Flagger Instructor Application

Flagger Instructor Application
Thank you for your recent interest in becoming an Evergreen Safety Council certified flagger Instructor. In order to be considered for an upcoming training course, you must submit an application. If you have questions about the process or requirements, please do not hesitate to contact us at Flagger@esc.org.
To get started, please select the option that best describes you from the drop down below:*
Which curriculum are you seeking to become a flagger instructor for? *
If you are teaching for Idaho or Connecticut please select MUTCD

Personal information

Enter your personal details
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Drivers license number*
Date of Birth*

YearMonthDay
Date
Mailing address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Education

High school graduate or GED?College or University graduate?Other specialized training
Resume

A resume is required if you would like to teach as an independent contractor for Evergreen Safety Council.
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Authorized Training Provider (ATP) information
All instructors must be employed by an Authorized Training Provider (ATP). Please select your employer from the list below or select "New Provider" if your company is not yet an ATP.
Are you employed by a company that is currently an ATP or will you be a new training provider?

Current ATPNew ATP
ATP Name*
Company (or agency) name*
Company address (if different from mailing address entered above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact person*
Must be eligible to sign on behalf of the company/agency
Contact phone*
Please enter a valid phone number.
Contact email*
example@example.com
How many people do you anticipate training on an annual basis?*
Business documentation

In order to be eligible to become an ATP, you must provide the following documentation for verification:
- A valid business license
- Proof of commercial liability insurance (also called a COI)
Business license

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Certificate of Insurance (COI)

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Statement of interest
Briefly explain why you'd like to become a flagger instructor through Evergreen Safety Council. Please include any work zone experience as well as presentation/teaching experience you may have.
Statement of interest*

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Required prerequisites

Washington State Flagger Instructor
In order to be eligible to take the Washington State flagger instructor certification course, you must provide the following documentation as required by the Washington State Traffic Control Oversight Committee (TCOC):
- Proof of successful completion of a WSDOT-approved Traffic Control Supervisor (TCS) course within the last 4 years
- Driver license or government-issued photo ID; and
- Current Washington State Flagger Certification card
Please upload your prerequisites using the fields below.
Driver license or government-issued photo ID*

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Washington Flagger certification

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Washington TCS/TCT certification

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Required prerequisites

MUTCD Flagger Instructor
In order to be eligible to take the MUTCD flagger instructor certification course, you must submit a copy of your current flagger card AND one or more of the following:
- For Idaho, proof of successful completion of an Idaho Department of Transportation (IDT) approved TCS course;
- Letter verifying prior flagging instruction experiences, including teaching at least 4 flagging classes in the last 12 months (e.g., current WA or OR flagger instructor); OR
- Letter(s) verifying 1000 hours of flagging experience.
Please upload your prerequisites using the fields below.
Driver license or government-issued photo ID*

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Idaho Flagger certification

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Proof of IDT approved TCS course -- OR -- Letter verifying experience

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Optional 2nd letter verifying experience

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Applicant declaration
I declare under penalty of perjury that the information provided on this application is true and correct.
Signature*

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Date*

MonthDayYear
Date
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Personal information