WUAA/HEBC Falling and Bucking Endorsement Exam Application Application for Falling & Bucking Endorsement "*" indicates required fields Applicants must complete all fields of the form. Applicants must provide their personal contact information. Applications that provide company information in this field will be rejected. Please state your full given name as you want it to appear on any official documents you will receive if successful in obtaining the endorsement. Do not submit this form unless you are ready to accept exam scheduling opportunities. Applications are valid for 3 months unless a testing opportunity cannot be provided by HortEducationBC due to QST availability or environmental factors such as fire hazard season. Non-refundable Falling & Bucking Endorsement Application Fee* Price: GST* Price: $ 0.00 CAD Name* First Name Last Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Cell*Email* BC Certificate Number* Emergency Contact Name* First Last Emergency Contact Relationship* Emergency Contact Phone*Company Name* Company Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Phone*Company Contact Name* First Last Please give the name and contact information of the representative of your company who will be handling administration and payment of your Falling and Bucking Endorsement attempt. Company notification of exam result, and if successful, digital copies of endorsement documents will be sent to this individual. Company Contact Email* HiddenUpload your ITA Arborist Technician or Utility Arborist Certificate of Qualification*Accepted file types: jpg, jpeg, gif, tif, tiff, png, pdf, Max. file size: 2 MB.Required: Upload your ITA Certificate of Qualification showing proof of completion of the Arborist technician or Utility Arborist certification. Alternatively, you can access a pdf copy of your transcript through your ITA Direct Access Account. Video instruction of how to download a copy are at the following link http://www.itabc.ca/registration-checklist/how-guides#TranscriptUpload your ITA Arborist Technician or Utility Arborist Certificate of Qualification* Drop files here or Select files Accepted file types: jpg, jpeg, gif, tif, tiff, png, doc, docx, pdf, Max. file size: 2 MB, Max. files: 5. Required: Upload your ITA Certificate of Qualification showing proof of completion of the Arborist technician or Utility Arborist certification. Alternatively, you can access a pdf copy of your transcript through your ITA Direct Access Account. Video instruction of how to download a copy are at the following link http://www.itabc.ca/registration-checklist/how-guides#TranscriptProof of Insurance Files upload Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 2 MB, Max. files: 40. Optional form field: Proof of Insurance Files Upload 1. Certificate of Insurance with a minimum of $5 million Liability coverage. 2. WorkSafeBC Clearance Letter 3. Letter from Employer declaring the applicant is covered under the liability insurance policy and WorkSafeBC policies provided, as an employee for the company named in the policies, for the duration of the WUAA/HEBC, Falling And Bucking Examination. If you are unable to provide this with your application you can email it to [email protected] Note: Your application will not be processed until all proof of insurance documents are received. Contact [email protected] if you need assistance.Notice To Applicants* I have reviewed and agree to the Notice To Applicants. Only applicants with a BC Certificate of Qualification as a Certified Utility Arborist or a Certified Arborist Technician will be considered for assessment. You are required to provide a copy of your BC Certificate of Qualification. Non-refundable Application Fee: $250.00 (plus $12.50 GST)*. Note* Application fees are nontransferable. Upon approval of the application, WUAA/HEBC will contact the applicant to arrange a time and location for the written exam portion and field evaluation portion of the Falling & Bucking Endorsement. Candidates must be available to test at a site anywhere in British Columbia. HEBC will try to schedule the exam at a location as close as possible to the candidate's location; however, travel may be required. Candidates are responsible for their travel expenses. Alternatively, the candidate or their company can provide a site. Contact HEBC to review site requirements and QST costs. Applications are valid for 3 months unless a testing opportunity cannot be provided by HEBC. If a candidate turns down a testing opportunity, the application will expire 3 months after the date the application was approved. Applications will be extended indefinitely until a testing opportunity is made available. Payment of $1750.00 (plus $87.50 GST)* must be received by HEBC prior to the exam. If the applicant cancels 7 to 2 days prior to field test, a $350 (plus $15 GST)* will be charged to the applicant. If the applicant cancels the day before or day of the scheduled field test, the applicant must pay the full exam fee to re-schedule. If the applicant fails written or field evaluation, the applicant is responsible for paying any fees for QST mentoring required before re-testing. Applicant must reapply ($250 + GST) and submit proof of mentorship. The exam fee of $1750 (plus GST)* is due to HEBC prior to re-testing of the exam. Exam Fee Payment methods: Online payment by credit card, manual processing of credit card by phone or, Cheque to be made out to HortEducationBC, Mailed to: 24565 Dewdney Trunk Road Maple Ridge, BC V4R 1W9.Falling Bucking Endorsement Exam Terms* I have read and agree to the Falling Bucking Endorsement Exam Terms.I affirm that the information contained in this application is factual and accurate. I hereby request Falling and Bucking Endorsement assessment by a Qualified Assessor. I understand that loss of certification can occur if any information listed on the form is found to be false. I authorize the Western Utility Arborist Association (WUAA)/HortEducationBC (HEBC) to make whatever inquiries and investigations it deems necessary to verify credentials. I allow WUAA/HEBC to use information from my application for the purpose of statistical analysis, provided that my personal identification will be held in confidence. I am available to participate in the endorsement process, which includes: • Written exam (75% or higher must be achieved) • Field Evaluation (75% or higher must be achieved) I agree that the WUAA/HEBC or their designated agents shall be the sole authority as to who shall and who shall not be approved for endorsement. I understand and agree that the WUAA/HEBC falling and bucking endorsement does not qualify me to be a BC Forest Safety Council, Certified Faller. I will provide proof I will be covered by $5 million in liability insurance and have WorkSafeBC coverage. I have read and understand the cancellation policies and assume responsibility for these fees should they occur. I authorize HEBC to provide the company contact listed on this form with notification of exam "pass" or "fail", and if successful, digital copies of resulting endorsement documentation. I am responsible for QST expenses if the QST must travel to my location, an agreed upon location, or I will assume my own expenses to travel to the QST. I understand that I will not receive any refund in the event of an unsuccessful examination result and that I will have to pay the full fee to be re-tested. I have read and understood these statements, and I agree to be legally bound to them.Identity Declaration* I declare that I, the candidate named on this application, have completed this application myself and have agreed to the “Notice to Applicants” and “Terms” of this application form. I declare that this form has not been completed and submitted by a third party on my behalf. I declare that this application was completed on behalf of the candidate named on this application by an authorized representative of the company named. I understand that the candidate must confirm application information by phone with a HEBC representative and agree to the “Notice to Applicants” and “Terms” of this application form by email before the application will be processed. Authorized Company Representative Name* First Last Name of third party representative completing this form on behalf of the Candidate.Authorized Company Representative Email* Total Credit CardCard Details Cardholder Name "*" indicates required fields Applicants must complete all fields of the form. Applicants must provide their personal contact information. Applications that provide company information in this field will be rejected. Please state your full given name as you want it to appear on any official documents you will receive if successful in obtaining the endorsement. Do not submit this form unless you are ready to accept exam scheduling opportunities. Applications are valid for 3 months unless a testing opportunity cannot be provided by HortEducationBC due to QST availability or environmental factors such as fire hazard season. Non-refundable Falling & Bucking Endorsement Application Fee* Price: GST* Price: $ 0.00 CAD Name* First Name Last Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Cell*Email* BC Certificate Number* Emergency Contact Name* First Last Emergency Contact Relationship* Emergency Contact Phone*Company Name* Company Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Phone*Company Contact Name* First Last Please give the name and contact information of the representative of your company who will be handling administration and payment of your Falling and Bucking Endorsement attempt. Company notification of exam result, and if successful, digital copies of endorsement documents will be sent to this individual. Company Contact Email* HiddenUpload your ITA Arborist Technician or Utility Arborist Certificate of Qualification*Accepted file types: jpg, jpeg, gif, tif, tiff, png, pdf, Max. file size: 2 MB.Required: Upload your ITA Certificate of Qualification showing proof of completion of the Arborist technician or Utility Arborist certification. Alternatively, you can access a pdf copy of your transcript through your ITA Direct Access Account. Video instruction of how to download a copy are at the following link http://www.itabc.ca/registration-checklist/how-guides#TranscriptUpload your ITA Arborist Technician or Utility Arborist Certificate of Qualification* Drop files here or Select files Accepted file types: jpg, jpeg, gif, tif, tiff, png, doc, docx, pdf, Max. file size: 2 MB, Max. files: 5. Required: Upload your ITA Certificate of Qualification showing proof of completion of the Arborist technician or Utility Arborist certification. Alternatively, you can access a pdf copy of your transcript through your ITA Direct Access Account. Video instruction of how to download a copy are at the following link http://www.itabc.ca/registration-checklist/how-guides#TranscriptProof of Insurance Files upload Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 2 MB, Max. files: 40. Optional form field: Proof of Insurance Files Upload 1. Certificate of Insurance with a minimum of $5 million Liability coverage. 2. WorkSafeBC Clearance Letter 3. Letter from Employer declaring the applicant is covered under the liability insurance policy and WorkSafeBC policies provided, as an employee for the company named in the policies, for the duration of the WUAA/HEBC, Falling And Bucking Examination. If you are unable to provide this with your application you can email it to [email protected] Note: Your application will not be processed until all proof of insurance documents are received. Contact [email protected] if you need assistance.Notice To Applicants* I have reviewed and agree to the Notice To Applicants. Only applicants with a BC Certificate of Qualification as a Certified Utility Arborist or a Certified Arborist Technician will be considered for assessment. You are required to provide a copy of your BC Certificate of Qualification. Non-refundable Application Fee: $250.00 (plus $12.50 GST)*. Note* Application fees are nontransferable. Upon approval of the application, WUAA/HEBC will contact the applicant to arrange a time and location for the written exam portion and field evaluation portion of the Falling & Bucking Endorsement. Candidates must be available to test at a site anywhere in British Columbia. HEBC will try to schedule the exam at a location as close as possible to the candidate's location; however, travel may be required. Candidates are responsible for their travel expenses. Alternatively, the candidate or their company can provide a site. Contact HEBC to review site requirements and QST costs. Applications are valid for 3 months unless a testing opportunity cannot be provided by HEBC. If a candidate turns down a testing opportunity, the application will expire 3 months after the date the application was approved. Applications will be extended indefinitely until a testing opportunity is made available. Payment of $1750.00 (plus $87.50 GST)* must be received by HEBC prior to the exam. If the applicant cancels 7 to 2 days prior to field test, a $350 (plus $15 GST)* will be charged to the applicant. If the applicant cancels the day before or day of the scheduled field test, the applicant must pay the full exam fee to re-schedule. If the applicant fails written or field evaluation, the applicant is responsible for paying any fees for QST mentoring required before re-testing. Applicant must reapply ($250 + GST) and submit proof of mentorship. The exam fee of $1750 (plus GST)* is due to HEBC prior to re-testing of the exam. Exam Fee Payment methods: Online payment by credit card, manual processing of credit card by phone or, Cheque to be made out to HortEducationBC, Mailed to: 24565 Dewdney Trunk Road Maple Ridge, BC V4R 1W9.Falling Bucking Endorsement Exam Terms* I have read and agree to the Falling Bucking Endorsement Exam Terms.I affirm that the information contained in this application is factual and accurate. I hereby request Falling and Bucking Endorsement assessment by a Qualified Assessor. I understand that loss of certification can occur if any information listed on the form is found to be false. I authorize the Western Utility Arborist Association (WUAA)/HortEducationBC (HEBC) to make whatever inquiries and investigations it deems necessary to verify credentials. I allow WUAA/HEBC to use information from my application for the purpose of statistical analysis, provided that my personal identification will be held in confidence. I am available to participate in the endorsement process, which includes: • Written exam (75% or higher must be achieved) • Field Evaluation (75% or higher must be achieved) I agree that the WUAA/HEBC or their designated agents shall be the sole authority as to who shall and who shall not be approved for endorsement. I understand and agree that the WUAA/HEBC falling and bucking endorsement does not qualify me to be a BC Forest Safety Council, Certified Faller. I will provide proof I will be covered by $5 million in liability insurance and have WorkSafeBC coverage. I have read and understand the cancellation policies and assume responsibility for these fees should they occur. I authorize HEBC to provide the company contact listed on this form with notification of exam "pass" or "fail", and if successful, digital copies of resulting endorsement documentation. I am responsible for QST expenses if the QST must travel to my location, an agreed upon location, or I will assume my own expenses to travel to the QST. I understand that I will not receive any refund in the event of an unsuccessful examination result and that I will have to pay the full fee to be re-tested. I have read and understood these statements, and I agree to be legally bound to them.Identity Declaration* I declare that I, the candidate named on this application, have completed this application myself and have agreed to the “Notice to Applicants” and “Terms” of this application form. I declare that this form has not been completed and submitted by a third party on my behalf. I declare that this application was completed on behalf of the candidate named on this application by an authorized representative of the company named. I understand that the candidate must confirm application information by phone with a HEBC representative and agree to the “Notice to Applicants” and “Terms” of this application form by email before the application will be processed. Authorized Company Representative Name* First Last Name of third party representative completing this form on behalf of the Candidate.Authorized Company Representative Email* Total Credit CardCard Details Cardholder Name
