I am requesting a National LIFTOR CERTIFICATION PACKET for the following Candidate Industrial Truck Operator:

(To be completed by National LIFTOR CERTIFIED Instructors & Test Examiners, ONLY.)

 
Candidate Name:
Registry #:    If new candidate, leave blank.  If.
  re-certification, then enter 4 digit LIFTOR ID
  
Please
Select EEOC Code:		 

  

  
Gender:

  

  
Describe Truck:
  
CERTIFIED  Examiner: 
Email Address:
  
Company:
Street Address
City, State and ZIP
Telephone:
 Message:

 

 

 

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