Record of Experience
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| 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 |
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| 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:_____ |
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I confirm that during the period from January 1, 2009 through December 31, 2011, 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. NRCan may contact me to verify information related to this application.
Candidate Name: ________________________,
Date_____ / _____ / _____
YYYY/ MM/ DD
Signature: Your signature MUST NOT exceed the inner limits of the signature box