Compliance

2021 Virtual Basic Pesticide and Use Concerns Pesticide Inspector Regulatory Training (PIRT) Nomination Form

Supervisors/Managers of inspectors, please fill out the form below to nominate your Agency’s representative for the 2021 Virtual Basic Pesticide and Use Concerns Pesticide Inspector Regulatory Training (PIRT) Nomination Form course scheduled for April 19-22, 2021.

1 Start 2 Preview 3 Complete

Supervisor Information

Name (Required)

Telephone Number (Required)

Email Address (Required)

My State, Tribe, or Territory Organization (Required)

My State, Tribe, or Territory Organization Address (Required)

Country (Required)

Address 1 (Required)

Address 2

Postal code (Required)

City (Required)

Primary Nominee Information

Name of (up to one) inspector who will attend this training. Please double check inspectors' email address to make sure that they're correct. Otherwise, we won't be able to email them! (There is a separate section below to list an alternate nominee)

Name (Required)

Home Address

Home Address (Required)

Country (Required)

Address 1 (Required)

Address 2

City (Required)

State (Required)

ZIP Code (Required)

Email Address (Required)

Telephone Number (Required)

Years Inspector Experience (Required)

Primary Duties for Inspector (Required)

Both

Other

If Other: Describe Work Duties

Alternate Nominee Information

Name of (up to one) inspector who will attend this training. Please double check inspectors' email address to make sure that it is correct. Otherwise, we won't be able to email them!

Name

Home Address

Country (Required)

Address 1 (Required)

Address 2

Postal code (Required)

City (Required)

Telephone Number

Email Address

Years Inspector Experience

Primary Duties for Inspector

Both

Other

If Other: Describe Work Duties

Disclaimer (Required)

By submitting this form, I attest that I am a pesticide program supervisor/manager and that the inspectors who I am nominating for this training are committed to attending the course in its entirety. I also attest that the nominees are pesticide/structural field inspectors. I understand that submitting these nominations does not guarantee that the applicants will be admitted into the course, and that I will be notified of acceptance or rejection via email from the North Carolina Department of Agriculture and Consumer Services.

I agree to these terms and conditions.

Leave this field blank