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 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

CANCELLED 7/30/2010 8 am

Snapper Creek INST: Kiko Villarreal N/A N/A N/A N/A
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams start at 10:45 am

8/3/2010 8am

Best Western Jacksonville INST: Kiko Villarreal $350 N/A $175 $200
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams start at 10:45 am

CANCELLED 8/10/2010 8 am

Williams Tech Training Center, Sanford INST: Kiko Villarreal N/A N/A N/A N/A
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams start at 10:45 am

10/19/2010

Largo Training Center - Instructor: Kiko Villarreal $350 $50 $150 $200
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams start at 10:45 am

11/16/2010

Sanford Training Center - Instructor: Kiko Villarreal $350 $50 $150 $200
Asphalt Paving L-2 3 day session exam on day 3

8/4 - 6/2010

Best Western Jacksonville INST: Kiko Villarreal $410 N/A $275 N/A
  Asphalt Paving L-2 3 day session exam on day 3

8/11 - 13/2010

Williams Tech Training Center, Sanford INST: Kiko Villarreal $410 N/A $275 N/A
  Asphalt Paving L-2 3 day session exam on day 3

9/1 - 3/2010

Panama City INST: Kiko Villarreal $410 N/A $275 N/A
  Asphalt Paving L-2 3 day session exam on day 3

9/29 - 10/1/2010

Williams Tech Training Center, Largo INST: Kiko Villarreal $410 N/A $275 N/A
  Asphalt Paving L-2 3 day session exam on day 3

10/20 - 22/2010

Largo Training Center - Instructor: Kiko Villarreal $410 $350 $275 N/A
  Asphalt Paving L-2 3 day session exam on day 3

11/17 - 19/2010

Sanford Training Center - Instructor: Kiko Villarreal $410 $350 $275 N/A
ASPHALT PLANT L-1 3 day class

10/25 - 27/2010

Sanford Training Center - Instructor: Kiko Villarreal $600 N/A $200 $275
CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

7/20 - 21/2010

Best Western Jacksonville INST: Kiko Villarreal $375 N/A $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

CANCELLED 7/22 - 23/2010

Williams Tech Training Center, Sanford INST: Kiko Villarreal N/A N/A N/A N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

CANCELLED 7/28 - 29/2010

Snapper Creek INST: Kiko Villarreal N/A N/A N/A N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

8/30 - 31/2010

Hampton Inn, Panama City Beach INST: Kiko Villarreal $375 N/A $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

9/27 - 28/2010

Williams Tech Training Center, Largo INST: Kiko Villarreal $375 N/A $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

10/5 - 6/2010

Miami - Instructor: Kiko Villarreal $350 $225 $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

11/8 - 9/2010

Jacksonville - Instructor: Kiko Villarreal $375 $225 $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

11/22 - 23/2010

Largo Training Center - Instructor: Kiko Villarreal $375 $225 $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2

12/7 - 8/2010

Ft. Lauderdale - Instructor: Kiko Villarreal $375 $225 $185 N/A
EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

8/17 - 18/2010

Williams Tech Training Center, Sanford INST: Kiko Villarreal $450 N/A $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

8/24 - 25/2010

Williams Tech Training Center, Largo INST: Kiko Villarreal $450 N/A $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

9/7 - 8/2010

D-5 Deland Ops, 1650 N Kepler Rd INST: Kiko Villarreal $450 N/A $175 $200
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

9/14 - 15/2010

FDOT Midway Fac, INST: Kiko Villarreal $450 N/A $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

9/21 - 22/2010

Best Western Jacksonville INST: Kiko Villarreal $450 N/A $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

10/12 - 13/2010

Largo Training Center - Instructor: Kiko Villarreal $450 $150 $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

11/1 - 2/2010

Jacksonville - Instructor: Kiko Villarreal $450 $150 $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

11/30 -12/1/2010

Sanford Training Center - Instructor: Kiko Villarreal $450 $150 $175 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2

12/14 -15/2010

Tallahassee - Instructor: Kiko Villarreal $450 $150 $175 $175
EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

8/19 - 20/2010

Williams Tech Training Center, Sanford INST: Kiko Villarreal $400 N/A $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

8/26 - 27/2010

Williams Tech Training Center, Largo INST: Kiko Villarreal $400 N/A $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

9/9 - 10/2010

D-5 Deland Ops, 1650 N Kepler Rd INST: Kiko Villarreal $400 N/A $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

9/16 - 17/2010

FDOT Midway Fac, INST: Kiko Villarreal $400 N/A $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

9/23 - 24/2010

Best Western Jacksonville INST: Kiko Villarreal $400 N/A $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

10/14 - 15/2010

Largo Training Center - Instructor: Kiko Villarreal $400 $225 $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

11/3 - 4/2010

Jacksonville - Instructor: Kiko Villarreal $400 $225 $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

12/2 - 3/2010

Sanford Training Center - Instructor: Kiko Villarreal $400 $225 $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2

12/16 - 17/2010

Tallahassee - Instructor: Kiko Villarreal $400 $225 $185 N/A
QC MANAGER - 2 day class - Written Exam on day 2

cancelled 7/26 - 27/2010

Snapper Creek INST: Kiko Villarreal N/A N/A N/A N/A
  QC MANAGER - 2 day class - Written Exam on day 2

10/7 - 8/2010

Miami - Instructor: Kiko Villarreal $400 $275 $185 N/A
  QC MANAGER - 2 day class - Written Exam on day 2

10/28 - 29/2010

Sanford Training Center - Instructor: Kiko Villarreal $400 $275 $185 N/A
  QC MANAGER - 2 day class - Written Exam on day 2

11/10 - 11/2010

Jacksonville - Instructor: Kiko Villarreal $400 $275 $185 N/A
  QC MANAGER - 2 day class - Written Exam on day 2

12/9 - 10/2010

Ft. Lauderdale - Instructor: Kiko Villarreal $400 $275 $185 N/A
ASPHALT PAVE L-1 WRITTEN EXAM-CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 10600 Endeavour WY, Largo N/A N/A $150 N/A
  ASPHALT PAVE L-1 WRITTEN EXAM-CLOSED BOOK

8/18/2010 8 am

Williams Jacksonville Ofc, 11329 Distribution Ave West N/A N/A $150 N/A
  ASPHALT PAVE L-1 WRITTEN EXAM-CLOSED BOOK

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Dr, Panama City Beach N/A N/A $150 N/A
  ASPHALT PAVE L-1 WRITTEN EXAM-CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $150 N/A
ASPHALT PAVE L-1 PROF

call to schedule

Williams Tech Training Fac, Largo INST: KIKO VILLARREAL N/A N/A N/A $200
ASPHALT PLANT L-1 WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 AM

Williams Tech Training Ctr, 10600 Endeavour Wy, LARGO N/A N/A $200 N/A
  ASPHALT PLANT L-1 WRITTEN EXAM - CLOSED BOOK

8/18/2010 8 am

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $200 N/A
  ASPHALT PLANT L-1 WRITTEN EXAM - CLOSED BOOK

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Drive, Panama City Beach N/A N/A $200 N/A
  ASPHALT PLANT L-1 WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $200 N/A
ASPHALT PLANT L-2 WRITTEN EXAM - BOOK PROVIDED

7/29/2010 9 AM

Williams Tech Training Ctr, 10600 Endeavour Wy, Largo N/A N/A $275 N/A
  ASPHALT PLANT L-2 WRITTEN EXAM - BOOK PROVIDED

8/18/2010 8 am

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $275 N/A
  ASPHALT PLANT L-2 WRITTEN EXAM - BOOK PROVIDED

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Dr, Panama City Beach N/A N/A $275 N/A
  ASPHALT PLANT L-2 WRITTEN EXAM - BOOK PROVIDED

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $275 N/A
CONC BATCH PLANT OPER - WRITTEN EXAM - STUDY GUIDE PROVIDED

7/29/2010 9 am

Williams Tech Training Ctr, 10600 Endeavour Wy, Largo FL N/A N/A $200 N/A
  CONC BATCH PLANT OPER - WRITTEN EXAM - STUDY GUIDE PROVIDED

8/18/2010 8 AM

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $200 N/A
  CONC BATCH PLANT OPER - WRITTEN EXAM - STUDY GUIDE PROVIDED

8/31/2020 10:30 am

Hampton Inn, 2909 Thomas Dr., Panama City Beach N/A N/A $200 N/A
  CONC BATCH PLANT OPER - WRITTEN EXAM - STUDY GUIDE PROVIDED

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $200 N/A
CONC FIELD WRITTEN EXAM - BOOK PROVIDED

7/29/2010 9 AM

Williams Tech Training Center, 10600 Endeavour Wy, Largo N/A N/A $185 N/A
  CONC FIELD WRITTEN EXAM - BOOK PROVIDED

8/18/2010 8 am

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $185 N/A
  CONC FIELD WRITTEN EXAM - BOOK PROVIDED

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $185 N/A
EARTHWORK L-1 WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 10600 Endeavour Wy, Largo N/A N/A $175 N/A
  EARTHWORK L-1 WRITTEN EXAM - CLOSED BOOK

8/18/2010 8AM

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $175 N/A
  EARTHWORK L-1 WRITTEN EXAM - CLOSED BOOK

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Dr, Panama City Beach N/A N/A $175 N/A
  EARTHWORK L-1 WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $175 N/A
EARTHWORK L-1 PROFICIENCY EXAM

call to schedule

Williams Tech Training Center, Largo N/A N/A N/A $175
EARTHWORK L-2 WRITTEN EXAM - PLANS & SPECS PROVIDED

7/29/2010 9 am

Williams Tech Training Ctr, 10600 Endeavour Wy, Largo N/A N/A $185 N/A
  EARTHWORK L-2 WRITTEN EXAM - PLANS & SPECS PROVIDED

8/18/2010 8 AM

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $185 N/A
  EARTHWORK L-2 WRITTEN EXAM - PLANS & SPECS PROVIDED

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Dr, Panama City Beach N/A N/A $185 N/A
  EARTHWORK L-2 WRITTEN EXAM - PLANS & SPECS PROVIDED

7/29/2010 9 am

Williams Tech Training Center 30 Keyes Ct, Sanford N/A N/A $185 N/A
FINAL ESTIMATES L-1 WRITTEN EXAM - CLOSED BOOK

8/13/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $185 N/A
  FINAL ESTIMATES L-1 WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 10600 Endeavour Wy, Largo N/A N/A $185 N/A
  FINAL ESTIMATES L-1 WRITTEN EXAM - CLOSED BOOK

8/18/2010 8 AM

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $185 N/A
  FINAL ESTIMATES L-1 WRITTEN EXAM - CLOSED BOOK

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Dr, Panama City Beach N/A N/A $185 N/A
  FINAL ESTIMATES L-1 WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct., Sanford N/A N/A $185 N/A
FINAL ESTIMATES L-2 WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 10600 Endeavour Wy, Largo FL N/A N/A $185 N/A
  FINAL ESTIMATES L-2 WRITTEN EXAM - CLOSED BOOK

8/18/2010 8 AM

Williams Jacksonville Ofc, 11329 Distriubtion Ave WEST N/A N/A $185 N/A
  FINAL ESTIMATES L-2 WRITTEN EXAM - CLOSED BOOK

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Dr, Panama City Beach N/A N/A $185 N/A
  FINAL ESTIMATES L-2 WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $185 N/A
PILE INSPECTORS WRITTEN EXAM - BOOK PROVIDED

7/29/2010 9 AM

Williams Tech Training Ctr, 10600 Endeavour Wy, Largo FL N/A N/A $275 N/A
  PILE INSPECTORS WRITTEN EXAM - BOOK PROVIDED

8/31/2020 10:30 am

Hampton Inn, 2909 Panama City Beach N/A N/A $275 N/A
  PILE INSPECTORS WRITTEN EXAM - BOOK PROVIDED

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $275 N/A
  PILE INSPECTORS WRITTEN EXAM - BOOK PROVIDED

8/19/2010 8 am

Williams Jacksonville Ofc, 11329 Distribution Ave W N/A N/A $275 N/A
QC MANAGER WRITTEN EXAM - CLOSED BOOK

7/29/2010 9 AM

Williams Tech Training Ctr, 10600 Endeavour Wy, Largo FL N/A N/A $185 N/A
  QC MANAGER WRITTEN EXAM - CLOSED BOOK

8/18/2010 8 am

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $185 N/A
  QC MANAGER WRITTEN EXAM - CLOSED BOOK

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Dr, Panama City Beach N/A N/A $185 N/A
  QC MANAGER WRITTEN EXAM - CLOSED BOOK

07/29/2010 - 9 am

Williams Tech Training Ctr, 30 Keyes Ct., Sanford N/A N/A $185 N/A
Drilled Shaft Inspection 3-day course, Written & Prof on 3rd day

Wed 9/8 Fri 9/10/10

Williams Tech Training Center, Largo INST: Keith Bennett $675 N/A $275 $300
DRILLED SHAFT WRITTEN EXAM - BOOK PROVIDED

7/29/2010 9 AM

Williams Tech Training Ctr, 10600 Endeavour Way, Largo FL N/A N/A $275 N/A
  DRILLED SHAFT WRITTEN EXAM - BOOK PROVIDED

8/18/2010 8 am

Williams Jacksonville Ofc, 11329 Distribution Ave WEST N/A N/A $275 N/A
  DRILLED SHAFT WRITTEN EXAM - BOOK PROVIDED

8/31/2010 10:30 am

Hampton Inn, 2909 Thomas Dr, Panama City Beach N/A N/A $275 N/A
  DRILLED SHAFT WRITTEN EXAM - BOOK PROVIDED

7/29/2010 9 am

Williams Tech Training Ctr, 30 Keyes Ct, Sanford N/A N/A $275 N/A
Pile Driving Inspection 2 1/2-day class - written exam on last day

9/21-9/23/2010

Williams Tech Training Center, 10600 Endeavor Way, Largo $675 N/A $275 N/A


PAYMENT INFORMATION

Credit Card    
(MasterCard, Visa, and American Express)   
Card Number
Expiration Date             
Cardholder's Name    
(as it appears on card)
For your security, we ask for the   
3 or 4 digit Account Verification Code   
located on the back of your card or on American Express on the front.
Account Verification Code
Cardholder Email
Cardholder Billing Address
Cardholder Billing City
Cardholder Billing State
Cardholder Billing ZIP

By submitting this application, I agree that all information is truthful and I confirm I have met the minimum work experience and training course prerequisites required for the above listed qualification, if applicable. I understand any incorrect information on this form could cause my application to be delayed or rejected. If information contained in this form is discovered to be blatantly false, this could lead to revocation of FDOT issued qualifications. By submitting this online form, I understand the procedure for obtaining qualification is described in the FDOT Construction Training manual and will abide by the terms contained in the manual.

All information you provide is submitted via our Secure Server
using the latest in SSL 128 bit data encryption technology.

     

Revised: May 07, 2007

Copyright© 2007      Williams Earth Sciences, Inc.     All Rights Reserved.