KLA Application for Certification

The Kentucky Laboratory Analysts Committee was created under the KY Water and Wastewater Operators’ Association (KWWOA) for individuals employed in the water quality field. The mission of the KLA is to promote the development of precise and accurate data for the protection and interest of our water quality laboratories and systems.

General Information
Classification:*
Level:*
Name*
First Middle Last
Address:*
Street Address Address Line 2 City State Zip Code
Last 4 Digits of Social Security Number:*
Email:*
Phone:*
Fax:*
KWWOA Member:*
Must be a KWWOA/KLA member to apply.
Chapter*
Training and Education
High School Diploma or Equivalent:*
Upload High School Documentation:
Max. file size: 1 GB.
College or Equivalent:*
Upload College Documentation:
Max. file size: 1 GB.
Major:
Minor:
Details of other post-secondary training:
Experience
Current Employer's Name:*
Current Employer's Address:*
Current Supervisor's Name:
Current Employer's Work Phone:*
Current Job Title:*
Start of Current Employment:*
MM slash DD slash YYYY
End of Current Employment:
MM slash DD slash YYYY
Current Duties:*
Previous Employer's Name:*
Previous Employer's Address:*
Previous Supervisor's Name:
Previous Employer's Work Phone:*
Start of Previous Employment:*
MM slash DD slash YYYY
End of Previous Employment:*
MM slash DD slash YYYY
Previous Duties:*

KLA Application for Certification

General Information

Training and Education

Experience