson VUE at 888‐749‐3881. About 2 to 3 weeks later your should receive your Official test results from CWEA by email (make sure you give us a good email address). If you pass, we’ll mail your new certificate to you!

Renewal and Recertification All certificates must be renewed annually to be valid. The first renewal is due one year on the last day of the month in which the certification was earned. Certificate renewals more than one month past due are subject to a late fee. Re‐testing is required to reinstate certificates more than two years past due. Renewal notices are mailed to certificate holders two months before the due date. It is the responsibility of the certificate holder to ensure it remains valid. In addition to annual renewal, certificate holders must provide evidence of 12 contact hours of continuing education every two years. For more information visit cwea.org/cert.

Your Privacy We’re serious about protecting your privacy. To do so, we keep all results confidential and only release results and any other information regarding your application to you, the certificate candidate. Results are not given over the phone, or by fax. Once you’re certified, your basic certificate information will be available on our Certification Registry on myCWEA.org.

CWEA Certification Policies

Americans with Disabilities Act In compliance with the Americans with Disabilities Act, reasonable accommodations will be provided for those individuals who provide CWEA with a physician’s certificate (or its equivalent) documenting a physical or psychological disability that may affect the individual’s ability to successfully complete the certification examination. Written requests for reasonable accommodations must be submitted with the test application.

Don’t Pay Unnecessary Fees! Be sure to manage your scheduled exam date carefully to avoid paying reactivation fees. The following will result in a $75 application reactivation fee:

Failing to appear at your scheduled test appointment; Arriving at the testing site without a current, government‐issued photo ID; Arriving at the testing site 15 minutes or more after your scheduled test appointment.

If you missed your test appointment, arrived 15 minutes late, or did not have proper identification, you will

need to pay the application reactivation fee before being allowed to reschedule your appointment. If that does

happen, get your application reactivated by contacting us at 510‐382‐7800 option 4, or

MemberServices@cwea.org.

CWEA Certification Policies

Professional Examination Rules ˆ No personal items, including cellular phones, hand-held computers/personal digital assistants (PDAs) or other electronic

devices, pagers, watches, wallets, purses, hats (and other head coverings), bags, coats, books and notes are allowed in the

testing room. You must store all personal items in a locker. Cell phones, pagers or other electronic devices must be turned

off

before storing them in a locker. The test center is not responsible for lost, stolen or misplaced personal items.

ˆ Before you enter the testing room, the test administrator will provide you with an erasable noteboard, a marker and any other

items specified by the exam sponsor. You may not remove these items from the testing room at any time during the exam,

and you must return them to the test administrator after the exam.

ˆ You may not write on the erasable noteboard until after the exam has been started. If you fill your noteboard during the exam,

raise your hand and the administrator will bring you a new one.

ˆ The administrator will log you in to your assigned workstation, verify that you are taking the intended exam and start the

exam. Please remain in your assigned seat until escorted out by a Test Administrator. Eating, drinking, chewing

gum, smoking and making noise that creates a disturbance for other candidates are prohibited during the exam.

ˆ You understand that a Non-Disclosure Agreement may be presented to you before the exam and if so, you must agree to its

terms and conditions within the specified time limit in order to take the exam or else you will forfeit your exam fees.

ˆ To ensure a high level of security throughout your testing experience, you will be monitored at all times. Both audio and

video will be recorded.

ˆ Break policies are established by the exam sponsor. Some exams may include scheduled breaks, and instructions will appear

on the computer screen at the appropriate time; whether or not the exam timer stops depends on the sponsor’s policy. If

you take an unscheduled break at any other time, the exam timer will not be stopped. The administrator will set your

workstation

to the break mode, and you will take your ID with you when you leave the room. The administrator will check your ID before you return to your seat and will then restart your exam.

ˆ While you are taking a scheduled break, you are permitted to access personal items that you stored during the exam. While you

are taking an unscheduled break, you are NOT allowed access to personal items other than medication or food required at a

specific time and with the approval of the test administrator. Items not permitted include but are not limited to: cellular phones,

exam notes and study guides, unless specifically permitted by the exam sponsor.

ˆ You must leave the testing room for all breaks. You will either be fingerprinted or have your palm vein pattern captured

when you leave the testing room and again before you re-enter the testing room. The administrator will restart the exam

for you when you return.

ˆ While you are taking a break, you are permitted to access personal items that you stored during the exam only if

necessary—for example, if you need to take medication at a specific time. You are NOT allowed access to other

items, including cellular phones, exam notes and study guides, unless the exam sponsor specifically permits this.

ˆ If you experience hardware or software problems or distractions that affect your ability to take the exam, notify the

administrator immediately by raising your hand. If you have other questions or concerns, raise your hand and the

administrator will assist you as long as other candidates are not disturbed. The administrator cannot answer questions

related to exam content.

ˆ After you finish the exam, you may be asked to complete an optional, onscreen evaluation. After completing the exam or the

evaluation, raise your hand. The administrator will come to your workstation and ensure your exam has ended properly.

The exam sponsor may display a score on the screen after the exam or may provide a printed score report or a

confirmation that you completed the exam. If printed information is provided, you will receive it after returning the

erasable noteboard and other materials to the administrator. Do not leave these items at your testing workstation. You

will be either fingerprinted or have your palm vein pattern captured when you leave the testing room.

ˆ You may not remove copies of exam questions and answers from the testing center and may not share or discuss the questions

or answers seen in your exam with other candidates.

ˆ If you do not follow the above rules, if you tamper with the computer or if you are suspected of cheating, appropriate action

will be taken. This may include invalidation of your exam results.

Your privacy - Your exam results will be encrypted and transmitted to Pearson VUE and the exam sponsor. The test

center does not retain any information other than when and where your exam was taken. The Pearson VUE Privacy Policy

Statement provides additional information regarding this which you can obtain by visiting the Pearson VUE Web site

(www.pearsonvue.com) or by contacting a Pearson VUE Call Center.

Candidate Statement: By providing a digital signature, I give Pearson VUE my explicit consent to retain and transmit

my personal data and test responses to Pearson VUE and to the exam sponsor (either of which may be outside of the

CWEA Certification Policies

country in which I am testing). I understand the information provided above and agree to follow the Rules. If I do not

follow the Rules or I am suspected of cheating or tampering with the computer, this will be reported to Pearson VUE and

the exam sponsor, my exam may be invalidated, the sponsor may take other action such as decertifying me, and I will not

be refunded my exam fee.

Professional Examination Rules