Fillable Form 8.2.1-004 - Renewal and Rertification Application Form

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Form 8.2.1-004 - Renewal and Rertification Application Form

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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 ap
plication 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_______M
M______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-re
fundable 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 2017-06-09
Page1 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 acces
sible en
f
rançais
Version 03
Published 2017-06-09
Page 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
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
___________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
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 photographs
attached 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 supervisor
will normally be located 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 or non-
certificated personnel who, in the opinion of
the
NRCan
NDTCB
, 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.) 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 the applicant who signed this application form. I have also signed and dated page 2 of this application. The
NRCan 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's
application. 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 the
applicant 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
Aussi accessible en français
Version 03
Published 2017-06-09
Page 3
of 6
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 Inf
ormation
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 A
pplication Form
Aussi accessible en français
Version 03
Published 2017-06-09
Page 4 of 6
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 required
attestations. 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) FEES
Method of Payment: The following forms of payment are accepted by the NDT Certification Body: company cheque, money
order, MasterCard, Visa or American Express. No personal cheques will be accepted for renewal. Company cheques and
money orders are to be made payable to the Receiver General for Canada. If paying by credit card, you must print the name
identified on the credit card, card number, expiry date and amount. Please note that we do not accept credit card information by
email.
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 the
regular fees.
3)
RECORD OF EXPERIENCE (PAGE 2)
Verifiable documentary evidence of continued satisfactory work activity without significant interruption in the method and sector
for 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 with
prevents the certified individual from practising the duties corresponding to the level in the method and the sector(s) within the
certified 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 applicant
has 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 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 work using your indicated NDT methods
within 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 that
personal integrity and professional competence are the fundamental principles on which their activities are founded. Accordingly, it
is 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 recognized
personnel attesting that the candidate has completed a satisfactory vision test as outlined by the Vision Test Report Form
for Non-Destructive Testing Personnel. The report must be dated within 12 months prior to the certification expiration date.
7) TWO (2) PASSPORT PHOTOS
Certified 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 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.
9) RECERTIFICATION FEES (RECERTIFICATION ONLY)
Recertification examination registration fees are required for each method due for recertification in addition to the appropriate
renewal fee.
NRCan National NDT Certification Body (NDTCB)
8.2.1-004 Renewal and Recertification Application
Form
Aussi accessible en français
Version 03
Published 2017-06-09
Page 5 of 6
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 15
th
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: NDT@NRCan.gc.ca , ndt.recertification@nrcan.gc.ca
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
Aussi accessible en français
Version 03
Published 2017-06-09
Page 6 of 6
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