DDW-2025-001806

pg 1 of 3 - revised 05/16/2022
For those who are already certified
State of Utah
Division of Drinking Water
Operator Certification Program
EXAM APPLICATION
Online Exam Registration Paper Exam Registration
Rural Water Association of Utah
(RWAU) 14572 S 790, A203Bluffdale, UT 84065
Phone: [phone]
Email: [e-mail]
www.rwau.net
Division of Drinking Water (DDW)
P.O. Box 144830
Salt Lake City, UT 84114
Phone: [phone]
E-mail: [e-mail]
DDWOpCert.utah.gov
"In compliance with the American Disabilities Act, individuals with special needs (including auxiliary communicative aids and services)
should contact Kimberly Diamond-Smith, Office of Human Resources, at: [phone], TDD [phone], to schedule a meeting."
Checklist Instructions
☐Online Exam - Register through RWAU ☐Paper Exam - Register through DDW
☐Step 1 Fill out this application completely and get
your proof of citizenship form (attached) notarized
☐Step 2 Submit the application, pay the $174 exam
fee, and schedule an exam with the RWAU by
completing the Online Exam Proctor Request Form.
https://rwau.formstack.com/forms/online_proctor_exams
☐Step 1 Fill out this application completely and get your proof of
citizenship form (attached) notarized.
☐Step 2 Submit your application and pay the $240 Paper exam fee to
DDW by the application deadline.
Location: RWAU Conference in St. George, Utah
Exam Date: 2/28/2025 Application Deadline: 2/14/2025
https://deq.utah.gov/drinking-water/dw-payment-portal#opcert
Certifications are due for renewal every 3-years on December 31st. Operators are required to obtain Continuing Education Units (CEU’s) during their 3-
year cycle before applying for renewal. Operators’ 3-year cycle for CEU’s begins on January 1st after passing the exam. Any training accrued during the
year of certification or prior will not apply towards renewal. Find more information at DDWOpCert.utah.gov.
PERSONAL INFORMATION
First, Middle, Last Name (Mr. or Ms.): Certification #:
Email: Date of Birth:
Home Address: Cell phone:
City: State: Zip: Home phone:
GRADE LEVEL DESIRED
Select one. Only one exam is allowed per paper exam.
Water Distribution: SS☐ 1☐ 2☐ 3☐ 4☐
Distribution includes chlorination
Water Treatment: 1☐ 2☐ 3☐ 4☐
Treatment complete treatment of surface water
EDUCATION
What is the highest level of education you have completed?
HIGH SCHOOL DIPLOMA OR EQUIVALENT: ☐
COLLEGE GRADUATE: Degree Major Year
Degree Major Year
CURRENT EMPLOYMENT
Employer/Water System:
Water System numbers: Phone:
Job Title: Email
Start Date: End Date: Total years with this employer: Total years of DRC experience:
pg 2 of 3 - revised 05/16/2022
CURRENT EMPLOYMENT (Continued)
Description of experience:
EMPLOYMENT
Employer/Water System:
Water System numbers: Phone:
Job Title: Email
Start Date: End Date: Total years with this employer: Total years of DRC experience:
Description of experience:
EMPLOYMENT
Employer/Water System:
Water System numbers: Phone:
Job Title: Email
Start Date: End Date: Total years with this employer: Total years of DRC experience:
Description of experience:
Operator's signature: Date:
" By signing, I certify the above information is correct & complete.
I understand that all info might be verified by Drinking Water staff. "
☐
Proof of Citizenship

Under Utah State Law the Utah Department of Environmental Quality (DEQ) is required to verify the lawful presence
in the United States of an individual at least 18 years of age (includes sole proprietor doing business under assumed
name) who has applied for Water Operator certification or Backflow Technician certification. This law also applies for
renewal, reinstatement, and reciprocity applications. These documents will be confidential and not distributed
publicly.
Applicants for these certifications are required to notarize and attach the following documents:
 Complete and attach the form below
 Attach copy of your government issued photo ID
 Have the document notarized
Questions? Division of Drinking Water 195 North 1950 West P.O. Box 144830 Salt Lake City, UT 84114-4830 Phone: [phone] http://drinkingwater.utah.gov
I’ve already submitted a citizenship form.
U t a h Department of Environmental Q u a li t y
Certification Pursuant to U C A 6 3 G - 12 - 104 This paperwork must be:
 Completed prior to issuance of
certificate.

I, , hereby certify under penalty of perjury that I am:
Full Name
☐ a United States citizen. Must have copy of government issued photo ID attached.
OR
☐ a qualified alien as defined in 8 USC, Sec. 1641, and lawfully present in the United States.
Alien ID #:
Dated this day of , 20 .
Applicant’s Full Name:
Address:
Applicant’s Signature:
SUBSCRIBED AND SWORN to before me this day of , 20 . County: State: . Government Issued
PHOTO ID
(Place copy here)
(driver’s license, passport, etc.) (can attach copy, cut and tape, or print copy on back)
NOTARY PUBLIC
My commission expires: