Laboratory Analyst Application Please note that this application must be completed at one time. There is no option to save. Required fields are noted with a red *. "*" indicates required fields Step 1 of 4 25% Name* First Middle Last Mailing Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Best Number to reach you*Email* EDUCATION & TRAININGHave you taken or do you plan on taking any training/prep course for this exam?* Yes No Did you attend High School and/or receive your GED?* Yes No List your year of graduation/completionList the location of the schoolDid you attend a College or University?* Yes No List Dates AttendedList your MajorCredit or Degree ObtainedDate of Leaving or GraduatingDid you obtain a secondary degree from a College or University? Yes No List Dates AttendedList your MajorCredit or Degree ObtainedYear of Leaving or GraduatingAdditional EducationList other educational courses completed such as vocational school, correspondence, armed services, specialized courses, operators’ short courses, business school, etc. Give date, name and duration of course and name of school or sponsoring organization. EXPERIENCEName of facility or company*What is your title/position?*Give a brief description of your present experience in conducting or supervising wastewater analyses*How long have you held your present position?*List in detail all positions you have held in the past 5 years that involve experience in conducting or supervising wastewater analyses.*Start DateEnd DateEmployer and LocationDescribe in detail duties and state whether responsible charge or to whom you reported Add RemoveList in detail all positions that you are claiming experience for. It is necessary for the evaluator of this application to have as much information about your work experience as possible. Use the + sign to add more rows. Select the grade level you are applying for.*Select a grade levelGrade IPlease note that Lab Analyst II exam is currently not available, check back in September 2021.Reciprocity: Do you hold a valid certification or license in New England or from another state?*Select oneYesNoIf yes, list the state, grade and date of issue.*Are you taking a ReTest (taking the same grade level for a better grade)?*select oneYesNoIf "yes", What Grade Level are you retesting for?*select oneGrade IREFERENCESGive names and phone numbers of at least two persons, not relatives, who have knowledge of your character, experience, and ability.List your first reference's name and phone number*List your second reference's name and phone number*Agreement*I hereby certify that this application contains no willful misrepresentations or falsifications, and that the information given by me is true and complete to the best of my knowledge and belief. I further agree to abide by the provisions of the Voluntary Certification Program for Wastewater Laboratory Analysts of the New England Water Environment Association, Inc. I agree PaymentExam Fee*select optionLab Analyst I Exam FeeTotal Payment Method*Credit CardPurchase Order/CheckEnter the Purchase Order or Check #*Please mail checks to: NEWEA, 10 Tower Office Park, Suite 601, Woburn, MA 01801 and make sure to reference Lab Analyst Exam and the person's name.Please upload a copy of the purchase order if applicableAccepted file types: jpg, gif, pdf, Max. file size: 50 MB.Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name Δ
