DDW-2025-001854

Page 1 of 2
Utah Division of Drinking Water
Operator Certification Program
UNRESTRICTED CERTIFICATE APPLICATION
Checklist Instructions:
☐Step 1 Verify if you have the required experience using the chart here:
 https://documents.deq.utah.gov/drinking-water/field-services/DDW-2021-000195.pdf
☐Step 2 Fill out this application completely and send it to the Division of Drinking Water.
Check your restricted status, CEU amounts, Op Cert #, and more information here:
 https://waterlink.utah.gov/deqWater/public/ceuReport.html
PERSONAL INFORMATION
Distribution Grade level (SS,1,2,3,4): Treatment Grade level (1,2,3,4): Certification #:
First, Middle, Last Name (Mr. or Ms.):
Email address: Cell phone:
Home Address: Home phone:
City: State: Zip: Work phone:
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 #:
Email: Phone:
Water System #s:
Start Date: End Date:
Total years with this employer: Total years of water-related experience:
Job Title & Description:
Division of Drinking Water
Operator Certification Program
P.O. Box 144830
Salt Lake City, Utah 84114-4830
Phone: [phone]
E-mail: [e-mail]
DDWOpCert.utah.gov
Page 2 of 2
EMPLOYMENT HISTORY
Employer/Water System: Water System #:
Email: Phone:
Water System #s:
Start Date: End Date:
Total years with this employer: Total years of water-related experience:
Job Title & Description:
EMPLOYMENT
Employer/Water System: Water System #:
Email: Phone:
Water System #s:
Start Date: End Date:
Total years with this employer: Total years of water-related experience:
Job Title & Description:
Duplicate this page until the experience required for unrestricted status is met.
Operator's signature: Date:
" By signing, I certify the above information is correct & complete.
I understand that all info may be verified by Drinking Water staff. "
You will be notified of the outcome of your application via US Mail or via e-mail if an e-mail address is provided.