ASNT Level III Certification Application

1 App-liii-2f 1 of 8 Rev 6/7/12 asnt Level III Certification Application asnt Identification Number If you have previously been given an asnt identification number, please enter it in this box: Personal Data Mail Certification information to: Home Work Mail membership material to: Home Work ___Mr ___Miss ___Mrs ___Ms Name Print your name as you would like it to appear on your certificate. (First, Middle or Middle Initial, Last) Home Address City State/Prov. ZIP/Postal Code Country Phone Fax Email Work Organization Name Address City State/Prov. ZIP/Postal Code Country Phone Fax Email Fees All fees are in US dollars.

2 Save on Certification fees by becoming an asnt member. See page 7 for all the benefits members enjoy. Basic Examination Total From page 2 Method Examination Total From page 2 International Mailing Surcharge Add for all Non-US Residents $40 Membership Option Take advantage of member pricing now by completing the membership Application on pages 7 and 8 and include the total here. Total Fees Less transfer in (if applicable- include copy of transfer letter) - Total Due Payment Payment must accompany Application Personal Credit Card Company Credit Card Check Money Order Discover Visa Card Holder s Name(please print) Funds Transfer MasterCard Credit Card Billing Address American Express Card Number Make payable to asnt (must be drawn on a US bank) Expiration Date CIN Number* Card Holder s Signature Date *Credit Card Identification Number: Visa/MasterCard/Discover: The three-digit number is printed on the signature panel on the back of the card following the account number.

3 American Express: The four-digit number is printed above the account number on the front of the card. app-liii-2f 2 of 8 Rev 6/7/12 Examination Scheduling Use the tables below to designate the examinations you would like to take. Please observe the Application deadline date for the examination location and dates you are choosing. Note: This Application is valid for initial Certification and for recertification by examination. To renew without further examination (by points), you must use the asnt Level III Renewal Application . Location and Dates Select a location from the asnt US Examination Schedule and enter the location of the exam here. You may also choose to take your examination(s) at one of asnt S Authorized Examination Centers (AECs).

4 If you are applying to take your examination at an AEC, just enter AEC . Authorized Examination Centers may charge additional fees. Schedule To apply for an exam, enter the date and time when you d like to take the exam. Exam dates are listed in the asnt Examination Schedule. Only one examination may be taken in a session. You may take a maximum of two (2) examinations per day at a scheduled test site. If you are applying to take your examination at an AEC, just write AEC under Date . You will schedule the date and time of your examination directly with the AEC after you receive your Notification of Approval from asnt . Check a box indicating if this is a new or added method, a retake of an exam that you failed within the last five years, or a recertification exam if you are currently certified in the method.

5 Basic Examinations First time applicants must take a Basic examination. To become certified as an asnt NDT Level III in any method, the NDT Basic examination and the method examination must be passed. To become certified as an asnt PdM Level III, both the PdM Basic examination and the IR method examinations must be passed. Exam Date Time (8 AM or 2 PM) asnt Members Non-Members** Fee New $260 Retake $185 New $335 Retake $260 NDT Basic PdM* Basic *PdM Level III Certification is available only in IR NDT Level III Certification is available in all 10 methods. Basic Examination Total: Method Examinations Exam Date Time (8 AM or 2 PM) asnt Members Non-Members** Fee New/Recert $260 Retake $185 New/Recert $335 Retake $260 AE ET IR* LT ML MT NR PT RT UT VT *For IR, both NDT Level III and PdM Level III Certification is available.

6 Only NDT Level III Certification is available in the other methods. Magnetic Flux Leakage Method Examination Total: **You may take advantage of asnt Member pricing now by becoming an asnt member or renewing your membership with this Application . Location: app-liii-2f 3 of 8 Rev 6/7/12 Education & Experience Requirements asnt Level III applicants must satisfy one of the following eligibility criteria: Graduated from a minimum four-year college or university curriculum with a degree in engineering or a physical science, plus one year (12 months) of experience in nondestructive testing in an assignment comparable to that of an Level II in the applicable test method(s), as defined in asnt s Recommended Practice No.

7 SNT-TC-1A, latest edition; OR Completed with passing grades at least two full academic school years of engineering or a physical science study at a university, college, or technical school, plus two years (24 months) of experience in nondestructive testing in an assignment comparable to that of an Level II in the applicable test method(s), as defined in asnt s Recommended Practice No. SNT-TC-1A, latest edition; OR Four years (48 months) of experience in an assignment at least comparable to that of an Level II in the applicable test method(s), as defined in asnt s Recommended Practice No. SNT-TC-1A, latest edition. If you do not satisfy the above criteria for the method(s) in which you are applying, please do not submit an Application .

8 applications received from ineligible applicants will be returned to the applicant in accordance with the Transfer / Cancellation / Refund Policy. It is your responsibility to determine your own eligibility. Each time a new examination is attempted, you must supply documentary evidence of education and experience appropriate for that examination. Do not rely on past applications to meet this requirement. Recertifying and retaking personnel need only submit information new since the last Application . Education You must attach documentation for education if you are using post-secondary education to meet the Education and Experience Requirements. Copies of diplomas or transcripts are acceptable.

9 All documentation must be in English or accompanied by an English translation. Level of Post-Secondary Education List the name and address of the institution where your highest Level of education was obtained as it relates to your asnt Certification . 2 or more years of College in Engineering or Science 2-year Technical/College Degree 4-year College Degree Institution Address Major Course of Study Degree app-liii-2f 4 of 8 Rev 6/7/12 Experience Photocopy this page as necessary to list your experience history. List positions in reverse chronological order. You must supply documentary evidence of Level II or equivalent experience to meet the minimum experience requirements in the method(s) for which you are applying appropriate to your highest Level of education as described in the Education & Experience Requirements section on page 3.

10 Acceptable documents include employer or third-party certificates or Certification records, human resources records, a signed statement from the employer or responsible Level III, a signed statement from an asnt Level III or ACCP Professional Level III, or, for self-employed personnel, signed statements from at least two (2) customers. All documentation must be in English or accompanied by an English translation. Position # Dates of Employment Start Date End Date Total Time (Months) Organization Name Employer Contact Name Organization Address City State/Prov. ZIP/Postal Code Country Phone Fax Email Check methods below where NDT/PdM job functions were performed and indicate comparable Level AE ET IR LT ML MT NR PT RT UT VT Level Level Level Level Level Level Level Level Level Level Level Attachments: List the document(s) that are attached to this Application as evidence of this engagement.