Application Form for XRF certification

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Application for X-Ray Fluorescence Operator (XRF) Certification, Renewal and Recertification

Mr. Mrs. Ms
Language: English Français
Name: surname given names
Address: city province postal code
Telephone: Date of Birth: yyyy/mm/dd
By signing this application, the candidate authorizes NRCan to disclose the candidates name, certification status, expiry date, city and province. Example: Web Listing of NDT Certified Personnel
CANDIDATE’S SIGNATURE
The signature MUST NOT exceed the inner limits of the signature box

DATE (yyyy/mm/dd)

Employer: (Please print)
Address:
City:
Province:
Postal Code:
Telephone:

For NRCan Use Only
Name:
Registration Number:
Received Date:
Approved By:
Approval Date:
Attached: Verification and two photos Training declaration Eye exam report Code of conduct Copy of log (Renewal) Application fee Examination fees

TYPE OF PAYMENT: Cheque Money Order (Cheques & money orders are payable to the Receiver General for Canada) Credit Card: Personal Company MasterCard Visa AMEX

Cardholder's Name, Amount: $, Card Number, Expiry Date

With your application you are required to submit the following forms:

Signed photo verification form + 2 passport photos ( 2 in x 2 ¾ in)
Signed training declaration (for initial certification and recertification)
Signed eye exam report
Signed code of conduct

For Renewal and Recertification
A copy of the log of safety checks as required by Safety Code 34 Section 2.3, Article 9.

Submit this application to: (Please allow two (2) weeks for the NDT Certifying Agency to process an application)
NDT Certifying Agency
CANMET Materials Technology Laboratory
http://www.nrcan.gc.ca/minerals-metals/non-destructive-testing/2969

Telephone: 905-645-0653 or 1-866-858-0473
Fax: 905-645-0836
Email: ndt@nrcan.gc.ca