SC-202 Application for Interstate/Intrastate Commerce Inspector

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OMB No. 0581-0125

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According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond
to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information
collection is 0581-0125. The time required to complete this information collection is estimated average 30 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.
Non-Discrimination Policy: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA
programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender
expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance
program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA
(not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape,
American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and
TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made
available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter
all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed
form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400
Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
APPLICATION FOR INTERSTATE/INTRASTATE
COMMERCE INSPECTOR’S LICENSE 1

NOTE: Applicants for this License must have at least 36 months of fresh fruit and vegetable grading experience as a USDA Licensee.
1. NAME (Last, First, Middle)
E-MAIL

2. BIRTHDATE (Month, Day, Year)

3. MAILING ADDRESS (City, State, Zip)

4. CURRENT DUTY STATION (City, State, Zip)

5. IMMEDIATE SUPERVISOR’S NAME (Last, First, Middle)

6. TELEPHONE NUMBER

7. LIST ALL STATES IN WHICH YOU HAVE BEEN LICENSED AND SHOW THE TOTAL NUMBER OF MONTHS YOU WERE LICENSED BY THAT STATE:
STATE(S)

MONTHS

STATE(S)

MONTHS

STATE(S)

MONTHS

STATE(S)

MONTHS

STATE(S)

MONTHS

STATE(S)

MONTHS

8. LIST ALL PREVIOUS EMPLOYERS FOR THE PAST FIVE YEARS (If additional space is required, use back of this form):
EMPLOYER’S NAME

EMPLOYER’S ADDRESS (City, State, Zip)

9. DID YOU GRADUATE FROM HIGH SCHOOL (if you have a GED, answer yes)?

DATE BEGAN

YES

DATE ENDED

NO

10. IF NOT, WHAT IS THE HIGHEST GRADE THAT YOU COMPLETED?
11. +AVE YOU ATTENDED COLLEGE (if yes, list below all colleges attended, use back if needed)?
NAME OF COLLEGE

YES

NO

COLLEGE ADDRESS (City and State)

TYPE OF DEGREE OR TOTAL
SEMESTER HOURS

12. LIST CHIEF UNDERGRADUATE SUBJECTS

13. APPLICANTS SIGNATURE

DATE

By signing above, I agree to abide by all Federal instructions governing the inspection of fruits and vegetables, whether given to me in writing (Inspection Instruction, Administration,
Inspection or Management (AIM) documents, etc.) or orally by the Federal Program Manager/Supervisor. I also agree to surrender my license card when so requested by the Federal
Supervising Inspector or upon termination of my employment with my current employer.
THE FOLLOWING TO BE COMPLETED BY APPROVING OFFICIALS ONLY
FEDERAL PROGRAM MANAGER / SUPERVISOR’S SIGNATURE

CHECK ONE

Unrestricted License

DATE RECOMMENDED

Other (Specify)

Restricted License – to what commodities?
The state concurs in the need for an unrestricted license and agrees to send the applicant to a Market Inspector Training class within two years from date of approval and
to provide other training as deemed necessary by the USDA Director of the Specialty Crops Inspection Division.
DATE:

STATE MANAGER’S SIGNATURE:

Concurrence

Disapproval

SC-202 (6-2017) Destroy previous editions.

BRANCH CHIEF’S SIGNATURE:

DATE:

1

As defined in the current SCI Division Manual for Federal and Federal State Supervisors