NRCan National NDT Certification Body (NDTCB)
8.2.1-001 Application Form for Non-Destructive Testing Certification
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*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.
A) Employer: A member of the management staff of the organization that the applicant works for on a regular basis. 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.
____________________________________________________________________________ Date ___________/___________/_____________
Employer's full given name (Please Print) YYYY MM DD
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
, 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. 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.
___________________________________________________________________________ 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.
Sponsor’s name (Please Print)
Date __ /___________/_____________ _________
YYYY MM DD
Sponsor’s signature Sponsor's job title
Current employer Sponsor’s telephone number
Applicant: I attest that the statements made by myself 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, and/or the resultant certification be withdrawn. 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 attest that I have reached the age of majority in
my province and that I have not applied to the NRCan NDTCB previously using a different name or alias unless otherwise stated. The NRCan NDTCB may contact me to verify
information related to this application. My signature is an attestation that I clearly understand and will comply with the terms and conditions of NRCan NDTCB’s program for certification.
Your signature MUST NOT exceed the inner limits of the signature box.
Date : _ ________ _________ _______ // Name:___________________________________
Please Note: 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.
RELEASE OF INFORMATION
This is to authorize the NDTCB, if requested, to release my examination results and/or admittance forms to my employer and/or the payee of my examination fees.
_____________________________________________ Date: _ _/______/______ ______
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
DOCUMENT MUST BE COMPLETED IN ITS ENTIRETY FOR PROCESSING
PROTECTED (when complete)