NDT Renewal Form 2012

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PROTECTED (when complete)

** These documents must be completed in their entirety for processing **

NDT PERSONNEL CERTIFICATION TO THE STANDARD CAN/CGSB-48.972-2006

RENEWAL APPLICATION FORM
for NDT pocket cards expiring December 31, 2012

Mr./M □ Mrs./Mme □ Ms □

Name /
Surname Given Names Card Reg #

Address
City _________ Province _________ Postal Code _________

Tel. _________ Email: __________________

Date of Birth: YYYY ______ MM ______ DD ______

Check □ NDT Methods and sectors:
RT-EMC□ RT-A/S□ UT-EMC□ MT-EMC□ PT-EMC□ ET-EMC□

Present Employer:

Address

City _________ Province _________ Postal Code _________

Tel. _________ Email: __________________

Payable to Receiver General for Canada
Application received after December 31st, 2012 must include a $100 late fee.
**Personal cheques are not accepted for renewal**

Type of Payment:

Company Cheque □ Money Order □
Credit Card: □ Personal □ Company □ Visa/Mastercard □ Amex

Cardholder Name __________________ Amount __________________

Card No. ____________________________________ Expiry Date__________________

Signature:

Please Note: Payment of fees does not complete or guarantee the renewal process. Renewal of certification is issued only after completion, verification, and NRCan approval of application.

Late Renewal Policy

Candidates are responsible for ensuring the active status of their NDT certification by renewing their certificates before the expiry date. To apply for renewal of certification, a candidate must submit to the NDT Certifying Agency a properly completed renewal application, an eye examination report, a signed code-of-conduct form, the applicable renewal fee, and, if required, 2 personal photographs. To avoid a lapse of certification after the December 31 expiry date, it is strongly recommended that candidates ensure their renewal applications are received by the NDT Certifying Agency no later than December 1^st 2012.
NDT certification status becomes inactive if a candidate fails to renew by the certificate expiry date.
Up to 2 years after the certificate expiry date, a candidate's certification status can apply for reactivation by submitting the documents mentioned above, along with a completed and signed proof-of-work-experience form and a $100 late renewal fee in addition to the regular renewal fee. Late renewals may require additional information, documentation and/or verification.

If the renewal application is submitted more than 2 years after the certificate expiry date, a candidate can reactivate their certification status by successful recertification.

Record of Experience
Please check the applicable boxes and fill in the information requested.
General Work History in NDT Over The Last Three (3) Years
Industry		Applications	Materials		Percentage of Time		Approximate Percentage Time Spent
Aviation/aerospace Nuclear Petro-Chemical Manufacturing Mining Pulp and paper Ship Yard Structural Training/Certification Research Other: _______		Welds Forgings Castings Pipe/Tubes Fittings/valves Pressure vessels Nozzles/nodes Storage tanks Lift Equipment Structures Other: _______	Steel Stainless Steel Copper Aluminum Magnesium Concrete Ceramic Plastic Composites Other: _______		_____ % MT _____ % PT _____ % RT _____ % UT _____ % ET 100% Total		____ % doing inspections ____ % planning/reporting ____ % supervision of staff/meetings ____ % training (take/give) conferences ____ % writing procedures /documents ____ % other
Details (approximate) of Work History in each NDT method Over the Last Three (3) Years
MT	PT			RT		UT		ET
Certification Level___ Yoke Coil wrap Prods Wet bench Dry Powder Aerosol Visible Fluorescent Other:______ Reports Instruction Procedures Standards Other:______	Certification Level___ Aerosol Brush Dip Tanks Solvent removable Water wash Post emulsifier Visible Fluorescent Other:_____ Reports Instruction Procedures Standards Other:_____			Certification Level___ Isotope X-Ray Linear accelerator Film Fluoroscopy Digital Auto develop Manual dev Other:_____ Reports Instruction Procedures Standards Other:_____		Certification Level___ Thickness gauge Flaw detector Phased array Straight beam Angle beam Contact Immersion Other:_____ Reports Instruction Procedures Standards Other:_____		Certification Level___ Analog meter Phase display Single freq Multi-freq Remote field Absolute mode Differential mode Spinning mode Other:_____ Reports Instruction Procedures Standards Other:_____

I confirm that during the period from January 1, 2010 to the date of this application, I did not have an absence or change of activity that prevented me from practicing the duties to my level in the NDT method and sectors for which I am certified, for either a continuous period in excess of one year or two or more periods for a total time exceeding two years.

I attest 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. I agree that NRCan may contact me or signatories to verify information related to this application. Renewal of certification is issued only after completion, verification and NRCan approval of application.

Candidate Name: __________________,
Date
YYYY/MM/DD Card Reg #

Signature: Your signature MUST NOT exceed the inner limits of the signature box.

ATTESTATIONS
*Please Note: All 3 attestation sections need to be completed. Applicants cannot sign for themselves.* For the required signatures, the same person(s), appropriately qualified for each of these definitions, may sign for one or more of these roles. Unemployed applicants may complete the ‘Unemployment form for renewal’ and are only exempt from two signatures on the attestation form (the employer and supervisor sections) however, still require a qualified personnel to sign the attestation form to attest to your working using your indicated NDT methods within the time period of concern. For more clarification for special circumstances, please contact the NDT CA directly.

Employer: [A member of the management staff of the organization that the applicant works for on a regular basis. (If self-employed, a partner/co-worker, a business associate or a customer may sign in this capacity.)]

I attest that the information given on this form is accurate and the photographs attached are those of the applicant who signed this application form. NRCan may contact me to verify information related to this application.

____________________________________ Date:_____ / _____ / _____
Employer's name (Please Print) YYYY MM DD

Employer's signature Employer's job title

Curent employer __________ Address __________

Tel. : __________ Email _______________

Supervisor An appropriately qualified individual who is accountable for directing the technical work and safety of the applicant. The supervisor will normally belocated at the facility or field site of the test or inspection activity and is responsible for supervising the technician(s) and other procedural aspects of the job. Qualified supervisors would include personnel certified at the appropriate level under CAN/CGSB-48.9712-2006 or non-certificated personnel who, in the opinion of NRCan, possess the knowledge, skill, training and experience required to properly provide such supervision. In some cases, it is possible that a supervisor may not be employed by the same employer as the applicant. In that case, please provide a document explaining the supervisory relationship. (If self-employed, a partner/co-worker, a business associate or a customer may sign in this capacity.)]

____________________________________ Date: _____ / _____ / _____
Supervisor's name (Please Print) YYYY MM DD

Supervisor's signature Supervisor's job title

Curent employer __________ Address __________

Tel. : __________ Email _______________

Sponsor [Active NRCan/CGSB-certified Level 2 or Level 3 personnel that can attest to and substantiate the validity of the candidate's application.] Cert. Number

____________________________________ Date: _____ / _____ / _____
Sponsor’s name (Please Print) YYYY MM DD

Sponsor’s signature Sponsor's job title

Current employer __________ Address__________

Tel. : __________ Email _______________

** These documents must be completed in their entirety for processing

When applying for renewal you should include:

□ This Current version of the Renewal Application Form

Record of Experience
Attestation Form
- Employer
- Supervisor
- Sponsor (Certified CGSB Level 2 or Level 3)

*Please Note: Applicants cannot sign for themselves*
For the 3 required signatures of the following declarations, please note that the same person, appropriately qualified for each of these definitions, may sign for one, or more than one or all of these roles.

□ Eye Examination Report dated within 2012
□ Code of Conduct
□ Applicable fees

The renewal fees for this three year term are as follows:

Number of methods
1	2	3	4	5
$150	$255	$345	$405	$435

Methods certified within the renewal year is $0

*Renewals submitted after December 31^st 2012 will be required to include a $100 late fee in addition to the regular renewal fees*
It is important to note that there will be no renewal fee applied to initial certification and/ or recertification acquired in a NDT method in Jan 1- Dec 31^st 2012.

□ 2 Passport Photographs- photograph size 2 in x 2 ¾ in

Unemployed applicants please refer to the Photo Verification Form.

Please Note: Renewal applications are subject to current NRCan policies and procedures. Processed payment does not complete or guarantee the renewal process. Renewal of certification is issued only after completion, verification and NRCan approval of application. Late renewals may require additional information, documentation and/or verification. As renewal applications are processed in arrival sequence, processing times may vary depending on the volume of applications received and are not guaranteed. Incomplete documentation or complexity of routine verifications and checks may also lead to longer processing times.

*** These documents must be completed in its entirety for processing***

IMPORTANT

The NDT Certifying Agency has relocated to Hamilton from Ottawa
Please check our website for most up-to-date information & policies
http://www.nrcan-rncan.gc.ca/mms-smm/ndt-end/index-eng.htm

NDT Certifying Agency
CanmetMATERIALS
183 Longwood Road South
Hamilton, Ontario L8P 0A5

Tel.: 905-645-0653 or 1- 866-858-0473
Fax: 905-645-0836

Key Contacts Page:
http://www.nrcan-rncan.gc.ca/mms-smm/key-pri-eng.htm#ndt

NDT Renewal Form 2012

RENEWAL APPLICATION FORM for NDT pocket cards expiring December 31, 2012

RENEWAL APPLICATION FORM
for NDT pocket cards expiring December 31, 2012