Application form for CNSC's exposure device operator examination
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APPLICATION FORM
CANADIAN NUCLEAR SAFETY COMMISSION (CNSC)
EXPOSURE DEVICE OPERATOR (EDO) EXAMINATION
{Before completing this application, please refer to the
"Instructions for candidates applying for the CNSC examination for Exposure Device Operator" guide.}
Mr. Mrs. Ms
Language: English, French
NAMES: SURNAME, GIVEN NAME
ADDRESS: CITY, PROVINCE, POSTAL CODE,
TELEPHONE:
DATE OF BIRTH: YYYY.________│MM________│ DD______
CANDIDATE’S SIGNATURE
DATE YYYY/MM/DD
PRESENT EMPLOYER:
ADDRESS:
CITY, PROVINCE
TELEPHONE: FAX:
Candidates registering with the NDT Certifying Agency FOR THE FIRST TIME must provide two (2) signed passport photographs (Dimensions of 2 in x 2 3/4 in).
EMPLOYER VERIFICATION:
I verify that the attached photographs are those of the employee whose name appears on this application.
Supervisor:
Signature:
(please print)
Date:
YYYY/MM/DD
PLEASE INDICATE YOUR EXAM STATUS: Application for initial attempt only (Fee $250.), Rewrite (Fee $200.), I will do my practical at a NDT test centre, First Attempt (Fee $60.), Repeat (Fee $60.)
Type of Payment : Cheque, Money Order, (Cheques and money orders are made payable to the Receiver General for Canada)
Credit Card: Personal, Company, MasterCard, Visa, Amex
Cardholder's Name, Amount, Card No., Expiry Date
SUBMIT APPLICATION AND FEES TO:
NDT Certifying Agency
CANMET Materials Technology Laboratory
Natural Resources Canada
183 Longwood Road South
Hamilton, ON L8P 0A5
INQUIRIES:
Telephone: (866) 858-0473
Fax: (905) 645-0836
E-mail: ndt@nrcan.gc.ca
OFFICE USE ONLY
Name, Registration No
APPLICATION:
Rec’d: Date
Ackn’d: Date
Approved: Date
Fee Paid: Date
EDOAppl-E.wpd (December 16,2010)