Welding Inspector Exam Application AWS V4 CWI Only Pkg
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CERTIFIED WELDING INSPECTOR EXAM APPLICATION 8669 NW 36 St, # 130 Miami, FL 33166-6672 (800) 443-9353 or (305) 443-9353, ext. 273 Faxed or emailed applications are NOT accepted Last Name First Name I am applying for: CAWI Only MI CWI Only 1. Indicate the exam location of your choice: PLEASE ALLOW 3-4 WEEKS TO RECEIVE A CONFIRMATION LETTER TO THE EMAIL ADDRESS IN SECTION 6. OTHERWISE, IT WILL BE MAIILED. 1st Site Code: ________________ Exam Date: _________________ City/State: ___________________________ *Submission Deadline: __________________ 2nd Site Code: ________________ Exam Date: _________________ City/State: ___________________________ *Submission Deadline: __________________ 3rd Site Code: ________________ Exam Date: _________________ City/State: ___________________________ *Submission Deadline: __________________ NOTE: AWS strongly recommends the applicant indicate an alternate second and third site location. If the first choice is not available, registration will indicate the next available choice site. Please do not make any hotel or flight arrangements until you have received your exam confirmation letter from the Certification Department via email. * Please refer to AWS Policies and Fees. Seminar/Exam Schedule- Please visit our website http://www.aws.org/w/a/registrations/prices_schedules.html 4. Indicate the following AWS seminar of your choice or choose “Examination Only” below 2. Check and complete the following Your AWS Member # (if applicable):__________________________ D1.1 SEMINAR WEEK PAK (code book included) 1. D1.1 Code Clinic(Sun 1 PM – 5 PM & Mon 8 AM - 12 Noon) 2. Welding Inspection Technology Workshop (Tues – Thurs 8 AM – 5 PM) 3. Visual Inspection Workshop (Fri 8 AM – 5 PM) 4. Certification Exam (Sat 8 AM – 5 PM) add CWI Pre-Seminar (online course only) Check here if taking a non-AWS seminar prior to the exam. Name of Agency City, State: Date: API 1104 SEMINAR WEEK PAK (code book not provided) 3. Select one of the following code application test subject 1. 2. 3. 4. AWS D1.1 – Structural Steel Code API-1104 – Pipelines AWS D1.2 – Structural Aluminum Code *Code Clinic not available. API 1104 Code Clinic (Mon 1 PM – 5 PM) Welding Inspection Technology Workshop (Tues – Thurs 8 AM – 5 PM) Visual Inspection Workshop (Fri 8 AM – 5 PM) Certification Exam (Sat 8 AM – 5 PM) add CWI Pre-Seminar (online course only) FOR INDIVIDUAL CODE CLINICS/WORKSHOPS: D1.1 Code Clinic (code book not supplied) AWS D1.5 – Bridge Welding Code *Code Clinic not available. API-1104 Code Clinic (code book not supplied) AWS D15.1 – Railroad *Code Clinic not available. Welding Inspection Technology Workshop AWS D17.1 – Aerospace *Code Clinic not available. Visual Inspection Workshop ASME Sections VIII (Div 1) & IX *Code Clinic not available. CWI Pre-Seminar (online course only) ASME Section IX, B31.1 and B31.3 *Code Clinic not available. EXAMINATION ONLY (MUST PROVIDE OWN CODE BOOK) For code book editions and other exam information visit our website www.aws.org/certification/endorsebok Exam Fees- Please visit our website http://www.aws.org/certification/pricelist/ AWS USE ONLY 5. METHOD OF PAYMENT- ALL CHECKS AND MONEY ORDERS SHOULD BE MADE PAYABLE TO AWS. PAYMENT MUST ACCOMPANY YOUR APPLICATION Acct #: Check or money order #_______________________ VISA CC#: MC AMEX / Diners / Date: Discover / Exp: / Amt $: CWI SIGNATURE Welding Inspector Exam application Page 1 of 5 April 2, 2014 NAME: AWS MEMBER # __________________________________ 6. Personal Information Address Address (cont’d) Apt # City and State / Province / Country Zip Code Home Telephone Number Work Telephone Number Mobile Telephone Number Sign me up to receive text alerts regarding my certification status. Sign me up to receive text information regarding other AWS products and special promotions. *Normal text messaging rates & fees apply as determined by your cellular provider. DATE OF BIRTH MM/DD/YY U.S. SOCIAL SECURITY NUMBER x x x x x E-Mail Address (Confirmation notification will be sent to this address) 7. Associations Type of Business (check only ONE) Job Classification (check only ONE) A Contract construction 01 President, owner, partner, officer B Chemicals & allied products 02 C Petroleum & coal industries Manager, director, superintendent (or assistant) D Primary metal industries 03 Sales E Fabricated metal products 04 Purchasing F Machinery except elect. (incl. gas welding) 05 Engineer — welding G Electrical equip., supplies, electrodes 06 Engineer — other H Transportation equip. - air, aerospace 07 Inspector, tester I Transportation equip. - automotive 08 Supervisor, foreman J Transportation equip. - boats, ships 09 Welder, welding or cutting operator K Transportation equip. - railroad 10 Architect, designer L Utilities 11 Consultant M Welding distributors & retail trade 12 Metallurgist N Misc. repair services (incl. welding shops) 13 Research & development O Educational Services (univ., libraries, schools) 14 Technician 15 Educator 16 Student 17 Librarian 18 Customer service 19 Other 20 Engineer - design 21 Engineer - manufacturing 22 Quality Control P Engineering & architectural services (incl. assns.) Q Misc. business services (incl. commercial labs) R Government (federal, state, local) S Other Welding Inspector Exam application Page 2 of 5 Technical Interests (check ALL that apply) Ferrous metals Aluminum Non-ferrous except aluminum Advanced materials/intermetallics Ceramics High energy Processes Arc Welding Brazing & Soldering Resistance Welding Thermal Spray Cutting NDT Safety & Health Pipe & Tubing Pressure Vessels & Tanks Structures Roll Forming Sheet metal Stamping & punching Bending & shearing Aerospace Automotive Machinery Marine Other Automation Robotics Computerization of Welding April 2, 2014 NAME: 8. Education Level AWS MEMBER # __________________________________ Check the appropriate box below High school graduate or achieved GED certificate. CWI applicants must document five (5) years and CAWI applicants must document two (2) years of work experience in the Qualifying Work Experience Section below. (Please refer to the AWS B5.1) th Did not graduate high school, but completed the 8 grade. CWI applicants must document nine (9) years and CAWI applicants must document four (4) years of work experience in the Qualifying Work Experience Section below. (Please refer to the AWS B5.1) th Did not complete the 8 grade. CWI applicants must document twelve (12) years and CAWI applicants must document six (6) years of work experience in the Qualifying Work Experience Section below. (Please refer to the AWS B5.1) 9. Additional Education and Experience VoTech credits - MUST attach transcripts of welding related courses or diploma College credits - MUST attach transcripts of engineering-level courses or diploma Circle no. of years attended 0 1 2 3 4 Circle no. of years attended 0 1 2 3 4 Maximum one (1) year work substitution credit only if courses completed and within a curriculum related to welding. Maximum two (2) years work substitution credit only if the degree is in engineering technology, engineering, or physical science 10. Qualifying Work Experience: Resumes not accepted. This section must be completed. NOTE: PLEASE DUPLICATE THIS SECTION FOR EACH ADDITIONAL EMPLOYER IN ORDER TO MEET THE QUALIFYING WORK EXPERIENCE REQUIREMENTS FOR CWI/CAWI ELIGIBILITY. _______ I understand that all work experience documented on this application will be verified by AWS prior to exam confirmation. (Initials) Company Name Type of Business Company Street Address Supervisor’s Name Company Phone Number City, State, Zip Code Title of Immediate Supervisor Supervisor’s Email Address Department Applicant’s Job Title Employed From: To: (Mo.) (Mo.) (Yr.) (Yr.) Job Responsibilities- Detailed Description Required Company Name Type of Business Company Street Address Supervisor’s Name Company Phone Number City, State, Zip Code Title of Immediate Supervisor Supervisor’s Email Address Department Applicant’s Job Title Employed From: To: (Mo.) (Mo.) (Yr.) (Yr.) Job Responsibilities- Detailed Description Required Welding Inspector Exam application Page 3 of 5 April 2, 2014 NAME: AWS MEMBER # __________________________________ 11. Employment Verification This section MUST be completed by a supervisor or personnel manager for the most recent employer indicated in section 10. If currently self-employed or a contract applicant you must substitute this section with a letter of reference on company letterhead from two (2) separate clients attesting to the nature of work assignments during the period of performance, type of work done and length of time as a client. If the employer is no longer in business, please include a copy of the W2 form. Company Name: _________________________________________ Company Phone: __________________________________________ Company Address: ___________________________________________________________________________________________________ City, State: __________________________________________________ Zip Code: _________________________ Country: _____________ I ______________________________________________ , verify that __________________________________ maintained employment at Supervisor/Personnel Manager’s Name (print) Employee’s Name (print) ________________________________________ from _________________________ to __________________________ . Company Name Date mm/yyyy Date mm/yyyy or Present Signature: _________________________________________________________________ Date: __________________________________ Month/Day/Year Supervisor/Personnel Manager’s Name (print) 12. Visual Acuity Record A current Visual Acuity Record must be completed and submitted with this application. To download a copy of the form, please visit our website http://www.aws.org/certification/docs/VisualAcuityRecord.pdf. IMPORTANT: This form must be completed and received in the AWS Certification Department not later than 30 days after the applicant’s completed examination date. Applicants who have not fulfilled all requirements within 30 days after the examination date shall have all records, scores and applications voided and may be in jeopardy of forfeiting application fees. 2”x2” 2”x2” 13. Photo Identification Card Applicants MUST submit one (1) passport-style color photograph. Please print your name and membership number (if applicable) on the reverse of the photograph. Your photo is a vital part of your application. To learn more, review the information on how to provide a suitable photo to avoid processing delays by visiting our website http://www.aws.org/w/a/certification/photoidreqs.html . The acceptance of your photo is always at the discretion of the AWS. Photos copied or digitally scanned from driver’s licenses or other official documents are not acceptable. Only use scotch tape on the back of the photo DO NOT STAPLE OR PAPER CLIP PHOTO Photo Requirements: • In color • Printed on photo quality paper ONLY • Photo is sharp (in focus) without any visible pixels or printer dots • 2 x 2 inches (51 x 51 mm) in size • Sized such that the head is between 1 inch and 1 3/8 inches (between 25 and 35 mm) from the bottom of the chin to the top of the head. • Taken within the last 6 months to reflect your current appearance • Taken in front of a plain white or off-white background • Taken in full-face view directly facing the camera • With a neutral facial expression and both eyes open Welding Inspector Exam application Page 4 of 5 April 2, 2014 NAME: AWS MEMBER # __________________________________ 14. ADA Accomodations By checking this box I am requesting special accommodations due to a disability. I agree that I have read AWS Disability Accommodations requirements and agree to the terms and conditions set forth. A copy of the ADA form can be found at http://www.aws.org/certification/docs/ADA_accom.pdf . 15. Testimonial (Applicants must read and sign the following statement in front of a notary) Certified Welding Inspector QC1 Standard for the AWS Certification of Welding Inspectors & B5.1 Specification for the Qualification of Welding Inspectors I hereby certify that I have read the standard requirements contained in the certification programs indicated above. Further, I agree to comply with the existing requirements and any subsequent requirements that may be instituted by AWS. I have read and agree to the terms and conditions set forth in the AWS Policies and Fees form. I certify that the information I have included on this application is true; I understand that any false statements will nullify this application. I give AWS permission to verify this information. I agree to comply with the provisions set forth in the Standard concerning the administration of my examination and certification. Upon obtaining my certification, I give AWS the right to reveal my certification status as it relates to my validity and expiration date only. I further understand that any required information that is incomplete or missing will cancel this registration. Furthermore, I certify that I have not obtained any exam materials, have no prior knowledge of the AWS exam questions or answers, and have not and will not accept any solicitation for the AWS exam questions or answers from anyone at any time before or after the exam. I understand that a violation of this oath may be grounds for invalidation of my certification. Applicant’s Signature _______________________________________________________ Date _________________________ THE FOLLOWING IS TO BE COMPLETED BY A NOTARY PUBLIC Sworn to and subscribed before me this _______ day of______________________ 20____. My commission expires ___________________ Notary Public Signature ________________________________ NOTARY STAMP AND/OR SEAL IS REQUIRED Welding Inspector Exam application Page 5 of 5 April 2, 2014
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