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Home My WebLink About252153 12/02/15 Q CITY OF CARMEL, INDIANA VENDOR: 363573 ONE CIVIC SQUARE DAVID TURNER CHECK AMOUNT: $**... ..65.00* CARMEL, INDIANA 46032 4800 W.STATE ROAD 32 CHECK NUMBER: 252153 ANDERSON fN 46011 CHECK DATE: 12/02/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 65.00 OTHER EXPENSES r APPLICATION FOR VOLUNTARY COLLECTION SYSTEM OPERATION CERTIFICATION Administered by the Indiana Water Environment Association's Collection System Committee EXAM DATES: April 28 and October 27 at Clay Township/April 30 and October 29 at Fort Wayne NOTE:A complete application form is required, including a$65.00(non-refundable)application fee for class I&11 examinations and$75.00(non refundable)application fee for class 111&IV examinations:detailed employment information:supervisor's and applicant's signatures:and verification of your post high school educational qualifications attached. The application is to be typed, or neatly printed. Checks shall be payable to IWEA. Failure to return a completed application form by the final filing date ivill result in your ineligibility for that examination and forfeiture of your application fee. ALL EDUCATION AND EXPERIENCE REQUIREMENTS MUST BE MET AND CLEARL 3'STATED. FAILURE TO MEET OR VERIF}'EITHER OF THESE WILL RESULT IN INELIGIBILTY FOR THE EXAMINATION. All applications must be received prior to the 2nd Thursdgp in March for the April Examination and the 2ndThursday in September for the October Examination. CERTIFICATION EXAM INATIONLiCATiON,CLASS: C S-1 CS-11 CS-Ii1 CS-IV (CIRCLE ONE) DATE: :7- < I. APPLICANT INFORMATION A. NAME z"Uri L CXsC� "V !� rl[ Middle B. MAILING ADDRESS z Street ' City ��SSftate Zip Code 6-1/ County C. WORK PHONE NUMBER: (�l�) 7l Z4:1 IOME PHONE NUMBER:I�� ) C!L Area Code&Number Area Code&Number / D. E-mail Address: // ! U� � C�/��G� /��f 4(/1�" E. What is the preferred way of contacting you?(Certifications will still be sent to mailing address. All other correspondence will occur by your preference) CiRCLE ONE Mailing Address E-mail Address F. Have you previously applied for a Collection System Certificate? YES NO (CIRCLE ONE) G. What certifications do you presently hold? List all that apply: Certification Number State Grade(Class) Water Treatment Water Distribution _ Municipal Wastewater'freatment Industrial Wastewater Treatment Wastewater Collection System Other If. EDUCATION AND TRAINING ( > .t�1 A. High School: Name of School: <" Location: :5 `/ /rd r_/�/J Years Attended: Date of Graduation: B. College: Name of School: Location: Years Attended: Date of Graduation: C. NOTE: Attach verification of your post-high school educational qualifications. Copies of college transcripts or certificates of completion for courses related to wastewater treatment/collection provide acceptable proof of educational qualifications. You may list training courses,short courses,or other courses in the wastewater field that you have attended on Page 4. include only post high school information III. WORK EXPERIENCE HISTORY List your present employment first then any additional employment. Give a detailed description ofyour collection system work experience as designated below. 1f you are not a fill-time Collection Systems Operator, specify the average number of hours per week that are spent in the actual operation and maintenance of the collection system. NOTE: If you are applying for a Class III or IV examination, clearly define AND document your "in-charge" experience and qualiftcations (supervision does not necessarily dictate "in-charge"experience), CURRENT EMPLOYMENT: /� Current Employer: �/� �J� C—�/�j�� Dates—From 0// to Present Job Title: /// � � Number of Persons Supervised: 1 Job Description: 11.1 7—X1 Collection System Duties: Classification of Wastewater Treatment Plant: Municipal- 1 11 Ill IV (Circle One) ^� Industrial- I-SP A-SO A B C D Wastewater Treatment Plant Capacity: Z Gallons Per Day(gpd) Supervisor's Name: Address: Phone No.: ( ) PRIOR EMPLOYMENT: Past Employer: / j Dates—From Job Title: G/ ��°�� Number of Persons Supervised: �— Job D&scription: L� � �G 745 X, L 5—;- Collection Collection System Duties: Classification of Wastewater Treatment Plant: Municipal- I 11 Ill IV (Circle One) Industrial- I-SP A-SO A B C D Wastewater Treatment Plant Capacity: Gallons Per Day(gpd) Supervisor's Name: Address: Phone No.: ( ) r ! IV. ADDITIONAL EDUCATION (Attach Copy of Completion Verification and/or Transcripts) 1. NAME/DESCRIPTION OF COURSE: (Location) (Dates) (College Units or Class Hours) 2. NAME/DESCRIPTION OF COURSE: (Location) (Dates) (College Units or Class Hours) 3. NAME/DESCRIPTION OF COURSE: (Location) (Dates) (College Units or Class Hours) 4. NAME/DESCRIPTION OF COURSE: (Location) (Dates) (College Units or Class Hours) V. SUPERVISOR'S VERIFICATION OF CURRENT EMPLOYMENT(to be completed by present Employer) I hereby verify that the information contained in the current employment section of the application made by to be true and correct to the best of my knowledge and belief. Date Supervisor's Signature Title Printed V1. SIGNATURE OF APPLICANT 1,the undersigned,certify hat I am the above applicant;that all statements made and information contained in this application are true tot est of o ledge and belief-,that I understand that any omissions or misrepresentations may result in ineligibil' f the e m' ion applied for. I also consent to a thorough investigation of my employment record and other qualif atio in re to ctivities for the purpose of verification of my qualifications for the certificate for which I have applied. - (S natureofApplicant) f (Date) Completed application form with check/money order for proper amount,and payable to IWEA,should be returned to: IWEA 200 South Meridian Street Suite 410 Indianapolis,IN 46225 NOTE: DUE DATE FOR APPLICATIONS,MARCH 12,2015. FOR SPRING EXAM/SEPTEMBER 10,2015 FOR FALL EXAM LATE APPLICATIONS WILL NOT BE REVIEWED. ` - (lnlion Banking Page l of Print this Page TURNER 3272 VAVID TURNER -)04/740 20 JOYC15 15' ROAD 32 V STATE 000 V - ON,IN 46011-1673 ANDERS Date pay to the 40 Z/ ' ^ � PKsYjmmN&uprwAq&pcwIon order � - ___--- Y to the --_--_-- WMM N, _---' -- � � � .� < � �a ' � / | ' Zp -__'- -- --- lirhpo'//\cnouuimkry stcr= C-- 11/19/2015 Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee T0694 I TURNER, DAVID Purchase Order No. WASTEWATER PLANT Terms Due Date 11/24/2015 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 11/24/201! TURNER, D� $65.00 I hereby certify that the attached invoice(s), or bill(s) is(are) true and correct and I have audited same in accordancewith IC 5-11-10-1.6 Date Officer VOUCHER # 156746 WARRANT # ALLOWED T0694 IN SUM OF $ TURNER, DAVID WASTEWATER PLANT Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code TURNER, DA 01-7042-05 $65.00 Voucher Total $65.00 Cost distribution ledger classification if claim paid under vehicle highway fund