PROTECTED (when complete) · renewal of certification, a candidate must submit to the NDT Certification Body a properly completed renewal application, a Vision Test Report Form for

PROTECTED (when complete)

RENEWAL AND RECERTIFICATION APPLICATION FORM **These documents must be completed in their entirety to be processed by Natural Resources Canada (NRCan) National Non-Destructive Testing Certification Body (NDTCB)**

Incomplete documentation may lead to longer processing times. This application form is for candidates applying for Non-Destructive Testing (NDT) Renewal or Recertification according to the CAN/CGSB-48.9712-2014 Standard.Please note: Applicants must submit the “Recertification Examination Request Form” when applying for recertification.

Mr □ Mrs □ Ms □ Preferred Language English □ Français □

Name ____________________________________________/_______________________________________ Reg # __________________ Surname (Last Name) Given Names

Former Surname (Last Name) if applicable ______________________________________________________________________________

Address of Residence___________________________________________________________________________________

City_____________________________________________________ Province ___________________ Postal Code___________________

Mailing Address (if different than above) _________________________________________________________________________________

City_____________________________________________________ Province _____________________ Postal Code__________________

Tel (Home) ____________________________________ Tel (Cell) ____________________________________________

Email ____________________________________________________________________________________________________________

Date of Birth: YYYY_______MM______DD______

Present Employer __________________________________________________________________________________________________

Contact Name ______________________________________________________ Title ___________________________________________

Address__________________________________________________________________________________________________________

City__________________________________________________ Province ___________________ Postal Code_______________________

Tel _________________________________ Email ___________________________________________________________ I am applying for Renewal and/or Recertification in the following methods: Note: Under the CAN/CGSB-48.9712-2014 Standard recertification is required every second period of validity (i.e. every 10 years).

Industrial Radiography Ultrasonics Magnetic Particle Liquid Penetrant Eddy Current EMC Sector Aerospace EMC Sector EMC Sector EMC Sector EMC Sector

□ Renewal □ Renewal □ Renewal □ Renewal □ Renewal □ Renewal□ Recertification □ Recertification □ Recertification □ Recertification □ Recertification □ Recertification□ Re-examination □ Re-examination □ Re-examination □ Re-examination □ Re-examination □ Re-examination

Applications received after certification expiry date must include a late fee. Type of Payment: **Personal cheques are not accepted for renewal** Personal Credit Card □ Company Credit Card □ Visa □ MasterCard □ Amex □ Company Cheque □ Money Order □

Cardholder Name ____________________________________________________________ Amount__________________

Card No._________________________________________________________________ Expiry Date__________________

Cardholder Signature______________________________________________________ Payable to “Receiver General for Canada” Fees are non-refundable and non-transferable. Please Note: Payment of fees does not complete or guarantee the renewal or recertification process. Renewal of certification is issued only after completion, verification, and NRCan NDTCB approval of application. It is the applicant’s responsibility to provide the NRCan NDTCB with payment information for each application submitted. To protect payment information, we ask that all forms containing credit card information (Mastercard, Visa, AMEX) be submitted via Fax or Mail only. Do not send credit card information by e-mail. If you have any questions, please call 1-866-858-0473 or our Recertification Hotline 905-645-0835. Renewal applications are subject to current NRCan NDTCB policies and procedures. 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. The NRCan NDTCB makes all reasonable efforts to ensure candidate applications, examination requests and certification submissions are completed as per service standard targets. Despite these efforts, the occurrence of errors, omissions and delays cannot be completely ruled out and the NRCan NDTCB is not responsible for any direct and indirect costs, expenses or delays which may arise.

Aussi accessible en français NRCan National NDT Certification Body (NDTCB) 8.2.1-004 Renewal and Recertification Application Form Version 03

Published 2017-06-09Page1 of 6

____________________________________________________________

ro

YYYY-MM YYYY-MM

m ___________ To ____________ YYYY-MM YYYY-MM

DOCUMENT MUST BE COMPLETED IN ITS ENTIRETY FOR PROCESSING PROTECTED (when complete)

Record of Experience Please check the applicable boxes and fill in the information requested

Work History for the past 5 Years (include additional pages if required)

Period Of Employment: From ___________ To __________

Position held ___________

Period Of Employment: F

Position 1

Company ___________________________

Location ____________________________

Position 2

Company ___________________________

Location_____________________________ Position held ____________________________________________________________________ General Work History in NDT over the Last Five (5) 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

_______% VT

_______% Other Combined Total = 100%

_____ % 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 Five (5) Years MT PT RT UT ET VT □ Yoke □ Aerosol □ Isotope □ Thickness gauge □ Analog meter □ Coil wrap □ Brush □ X-Ray □ Flaw detector □ Phase display □ Prods □ Dip Tanks □ Linear accelerator □ Phased array □ Single freq

□ Wet bench □ Solvent removable □ Film □ Straight beam □ Multi-freq

□ Dry Powder □ Water wash □ Fluoroscopy □ Angle beam □ Remote field□ Aerosol □ Post emulsifier □ Digital □ Contact □ Absolute mode □ Visible □ Visible □ Auto develop □ Immersion □ Differential mode □ Fluorescent □ Fluorescent □ Manual dev Other:_________ □ Spinning mode Other:_________ Other: ________ Other:_________ Other:_________

□ Reports □ Reports □ Reports □ Reports □ Reports □ Instruction □ Instruction □ Instruction □ Instruction □ Instruction□ Procedures □ Procedures □ Procedures □ Procedures □ Procedures □ Standards □ Standards □ Standards □ Standards □ Standards Other:_________ Other: ________ Other: ________ Other: ________ Other: ________

I attest to the validity of the information provided above:

Applicant Signature _____________________________________________________ Date_____________________________

Supervisor* Signature ___________________________________________________ Date_____________________________

Aussi accessible en français Version 03

Published 2017-06-09Page 2 of 6

YYYY-MM-DD

YYYY-MM-DD*Same Supervisor as Section B on page 3

NRCan National NDT Certification Body (NDTCB) 8.2.1-004 Renewal and Recertification Application Form

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

___________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________


ATTESTATIONS *Please Note: All attestation sections must 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 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 NDTCB directly. A) Employer: A member of the management staff of the organization that the applicant works for on a regular basis. Self employed applicants:please indicate your status here. I attest to the best of my knowledge that the information given on this form is accurate and/or the photographsattached are those of the applicant who signed this application form. The NRCan NDTCB may contact me to verify information related to this application.Certification Number (if applicable): ____________________________

______________________________________________________________________ /___________/_____________ Employer's full given name (Please Print) YYYY MM DD

Date ___________

Employer's signature Employer's job title

Current employer Address

Telephone ______________________________________________ Email _________________________________________________________ B) Supervisor: An appropriately qualified individual who is accountable for directing the technical work and safety of the applicant. The supervisorwill normally be located at the facility or field site of the test or inspection activity and is responsible for supervising the technician(s) and otherprocedural aspects of the job. Qualified supervisors would include personnel certified at the appropriate level under CAN/CGSB-48.9712 or non-certificated personnel who, in the opinion of the NRCan NDTCB, possess the knowledge, skill, training and experience required to properlyprovide such supervision. In some cases, it is possible that a supervisor may not be employed by the same employer as the applicant. In thatcase, please provide a document explaining the supervisory relationship. (If self-employed, a partner/co-worker, a business associate or acustomer may sign in this capacity.) I attest to the best of my knowledge that the information given on this form is accurate and/or thephotographs attached are those of the applicant who signed this application form. I have also signed and dated page 2 of this application. TheNRCan NDTCB may contact me to verify information related to this application.Certification Number (if applicable):_______________________________

_________________________________________________________________________ Date /___________/_____________ Supervisor's name (Please Print) YYYY MM DD

Supervisor's signature Supervisor's job title

Current employer Address

Telephone _______________________________________________Email________________________________________________________ C) Sponsor: Active NRCan/CGSB-certified Level 2 or Level 3 personnel that can attest to and substantiate the validity of the candidate'sapplication. I attest to the best of my knowledge that the information given on this form is accurate and/or the photographs attached are those of theapplicant who signed this application form. The NRCan NDTCB may contact me to verify information related to this application.Certification Number:____________________________________

__________________________________________________________ Date ___________/___________/_____________ Sponsor’s name (Please Print) YYYY MM DD

______________________________________________________________________________________________________________________ Sponsor’s signature Sponsor's job title

_____________________________________________________________________________________________________________________ Sponsor’s telephone number Current employer



Published 2017-06-09

Page 3 of 6


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 Certification Body a properly completed renewal application, a Vision Test Report Form for Non-Destructive Testing Personnel, a signed NRCan NDTCB Code of Conduct form, the applicable renewal fee, and, if required, 2 passport photographs. NDT certification status becomes inactive if a candidate fails to renew by the certificate expiry date. Up to 12 months after the certificate expiry date, a candidate can apply for reactivation of certification status by submitting the documents mentioned above, along with a completed and signed proof-of-work-experience form and a 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 12 months after the certificate expiry date, a candidate can reactivate their certification status by successful recertification. Successful completion of the initial certification process is required if the candidate fails recertification.

Other Information Payment: Government of Canada Acquisition Cards are not accepted by the NRCan National Non-Destructive Testing Certification Body. Payment from Other Government Departments should be made by inter-departmental FIS transactions. Fees: Fees and other process requirements are subject to change; please refer to our website ndt.nrcan.gc.ca for the most current information. Privacy Policy: NRCan NDTCB is committed to protecting your privacy whether you are an existing client or a new applicant. All personal information created, held, or collected by the Government of Canada is protected under the federal Privacy Act. Our office will ensure that collected personal information will not be disclosed to anyone except Government of Canada personnel who require the information to complete their responsibilities and/or to a third-party that has been specified by the client or applicant in writing to our office. Any communications between the NDTCB and their clients or applicants are considered confidential and are for the exclusive use of the intended recipient. Personal information is collected pursuant to section 5 of the Natural Resources Act as stated in NRCan’s Info Source (PAA 3.1.2 – Materials and Certification for Safety and Security) and certified personnel's name, city and province of residence and certification status will be made publicly available in support of clause 9.3 of CAN/CGSB-48.9712-2014 as a supplementary mechanism of certification status verification. Responsibilities: Certified personnel and applicants must respond to NRCan NDTCB communication in a timely manner, and inform the NRCan NDTCB of any changes to address and contact information.

Applicant Attestation I confirm that during the past period of validity 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. Late renewals may require additional information and/or verification.

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

Your signature MUST NOT exceed the inner limits of the signature box

Name (Please Print):

______________________________________________

Date:

___________/____________/_____________ YYYY / MM / DD

RELEASE OF INFORMATION

This is to authorize the NDTCB, if requested, to release my examination results, additional information and/or admittance forms to my employer and/or the payee of my examination and application fees.

_____________________________________________ Date: ________/______/______ Applicant's signature YYYY MM DD

This is to authorize the NDTCB to allow ____________________________ to act on my behalf to provide application information and receive applicable updates/ correspondence. Contact’s Full Name

____________________________ ______________________________________ ____________________________________ Applicant’s signature Contact’s telephone number Contact Email





NDT RENEWAL AND RECERTIFICATION CHECKLIST Please include the following checklist when submitting application

All Renewal and Recertification applications will require the following requisites prior to certification approval: Enclosed

Yes No 1) APPLICATION FORM (PAGES 1-4)

The application form must be fully completed, signed and current dated by the applicant and must include all requiredattestations. Please see section four (4) below for more information. To apply for recertification, please select the “Recertification”option for the appropriate NDT method on the “Renewal and Recertification Application Form.”

� �

2) FEESMethod of Payment: The following forms of payment are accepted by the NDT Certification Body: company cheque, moneyorder, MasterCard, Visa or American Express. No personal cheques will be accepted for renewal. Company cheques andmoney orders are to be made payable to the Receiver General for Canada. If paying by credit card, you must print the nameidentified on the credit card, card number, expiry date and amount. Please note that we do not accept credit card information byemail.Payment of fees does not complete or guarantee the renewal or recertification process.

Renewal and Recertification applications submitted after the expiry date will be required to include a late fee in addition to theregular fees.

� �

3) RECORD OF EXPERIENCE (PAGE 2)Verifiable documentary evidence of continued satisfactory work activity without significant interruption in the method and sectorfor which certificate renewal is sought is required for Renewal and Recertification.Significant interruption is defined as per CAN/CGSB-48.9712-2014 Standard para 3.27 as absence or change of activity withprevents the certified individual from practising the duties corresponding to the level in the method and the sector(s) within thecertified scope, for either a continuous period in excess of one year or two or more periods for a total time exceeding two years.If the criterion for renewal is not met the individual will be required to recertify. Please ensure that the supervisor and applicanthas signed this page.

� �

4) ATTESTATIONS (PAGE 3)Please note: all three (3) attestation sections need to be completed. Applicants cannot sign for themselves. For the requiredsignatures, the same person(s), appropriately qualified for each of these definitions, may sign for one or more of these roles.Unemployed applicants 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 work using your indicated NDT methodswithin the time period of concern. For more clarification for special circumstances, please contact the NDTCB directly.

� �

5) NRCan NDTCB CODE OF CONDUCT (FORM 8.2.1-002)Individuals who are certified or individuals who are in the process of being certified by the NRCan NDTCB must recognize thatpersonal integrity and professional competence are the fundamental principles on which their activities are founded. Accordingly, itis a condition of NRCan NDTCB certification that these individuals shall sign and submit the NRCan NDTCB Code of Conduct form.

� �

6) VISION TEST REPORT FORM FOR NON-DESTRUCTIVE TESTING PERSONNEL (FORM 8.2.1-003)Each NDT candidate must undergo a visual acuity test with an ophthalmologist, optometrist or other medically recognizedpersonnel attesting that the candidate has completed a satisfactory vision test as outlined by the Vision Test Report Formfor Non-Destructive Testing Personnel. The report must be dated within 12 months prior to the certification expiration date.

� �

7) TWO (2) PASSPORT PHOTOSCertified Personnel must provide two (2) passport photographs every second period of validity (every 10 years).The photos must:- be taken by a commercial photographer, clear/focused, in color, taken straight on with the face and shoulders centered and squared

to the camera and measure 5cm wide and 7cm high (2 inches wide and 2-3/4 inches high);- reflect the candidate’s current appearance (taken within the last twelve (12) months);- be professionally printed on photographic paper (photos printed at home, self-taken or non-passport type photos are not acceptable);- show your complete name, as well as the name and complete address of the photo studio and the date the photo was taken on the

back of one photo;- additional photographs may be requested at any time if previous photographs are deemed unacceptable.

� �

8) RECERTIFICATION EXAMINATION REQUEST FORM (RECERTIFICATION ONLY) (FORM 8.2.1-005)Applicants for recertification must include a completed “Recertification Examination Request Form” in addition to the “Renewal andRecertification Application Form” in order to receive an admittance form. Clients are not permitted to attempt recertification examswithout an authorized, method-specific examination admittance and registration form.

� �

9) RECERTIFICATION FEES (RECERTIFICATION ONLY)Recertification examination registration fees are required for each method due for recertification in addition to the appropriaterenewal fee.

� �




DOCUMENT MUST BE COMPLETED IN ITS ENTIRETY FOR PROCESSING

MORE INFORMATION

PROTECTED (when complete)

CERTIFICATION EXPIRATION DATES: The NRCan NDTCB has introduced a new expiration date for all certifications. Newly certified personnel and existing certified personnel will have an expiration date of the 15th day in their birth month for up to 5 years (60 months or less). The new period of validity for existing certified personnel will be their birth month up to the fifth year (60 months or less) of certification following renewal. o Example: For an individual who is required to renew in December 2017 and is born in April: the new expiry date of the certification will be April 15 2022.

Certified personnel who receive a new certification under CAN/CGSB-48.9712-2014 / (ISO 9712:2012,IDT) will be required to renew in their birth month in the fifth year (60 months or less) following certification regardless of any other renewal dates set by the NDT Certification Body. Note: Clients may have existing methods however subsequent methods will be issued a period of validity separately. RECERTIFICATION QUALIFICATIONS: Prior to the completion of each second period of validity (every 10 years), the certified individual may be recertified by the certification body for a new period of five years or less, provided that the individual meets the criterion for renewal. Please note: Applicants must include a completed “Recertification Examination Request Form” in addition to the “Renewal and Recertification Application Form” in order to receive an admittance form. Clients are not permitted to attempt recertification exams without an authorized, method-specific examination admittance and registration form. RECERTIFICATION (BY EXAMINATION): Recertification is completed by examination as follows: Level 1: Recertification by practical examination.Level 2: Recertification by practical examination and written instruction (RT2: Film Interpretation instead of written instruction).Level 3: Recertification by practical examination (RT3 includes Film Interpretation) and a choice of either Structured Credit System or written examination. LEVEL THREE (3) RECERTIFICATION: For written examination: Level 3 Recertification may be processed differently than Level 1 or Level 2 in that a structured credit system will be allowed as an option to the written recertification examination as per 11.3.1 b) of CAN/CGSB-48.9712-2014 / (ISO 9712:2012, IDT). For practical examination: Level 2 practical exam is required, alternative documentation is not acceptable. RE-EXAMINATIONS: Level 1 and 2 If the individual fails to achieve a grade of at least 70% for each individual part and specimen of the recertification examination, two re-examinations of the recertification examination shall be allowed after at least 7 days and within six months of the first attempt at the recertification examination. In the event of failure in the two allowable re-examinations the certificate shall not be revalidated and, to regain certification for that level, sector and method, the candidate shall apply for new certification. Level 3 If the individual fails to achieve a grade of at least 70% for each individual part and specimen of the recertification examination, two re-examinations of the recertification examination shall be allowed after at least 7 days and within 12 months of the first attempt at the recertification examination. In the event of failure in the two allowable re-examinations the certificate shall not be revalidated and, to regain certification for that sector and method, the candidate shall be required to achieve success in the appropriate main method examination. Structured Credit System: A candidate who applies for and does not meet the requirements of the credit system shall be recertified through successful completion of a written examination. In the event of failure at the first attempt at recertification by examination, only one re-examination shall be allowed within 12 months of the date of application for recertification via the structured credit system. SURNAME AND GIVEN NAME(s) to appear on certification ID card: For a change of name you must provide a status update to the NDTCB by supplying a new signature as well as any supporting documents (i.e. copy of government issued ID) that can be used to support your request.

Example SIGNATURE You must sign your usual signature on page 4, as it will appear on your certification photo ID card. Your signature must not exceed the inner limits of the signature box. CERTIFIED PERSONNEL For an updated list of certified personnel by the NRCan NDTCB, please refer to our website. Please note that this list is regularly updated, however, there may be a period when a person is certified before an updated list is made available to the website. PLEASE NOTE: Renewal applications are subject to current NRCan NDTCB policies and procedures. Processed payment does not complete or guarantee the renewal process. Renewal of certification is issued only after completion, verification and NRCan NDTCB 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. The NRCan NDTCB makes all reasonable efforts to ensure candidate applications, examination requests and certification submissions are completed as per service standard targets. Despite these efforts, the occurrence of errors, omissions and delays cannot be completely ruled out and the NRCan NDTCB is not responsible for any direct and indirect costs, expenses or delays which may arise Applying by Mail / Courier Applying by Email NRCan National NDT Certification Body Email: [email protected] , [email protected] CanmetMATERIALS Natural Resources Canada (Please do not submit credit card information by email) 183 Longwood Road South, Office 122 How to Contact Us Hamilton, Ontario, Canada, L8P 0A5 General Inquiries: 1-866-858-0473 Recertification Hotline: 905-645-0835 Applying by Fax NDT Website Fax: 905-645-0836 Website: http://ndt.nrcan.gc.ca I have read the requirements stated in this checklist and am submitting my application accordingly. � Yes



Published 2017-06-09 Page 6 of 6

http:http://ndt.nrcan.gc.camailto:[email protected]:[email protected]

Renewal and Recertification Application Form Page 1Demographic Information Payment Information

Page 2Work History Signatures

Page 3Employer Information Supervisor Information Sponsor Information

Page 4Applicant Signature Release of Examination Results

Page 5Checklist

Page 6Agreement

Mr: OffMrs: OffMs: OffEnglish: OffFrançais: OffSurname page 1: Given Names page 1: Registration Number page 1: Former Surname (last name) if applicable page 1: City page 1: Province of residence page 1: Postal Code of residence page 1: Mailing Address (if different than above) page 1: City of Mailing page 1: Province of Mailing page 1: Postal Code of Mailing page 1: Email page 1: Four digit Year of Birth page 1: Two digit month of birth page 1: Two digit day of birth page 1: Present Employer page 1: Contact Name page 1: Title page 1: Address of Employer page 1: City of Employer page 1: Province of employer page 1: Postal Code of Employer page 1: Telephone of employer page 1: Email of employer page 1: RT EMC Renewal page 1: OffRT EMC Recertification page 1: OffRT EMC Re-examination page 1: OffRT AS Renewal page 1: OffRT AS Recertification page 1: OffRT AS Re-examination page 1: OffUT REnewal page 1: OffUT Recertification page 1: OffUT RE-examination page 1: OffMT Renewal page 1: OffMT REcertification page 1: OffMT REexamination page 1: OffPT Renewal page 1: OffPT Recertification page 1: OffPT Reexamination page 1: OffET REnewal page 1: OffET REcertification page 1: OffET REexamination page 1: OffPersonal Credit Card page 1: OffCompany Credit Card page 1: OffVisa page 1: OffMastercard page 1: OffAmex page 1: OffCompany Cheque page 1: OffMoney Order page 1: OffCardholder Name page 1: Amount page 1: Card No page 1: Expiry Date page 1: Position 1 Company page 2: Period of Employment From page 2: Period of Employment To page 2: Position 1 Location page 2: Position Held for Position 1 page 2: Position 2 Company page 2: Position 2 Period of Employment From page 2: Position 2 Period of Employment To page 2: Position 2 Location page 2: Position 2 Position Held page 2: Percent Aviation/aerospace: Percent Nuclear: Percent Petro-chemical: Percent Manufacturing: Percent Mining: Percent Pulp and paper: Percent Ship Yard: Percent Strucural: Percent Training/Certification: Percent Research: Other Industry: Percent Welds: Percent Forgings: Percent Castings: Percent Pipe/Tubes: Percent Fittings/valves: Percent pressure vessels: Percent Nozzles/nodes: Percent Storage Tanks: Percent Lift Equipment: Percent Structures: Other applications: Percent Steel: Percent Stainless Steel: Percent Copper: Percent Aluminum: Percent Magnesium: Percent Concrete: Percent Ceramic: Percent Plastic: Percent Composites: Other materials: MT page 2: PT page 2: RT page 2: UT page 2: ET page 2: VT page 2: Other methods: percent doing inspections: percent planning and reporting: percent supervising staff and meetings: percent training to take and give conferences: percent writing procedures and documents: Percent of other: specify other: MT Yoke: OffPT Aerosol: OffRT Isotope: OffUT Thickness gauge: OffET Analog meter: OffMT coil wrap: OffPT Brush: OffRT XRay: OffUT Flaw detector: OffET Phase display: OffMT Prods: OffPT Dip Tanks: OffRT Linear accelerator: OffUT Phased array: OffET Single Freq: OffMT Wet bench: OffPT Solvent removable: OffRT Film: OffUT Straight beam: OffET MultiFreq: OffMT Dry Powder: OffPT Water wash: OffRT Fluoroscopy: OffUT Angle beam: OffET Remote field: OffMT Aerosol: OffPT Post emulsifier: OffRT Digital: OffUT Contact: OffET Absolute mode: OffMT Visible: OffPT Visible: OffRT Auto develop: OffUT Immersion: OffET Differential mode: OffMT Fluorescent: OffPt Fluorescent: OffRT Manual dev: OffOther UT: ET Spinning mode: OffOther MT: Other PT: Other RT: Other ET: MT Reports: OffPT Reports: OffRT Reports: OffUT Reports: OffET Reports: OffMT Instruction: OffPT Instruction: OffRT Instruction: OffUT Instruction: OffEt Instruction: OffMT Procedures: OffPT Procedures: OffRT Procedures: OffUT Procedures: OffEt Procedures: OffMT Standards: OffPT Standards: OffRT Standards: OffUT Standards: OffEt Standards: OffMT Other: PT Other: RT Other: UT Other: Et Other: Supervisor's Name page 3: Four digit Year page 3: Sponsor's name page 3: Current employer of Sponsor page 3: Certification Number of Employer page 3: Day in two digits page 3: Employer's full given name page 3: Year in four digits page 3: Employer's job title page 3: Current employer page 3: Address of employer page 3: Telephone of employer page 3: Email of Employer Contact page 3: Certification Number of Supervisor page 3: two digit day page 3: Supervisor's Job title page 3: Supervisor's current employer page 3: Address of supervisor's employer page 3: Supervisor's email page 3: Certification Number of Sponsor page 3: Day D D page 3: Sponsor's job title page 3: Sponsors telephone number page 3: Month in two digits page 3: two Digit month page 3: Telephone of Supervisor page 3: Year YYYY page 3: Month MM page 3: yes, Application form: Offno, Application form: Offyes, fees: Offno, fees: Offyes, record of experience: Offno, record of experience: OffYes, Attestations: OffNo, Attestations: Offyes, code of conduct: Offno, code of conduct: Offyes, Two passport photos: Offno, Two passport photos: OffYes, Recertifciation examination request form: OffNo, Recertifciation examination request form: OffYes, Recertification Fees: OffNo, Recertification Fees: OffYes, I have read the requirements stated in this checklist and am submitting my applications accordingly: OffName (Please Print) page 4: Year of signature page 4: Month of signature page 4: Day of signature page 4: Year of signature for release of examination results page 4: Month of signature for release of examination results page 4: Day of signature for release of examination results page 4: Contact full name page 4: Contact telephone number page 4: Contact email page 4: Date of applicant signature page 2: date of supervisor signature page 2: Home Telephone page 1: Telephone Cell page 1: Address of Residence page 1: yes, Vision Test Report Form for NDT Personnel: Offno, Vision Test Report Form for NDT Personnel: Off

Documents

PROTECTED (when complete) · renewal of certification, a candidate must submit to the NDT Certification Body a properly completed renewal application, a Vision Test Report Form for