Application Form Non-destructive Testing Certification

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Application Form Non-destructive Testing Certification

This application form is for candidates applying for NDT examination or Recertification examination, according to the CAN/CGSB 48.9712-2000 Standard. Before completing this application, please refer to the "Instructions for candidates applying for initial certification and recertification testing" booklet.

Mr. Mrs. Ms
Language: English, Français
Name: surname, given names
Address: city, province, postal code
Telephone, Date of birth

Present Employer
Address: city, province, postal code
Telephone, Fax, E-mail

Type of payment: Cheque, Money Order, Payable to Receiver General for Canada
Credit Card: Personal, Company, Visa, MasterCard, Cardholder's name, Amount, Card number, Expiry date

I am applying for examination as follows: With qualifying experience, without qualifying experience, 1st attempt, Retest, Recertification

Level 1, 2, 3
Industrial Radiography: EMC sector, Aerospace, Ultrasonics: EMC sector, Magnetic Particle: EMC sector, Liquid Penetrant: EMC sector, Eddy Current: EMC sector

Identification card photo: Applicants registering with the NDT Certifying Agency FOR THE FIRST TIME must provide two (2) photographs, picture size 2 in x 2 ¾ in.

Education: Education certificate(s) required for Level 3 applicants only
Elementary school, final grade passed, year.
Secondary school, address, final grade passed, date of certificate
University, degree or certificate - specialization, length - years, year

Training: Non-destructive Testing Courses only - Please submit a copy of each certificate
Sponsor, Subjects, Class hours, Lab hours, Date of certificate

Qualifying work experience: To gain a credit for work experience, one must work under "qualified supervision". Name(s) of supervisor(s) must be identified in the reference section.

The applicant must describe the Type of work performed, the materials inspected and the primary equipment used during employment. The work must be pertinent to the non-destructive testing method in which certification is requested.
Levels 1 & 2: Use additional sheet if space below for description is insufficient
Level 3 only: a) to complete summary of NDT experience in space below AND
b) to submit an exhaustive narration of NDT experience on separate sheets (8½" x 11")

Position 1: Company, Location, Position held, Period of employment dates, Acquired NDT experience: weeks, months, Percentage of time: RT, UT, MT, PT, ET

Description
1. Type of work performed, 2. Materials inspected, 3. Equipment used, 4. Codes, Standards and Specifications to which you worked

Position 2: Company, Location, Position held, Period of employment dates, Acquired NDT experience: weeks, months, Percentage of time: RT, UT, MT, PT, ET
Description
1. Type of work performed, 2. Materials inspected, 3. Equipment used, 4. Codes, Standards and Specifications to which you worked

References related to the above NDT Positions: Name, Registration Number, Certified CGSB, ASNT, PCN, etc., Title and Organization, Telephone

Declarations:
I certify that the statements made by me in this application are true and complete. I understand that if any of these statements are found to be untrue, this application may be rejected. Applicant's signature, Date.

I certify that the photographs attached are those of the applicant who signed this application form and that the information given on this form is to the best of my knowledge accurate. Supervisor's name and title, Supervisor's signature.

This section to be completed for candidates applying for Recertification by Examination.
Employer declaration: I certify that the candidate named herein has continued to be employed, without significant interruption* in the NDT method(s) and sector(s) identified on page 1 since the last common renewal date of January 1, _________ (YEAR).
*Significant interruption: An absence or a change of activity which prevents the certified individual from practising the duties corresponding to his/her level in the NDT method and the industrial sector(s) for which he/she is certified, for a continuous period exceeding one year. Name of company official, Signature.

Release of examination results: This is to authorize the NDT Certifying Agency, if requested, to release my examination results to my employer and/or the payee of my examination fees. Applicant's signature, Date.

IMPORTANT - Please allow two (2) weeks for the NDT Certifying Agency to process an application form.

NDT Certifying Agency, Natural Resources Canada, 183 Longwood Road South, Hamilton, Ontario, Canada L8P 0A5, Telephone: (866) 858-0473 or (905) 645-0653, Fax: (905) 645-0836

Office use only
Name, Method(s), Registration number, Application received, Acknowledged, Approved, Date, Fee Paid
Attached/Filed: Photo, vision, Ethics, Training, Education
Form AP3 Application.wpd Revised 2009