GPR Operator Certification Renewal 2022

GPR Operator's Name *

First

Last

Email *

Phone #

Company Name

Do you possess an unrestricted and current driver’s license? *

Would you able to produce a negative drug/alcohol screen test within last 60 days? *

In the last 2 years, do you have less than 2 lost-time Injury accidents? *

If you answered 'No' to any of the above question(s) you must provide a written explanation of why the GPR Operator no longer meets this requirement.

File Upload- Headshot Image OR email image to info@csda.org. This is for your updated ID Card.

Click or drag a file to this area to upload.

Headshot image should be from the shoulders up with the operator against a neutral background. Remove hats, sunglasses and any face coverings.

To the best of my knowledge as the Certified GPR Operator or as the authorized person on behalf of the Certified GPR Operator, I certify all information is true and accurate. *

First

Last

Signature *

Date *

GPR Operator Certification Renewal 2022

Categories