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About Us
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Privacy Policy
Board & Staff
Awards
Our History
Contact Us
Careers
Placing a Job Posting
Events
Conference
Backflow Prevention
Certification & Training
Tester List
FAQ
Order a Manual
Backflow Prevention in Ontario
Committees
Automation
Asset Management
Certification & Education
Climate Change
Construction
Cross Connection Control
Distribution
Diversity & Member Engagement Committee
Groundwater
Manufacturers & Associates Council (MAC)
Publications
Small Systems
Source Water Protection
Treatment
Water and Energy Efficiency
Water for People
Water Utility Council
Young Professionals
Advisory Panels
Communications & Public Affairs
University Research
Volunteer
News
Blog
Consultations
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NEOWWC - Application for 25 Year Service Certificate
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Application for 25 Year Service Certificate
Today's Date:
Name of Applicant:
Employer (Organization or Municipality):
Address 1
Address line 2
City
Province
Please Select
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland/Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Micronesia
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Outside U.S./Canada
Postal Code
Country
Please Select
Canada
Mexico
United States
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Congo
Congo, The Democratic Republic of the
Cote d'Ivoire - Really Ivory Coast
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea Bissau
Kenya
Lesotho
Liberia
Libyan Arab Jamahiriya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
Tanzania, United Republic of
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Afghanistan
Armenia
Azerbaijan
Bangladesh
Bhutan
Brunei Darussalam
Cambodia
China
East Timor
Georgia
India
Indonesia
Japan
Kazakhstan
Korea, Democratic People's Republic
Korea, Republic of
Kyrgyzstan
Lao People's Democratic Republic
Malaysia
Maldives
Mongolia
Myanmar
Nepal
Philippines
Russian Federation
Singapore
Sri Lanka
Taiwan
Tajikistan
Thailand
Turkmenistan
Uzbekistan
Viet Nam
Australia
Fiji
Kiribati
Marshall Islands
Micronesia, Federated States of
Nauru
New Caledoni
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Bermuda
British Virgin Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
Albania
Andorra
Austria
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Czech Republic
Denmark
Estonia
Finland
France
Germany
Great Britain
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia, Former Yugoslav Republic of
Malta
Moldova, Republic of
Monaco
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia and Montenegro
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
Bahrain
Cyprus
Iran, Islamic Republic of
Iraq
Israel
Jordan
Kuwait
Lebanon
Oman
Pakistan
Qatar
Saudi Arabia
Syrian Arab Republic
Turkey
United Arab Emirates
Yemen
Argentina
Bolivia
Brazil
Chile
Columbia
Curacao
Ecuador
French Guiana
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Present or latest position of Applicant:
Period of Water Works Service (from - to)
Total number of years:
Record of Water Works Service during this period:
Certification by Employer
I hearby certify the above information to be correct
First name
Last name
Primary Phone
Please Select
Home
Work
Cell
E-mail
Title
submit
