ONLINE REGISTRATION FORM
RETURNING STUDENT  (Non-FDOT Employee)

This form is to be completed by returning students who have previously registered for a CTQP course and who's registration information has not changed since the last class or exam.

APPLICANT INFORMATION

First Name  
Middle Initial  
Last Name  
FL Driver's License #  
E-mail


EMPLOYMENT INFORMATION

Employer
Work Location (City)


TRAINING CONTACT INFORMATION

This area to be completed only by those responsible for scheduling trainees for CTQP courses. If you have not been designated as a Training Contact for your employer, please do not complete this area.
 
Contact Person
Fax Number
Contact Phone #
Email

 
QUALIFICATION

Application for Qualification as
This application is for (check one) Initial Qualification  Re-Qualification
NOTE - Additional documentation or certificates may be required for certain qualifications. Refer to Construction Training and Qualification Manual for exact requirements. Qualification cannot be issued without required documentation.
Certificate Designation Issue Date Expiration Date Certificate Number


COURSE SELECTION & FEES


Step 1 - choose the classes you would like to attend

Step 2 - choose your preferred date or location

Step 3 - check the box with applicable course fee

CLASS SESSION # DATES LOCATION COURSE
& EXAMS
COURSE EXAM PROF

COURSE NOTE 1 - Exams and Proficiencies Only - Click Here  to view reporting times for these sessions

ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams start at 10:45 am 1509 000 00

8/25/09 class starts 8 am

JACKSONVILLE LOCATION TBD INST: KIKO VILLARREAL $350 $50 $150 $200
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams start at 10:45 am 1509 022 00

9/1/09 class starts @ 8 am

Panama City INST: KIKO VILLARREAL $350 $50 $175 $200
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams start at 10:45 am 1508 022 00

10/2/2009 class starts @ 8 am

Banquet Masters, Pinellas Park INST: KIKO VILLARREAL $350 $50 $175 $200
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams start at 10:45 am 1509 020 00

11/3/2009

Tallahassee $350 $50 $150 $200
PILE INSPECTION WRITTEN EXAM - NO BOOK PROVIDED - 2 HR EXAM 1509 000 00

8/19/2009

FDOT Midway Fac., Tallahassee N/A N/A $300 N/A
ASPHALT PAVING LEVEL 2 - Three-day class - Written Exam on day 3 1509 000 00

8/26-28/2009

JACKSONVILLE LOCATION TBD INST: KIKO VILLARREAL $600 $350 $275 N/A
  ASPHALT PAVING LEVEL 2 - Three-day class - Written Exam on day 3 1509 023 00

9/2-4/2009

Panama City INST: KIKO VILLARREAL $600 $350 $275 N/A
  ASPHALT PAVING LEVEL 2 - Three-day class - Written Exam on day 3 1509 023 00

10/5-7/2009

Banquet Masters, Pinellas Park INST: KIKO VILLARREAL $600 $350 $275 N/A
  ASPHALT PAVING LEVEL 2 - Three-day class - Written Exam on day 3 1509 023 00

11/4-11/6/2009

Tallahassee $600 $350 $275 N/A
Asphalt Pave L-1 PROFICIENCY 9am-3pm Call 727-541-3444 Lynn 1509 000 00

Call to schedule

Williams Largo Ofc, 10600 Endeavour Way N/A N/A $200 N/A
ASPHALT PLANT L-1-3 Day Class 1509 000 00

9/8-10/2009

Snapper Creek INST: KIKO VILLARREAL $875 $400 $200 $275
2009 Drilled Shaft 3-day course-exam & prof. on last day 1509 029 00

7/28-30/2009

Williams Sanford Ofc, 30 Keyes Court $675 $425 $275 $300
  2009 Drilled Shaft 3-day course-exam & prof. on last day 1509 029 00

8/10-12/2009

Panama City $675 $425 $275 $300
  2009 Drilled Shaft 3-day course-exam & prof. on last day 1509 029 00

9/8-10/2009

Banquet Masters, Pinellas Park $675 $425 $275 $300
  2009 Drilled Shaft 3-day course-exam & prof. on last day 1509 029 00

11/10-12/2009

Jacksonville $675 $425 $275 $300
CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2 1509 026 00

7/7-8/2009

Williams Sanford Ofc, 30 Keyes Court INST: KIKO VILLARREAL $400 $225 $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2 1509 026 00

8/4-5/2009

Jacksonville Location TBD INST: KIKO VILLARREAL $400 $225 $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2 1509 026 00

8/18-19/2000

FDOT MIDWAY FACILITY, TALLAHASSEE INST: KIKO VILLARREAL $350 N/A $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2 1509 026 00

10/27-28/2009

Banquet Masters, 8100 Park Blvd, Pinellas Park INST: KIKO VILLARREAL $400 $225 $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2 1509 026 00

11/12-13/2009

Ft. Myers $400 $225 $185 N/A
EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2 1509 024 00

7/14-15/2009

Okaloosa County PB Blvd, 1759 S. Ferdon Blvd INST: KIKO VILLARREAL $450 $150 $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2 1509 024 00

8/18-19/2009

Williams Sanford Ofc, 30 Keyes Ct INST: KIKO VILLARREAL $450 $225 $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2 1509 024 00

9/8-9/2009

Jacksonville INST: KIKO VILLARREAL $450 $150 $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2 1509 024 00

10/20-21/2009

Banquet Masters, Pinellas Park INST: KIKO VILLARREAL $450 $150 $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2 1509 024 00

9/29-30/2009

Snapper Creek INST: KIKO VILLARREAL $450 $150 $175 $175
EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2 1509 025 00

7/16-17/2009

Okaloosa County PB Blvd, 1759 S. Ferdon Blvd INST: KIKO VILLARREAL $400 $225 $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2 1509 025 00

8/20-21/2009

Williams Sanford Ofc, 30 Keyes Ct INST: KIKO VILLARREAL $400 N/A $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2 1509 025 00

9/10-11/2009

Jacksonville INST: KIKO VILLARREAL $400 $150 $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2 1509 025 00

10/22-23/2009

Banquet Masters, Pinellas Park INST: KIKO VILLARREAL $400 $225 $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2 1509 025 00

10/1-2/2009

Snapper Creek INST: KIKO VILLARREAL $400 $225 $185 N/A
2009 Pile Inspectors 3-day course-exam on last day 1509 029 00

CANCELLED 7/7-9/2009

Snapper Creek N/A N/A N/A N/A
  2009 Pile Inspectors 3-day course-exam on last day 1508 028 00

7/21-23/2009

Williams Sanford Ofc, 30 Keyes Ct INST: K BENNETT $1000 $425 $275 $300
  2009 Pile Inspectors 3-day course-exam on last day 1509 028 00

8/5-8/7/2009

Panama City $1000 $425 $275 $300
  2009 Pile Inspectors 3-day course-exam on last day 1509 029 00

9/22-24/2009

Banquet Masters, 8100 Park Blvd, Pinellas Park $1000 $425 $275 $300
  2009 Pile Inspectors 3-day course-exam on last day 1509 029 00

10/27-29/2009

Jacksonville $1000 $425 $275 $300
  2009 Pile Inspectors 3-day course-exam on last day 1509 000 00

11/17-19/2009

Ft. Myers $1000 $425 $275 $300
QC MANAGER - 2 day class - Written Exam on day 2 1509 031 00

CANCELLED 7/9-10/2009

Williams Sanford Ofc INST: KIKO VILLARREAL N/A N/A N/A N/A
  QC MANAGER - 2 day class - Written Exam on day 2 1509 035 00

10/29-28/2009

Banquet Masters, 8100 Park Blvd, Pinellas Park INST: KIKO VILLARREAL $450 $275 $185 N/A
  QC MANAGER - 2 day class - Written Exam on day 2 1509 031 00

11/10-11/2009

Ft. Myers $450 $275 $185 N/A
CONC FIELD EXAM - NO BOOK PROVIDED - 2 HR EXAM 1509 026 00

7/17/09 11 AM

Okaloosa County PB Bldg, Crestview FL INST: KIKO VILLARREAL N/A N/A $185 N/A
CONCRETE LAB TECH - NO BOOK PROVIDED - 2 HR EXAM 1509 026 00

7/17/09 11 AM

Okaloosa County PB Bldg, Crestview FL N/A N/A $200 N/A
  CONCRETE LAB TECH - NO BOOK PROVIDED - 2 HR EXAM 1509 026 00

8/10/2009 9 am

Williams Sanford & Largo Offices N/A N/A $200 N/A
  CONCRETE LAB TECH - NO BOOK PROVIDED - 2 HR EXAM 1509 026 00

10/28/2009 9 am

Williams Largo & Sanford Offices N/A N/A $200 N/A
Earthwork L-1 Exam 9am-3pm Call Lynn 727-541-3444 1509 024 00

Call to schedule date & time

Williams Largo & Sanford offices N/A N/A $185 N/A
Earthwork L-2 Exam 9am-3pm Call Lynn 727-541-3444 1508 025 00

Call to schedule date & time

Williams Largo, & Sanford Offices N/A N/A $185 N/A
Asphalt Pave L-1 Written Only Call Lynn 727-541-3444 1508 022 00

Call to schedule date & time

Williams Largo & Sanford Offices N/A N/A $150 N/A
Asphalt Pave L-2 Exam 9am-3pm Call Lynn 727-541-3444 1509 023 00

Call to schedule date & time

Williams Sanford & Largo Ofc N/A N/A $275 N/A
Asphalt Plant L-1 Written Only 9am-3pm Call Lynn 727-541-3444 1509 020 00

Call to schedule date & time

Williams Sanford & Largo Ofc N/A N/A $200 N/A
Asphalt Plant L-2 Exam 9am-3pm Call Lynn 727-541-3444 1509 021 00

Call to schedule date & time

WilliamsSanford & Largo N/A N/A $275 N/A
CONCRETE BATCH PLANT OPER WRITTEN EXAM 1509 033 00

7/17/2009 11 AM

Okaloosa County PB Bldg, Crestview FL N/A