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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
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____________________________________________________________
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
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____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
___________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
DOCUMENT MUST BE COMPLETED IN ITS ENTIRETY FOR PROCESSING
PROTECTED (when complete)
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
NRCan National NDT Certification Body (NDTCB) 8.2.1-004 Renewal
and Recertification Application Form
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Published 2017-06-09
Page 3 of 6
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DOCUMENT MUST BE COMPLETED IN ITS ENTIRETY FOR PROCESSING
PROTECTED (when complete)
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
NRCan National NDT Certification Body (NDTCB) 8.2.1-004 Renewal
and Recertification Application Form
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DOCUMENT MUST BE COMPLETED IN ITS ENTIRETY FOR PROCESSING
PROTECTED (when complete)
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.
� �
NRCan National NDT Certification Body (NDTCB) 8.2.1-004 Renewal
and Recertification Application Form
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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
NRCan National NDT Certification Body (NDTCB) 8.2.1-004 Renewal
and Recertification Application Form
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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