Fill - Free fillable CEDO%2520application%2520form%2520-%2520english%2520-%2520PCP-09 8.2.1-013 - Application Form for Exposure Device Operator Written Examination PDF form

NRCan National NDT Certication Body (NDTCB)

8.2.1-013 Application Form for Exposure Device Operator Written Examination

Aussi accessible en français

Version 02

Published 2017-10-24

Page 1 of 3

PROTECTED (When Complete)

RELEASE OF INFORMATION

I authorize the NRCan NDTCB, if requested, to disclose the details of my examination results, certication status, expiry date, and any other information

concerning my EDO examination with the NRCan NDTCB to my listed employer and/or payer of my examination fees.

Applicant’s Signature

Date

YYYY

APPLICATION FORM

FOR EXPOSURE DEVICE OPERATOR (EDO) WRITTEN EXAMINATION

IMPORTANT: Please visit our website for current application and examination process information and consult with the Canadian Nuclear Safety

Commission (CNSC) for pre-requisites and other requirements. This application form is for candidates applying for the EDO written examination

for certication with the CNSC and should be submitted to the Natural Resources Canada (NRCan) National Non-Destructive Testing Certication Body

(NDTCB). Before completing this application please refer to the checklist on page 2 and additional information on page 3. Candidates applying for initial

examination attempt must submit TWO (2) passport photographs to be veried on the “8.2.1-011 - Photograph Verication Form”, along with veried

true copies of TWO (2) valid pieces of Canadian Government recognized documents on the “8.2.1-026 - Identication Verication Form” as proof

of identication (ID). One of these documents must have your full legal name, date of birth, photo, and signature. Your name must appear on the application

form as it appears on your identication. All required documents must be completed in their entirety for processing. Incomplete documentation may lead to

longer processing times.

APPLICANT INFORMATION

Surname (Last Name) Given Name(s)

Mailing Address

City Province Postal Code

EMPLOYER INFORMATION

Present Employer

Telephone

FEES

Type of Payment:

(Please check all that apply)

Company Credit Card Company Cheque Money Order

Visa MasterCard Amex

Personal Credit Card

Mr.

Mrs.

Ms.

Preferred Language English Français

Telephone

Date of Birth /

YYYY

Email Address (mandatory)

Contact Name

Title

Address

City Province

Postal Code

OFFICE USE ONLY

Name

Registration Number

Application

Rec’d

Ackn’d

Approved

YYYY

/ MM DD

YYYY MM DD

Approved by

Amt paid

YYYY

/ MM DD

Cardholder’s Signature

Date

YYYY

Card Number Expiry Date Amount $

Cardholder’s Name Cardholder’s Email

TRAINING INFORMATION

Have you completed the 40-hour Exposure Device Operator vocational training course (as specied by CNSC requirements)?

Yes No

Training Organization

Location

I am applying for examination as follows: Re-examination ($200)Initial attempt ($250) Examination in support of renewal ($200)

To protect payment information, we ask that all forms containing credit card information be submitted via fax or mail only. Do not send credit card

information by e-mail. Personal cheques are not accepted. Company cheques and/or money orders are payable to the “Receiver General for Canada”.

Fees are non-refundable and non-transferable. Government of Canada Acquisition Cards are not accepted by the NRCan NDTCB. Payment from Other

Government Departments should be made by inter-departmental FIS transactions. Receipts for payment of EDO examination fees are issued electronically;

please ensure that the cardholder/payer email address has been provided below.

Registration #

(If applicable)

Applicant Name

(Please print)

Applicant’s signature MUST NOT exceed the inner limits of the signature box.

Applicant: By signing and completing this form, I attest that I am 18 years of age, that the information provided is true, and that I will abide by the

CNSC’s and NRCan’s certication and examination procedures. I understand that if any information is found to be untrue, this application may be

rejected, and/or the examination be voided. I understand that the NRCan NDTCB may conduct audits and investigations to verify the validity of the

information in this application, and that I will fully cooperate in providing any additional documentation and explanation as requested. I am fully aware that

the NRCan NDTCB may actively communicate with the individuals referenced in this application, and/or other related individuals, to ensure the validity

of the declarations on this application. I understand that the personal email I have provided in this application will be the main method of communication

with the NRCan NDTCB; I will inform the NRCan NDTCB of any changes to my email address or contact information as soon as possible.

APPLICANT ATTESTATION AND SIGNATURE

Date

YYYY

PROTECTED (When Complete)

EDO WRITTEN EXAMINATION APPLICATION CHECKLIST

Please include the following checklist when submitting application.

The following requirements must be completed in their entirety and submitted to the NRCan NDTCB with this application.

Incomplete documentation may lead to longer processing times. Applicants cannot verify their own photographs and identication

documents. Additional forms required for application are available on the NRCan NDTCB website.

Enclosed

Yes No

1. APPLICATION FORM

2. FEES

3. TWO (2) PASSPORT PHOTOGRAPHS WITH “PHOTOGRAPH VERIFICATION FORM”

4. TRUE COPIES OF TWO (2) VALID PIECES OF CANADIAN GOVERNMENT RECOGNIZED ID ON “IDENTIFICATION

VERIFICATION FORM” (Initial application only)

The application form must be fully completed, signed and current dated by the applicant who has reached the age of majority in their

province. Applicants are required to provide an email address on page 1. Unemployed applicants may leave the employer information

section blank.

Fees are dependent on the type of application and are payable to the “Receiver General for Canada”. Payments may be made via fax

or mail only. Please do not submit credit card information by email. Fees and other process requirements are subject to change. To

view the current fee schedule, please visit our website. Fees are non-refundable and non-transferable.

Please note that assessment of application forms and examination eligibility will not be performed unless the appropriate fee

accompanies the application.

Applicants registering with the NRCan NDTCB for the rst time must provide two (2) passport photographs with a completed

“8.2.1-011 - Photograph Verication Form”, signed by the listed employer (same as page 1 on the application form) or by a

professional individual as listed on the form. New passport photographs are required every ten (10) years (minimum).

• measure 5cm wide and 7cm high (2 inches wide and 2-3/4 inches high);

• be taken by a commercial photographer, clear/focused, in color, taken straight on with the face and shoulders centered and

squared to the camera;

• reect 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.

Applicants registering with the NRCan NDTCB for the rst time must provide veried true copies of two (2) valid pieces of Canadian

Government recognized identitiy documents on the “8.2.1-026 - Identication Verication Form”, signed by the listed employer

(same as page 1 on the application form) or by a professional individual as listed on the Identication Verication Form. If you have

already registered with the NRCan NDTCB, only one piece of Canadian Government recognized identitiy document is required.

One of these documents must have the applicants’ full legal name (name must appear on the application form as it appears on your

identication.), date of birth, photo & signature. An example of valid and acceptable proof of ID: passport, driver’s license, Military

identication, Certicate of Indian Status, Provincial or territorial health care card that includes your photo and signature (excluding

Alberta, Manitoba and Newfoundland and Labrador). Documents not in English or French must be translated by a certied translator.

I have read the requirements stated in this checklist and I am submitting my application accordingly.

Applicant’s Name: Date: DDMM

YYYY

The photographs must:

Yes

NRCan National NDT Certication Body (NDTCB)

8.2.1-013 Application Form for Exposure Device Operator Written Examination

Aussi accessible en français

Version 02

Published 2017-10-24

Page 2 of 3

PROTECTED (When Complete)

ADDITIONAL INFORMATION

RESPONSIBILITIES

RE-EXAMINATION

PROCESSING TIMES

EXAMINATION IN SUPPORT OF RENEWAL OF EDO CERTIFICATION

PLEASE NOTE

SURNAME AND GIVEN NAME(s) to appear on photo ID card

SIGNATURE

Clients 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. Clients and applicants are also responsible for regularly checking their email for communication from the NRCan NDTCB.

• A candidate who fails to obtain the pass grade for an examination is allowed two re-examination attempts; re-examinations can take place no earlier than

30 days from the date of the last examination.

• After three (3) unsuccessful examination attempts, the candidate must complete a 40 hour vocational training course prior to re-examination and submit

proof of the training to the NRCan NDTCB.

• To apply for a re-examination, please ll out page 1 of the “Application Form for Exposure Device Operator Written Examination”, check “Re-Examination”

and provide the appropriate examination fee. Please submit your application by mail, fax or email. Please do not submit credit card information by

email.

• If you are required to renew your EDO certication, please contact the CNSC to obtain information regarding all requirements and pre-requisites (including

whether you are required to complete the written EDO examination) prior to contacting the NRCan NDTCB.

• If you are required to pass the written EDO examination in order to qualify for CEDO renewal with CNSC, please submit a signed and completed

“Application Form for Exposure Device Operator Written Examination,” check “

Examination in support of renewal” on page 1, and include the

appropriate examination fee. You may submit new photos if required (see checklist on page 2), and you are not required to submit identication documents.

Please submit your application by mail, fax or email. Please do not submit credit card information by email.

• As 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 verications and checks may also lead to longer processing times.

• Please allow two (2) working weeks for the NDTCB to properly process an application form after it has been received by our ofce.

• The NRCan NDTCB makes all reasonable efforts to ensure candidate applications, examination requests and certication 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.

The 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 ofce will ensure that collected personal information and any

communications between the NDTCB and their clients or applicants are considered condential, protected, and are for the exclusive use of the intended recipient

to fulll certication program requirements. Personal information is collected as stated in NRCan’s Info Source (P

AA 3.1.2 – Materials and Certication for Safety

and Security - Bank Number: NRCan PPU 015).

• Payment of fees does not complete or guarantee the application and examination process.

• Approval to write the examination is granted only after payment of required fees and completion, verication and NRCan NDTCB approval of the application

and all requisites.

• The candidate is responsible to ensure all requisites/requirements have been met prior to examination.

• Applications are subject to current NRCan NDTCB policies, procedures and fees.

• Any misrepresentation or falsication on the required documents may result in the rejection of the application or the voiding of examination results.

For complete information on the EDO written examination, please visit the NRCan NDTCB Website.

For a change of name you must provide a status update to the NRCan 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

You must sign your usual signature on page 2, as it will appear on your photo ID card. Your signature

must not exceed the inner limits of the signature box.

I have read and understood the information stated on this page and I am submitting my application accordingly. Yes

Applying by mail/courier Applying by email

NRCan National Non-Destructive Testing Certication Body

CanmetMATERIALS, Natural Resources Canada

183 Longwood Road South, Ofce 120

Hamilton, Ontario, Canada, L8P 0A5

Email: nrcan.cedo-oaea.rncan@canada.ca

(Please do not submit credit card information or photographs by email.)

Applying by fax

Fax number: 905-645-0836

Contacting us by telephone

Phone Number: 1-866-858-0473 or 905-645-0653

NRCan NDTCB website

http://ndt.nrcan.gc.ca

Canadian Nuclear Safety Commission (CNSC)

Personnel Certication Division

P.O. Box 1046, Station B, 280 Slater Street, Ottawa, ON, K1P 5S9

Contacting the CNSC

Telephone: (800) 668-5284 Fax: (613) 995-5086

Email: CNSC.edo-oae.CCSN@canada.ca

Website: http://cnsc.gc.ca

NRCan National NDT Certication Body (NDTCB)

8.2.1-013 Application Form for Exposure Device Operator Written Examination

Aussi accessible en français

Version 02

Published 2017-10-24

Page 3 of 3

DOCUMENTS TO BE SUBMITTED TO CNSC BY APPLICANT AFTER SUCCESSFUL COMPLETION OF EDO WRITTEN EXAMINATION

• Copy of ofcial successful examination results letter from the NRCan NDTCB.

• Certication training and application requirements as outlined on the CNSC’s website (http://cnsc.gc.ca).

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