550 NW LeJeune Rd Miami, Fl 33126 (800) 443-9353 or (305) 443-9353, ext.

273
FAXED OR EMAILED APPLICATIONS ARE NOT ACCEPTED

CERTIFICATION RE-EXAM APPLICATION

CWI, CAWI, CWE: Re-examinations shall be considered as retaking the same exam. Candidates may take one (1) re-examination within one year of the original test date without further training. Any additional retests taken will require documentation of 40 hours of further training received in welding inspection meeting the requirements of 16.5.1. The maximum number of retests taken in any three-year period is three (3). SCWI: Re-examinations shall be considered as any tests taken within one year (12 months) of the original test date. Candidates may take up to two (2) re-examinations within one year of the original test date. CRI: Re-examinations shall meet the examinations requirements of AWS QC15:2008, Specification for the Certification of Radiographic Interpreters CWS: Re-examinations shall meet the examination requirements of AWS QC13:2006, Specification for the Certification of Welding Supervisors.

LAST NAME

FIRST NAME

MI

1. PLEASE INDICATE THE EXAM LOCATION OF YOUR CHOICE

PLEASE ALLOW 3-4 WEEKS PROCESSING TIME CONFIRMATION LETTERS WILL BE EMAILED UNLESS EMAIL ADDRESS IS NOT INDICATED

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 select a second and third site location alternative. If the first choice is not available, the next location will
be selected. *The application submission deadline is six weeks prior to the scheduled exam date. Applicants that do not meet these criteria must contact the Certification Department for Fast Track processing procedure and an additional fee will apply.

Date of original test: _________________________ Have you re-tested since then? Yes No Member account # (if applicable): ___________________ Certification # (if applicable): ___________________

3. PLEASE INDICATE THE FOLLOWING SEMINAR OF YOUR CHOICE:

D1.1 Code Clinic workshop (code book not supplied) API-1104 Code Clinic workshop (code book not supplied) Welding Inspection Technology workshop Visual Inspection Workshop D1.1 Seminar Week Pak API1104 Seminar Week Pak (code book not supplied) Certified Welding Supervisor week seminar Radiographic Interpreter week seminar NONE / EXAMINATION ONLY

2. PLEASE CHECK THE APPROPRIATE:

(You may only choose up to three parts for re-examination)

CERTIFIED WELDING INSPECTOR and ASSOCIATE ONLY Part A Fundamental ONLY Part B Practical ONLY Part C Code Application
D1.1 API-1104 D1.2 ASME VIII ASME IX All parts: A, B and C D1.1 API-1104 D1.2 ASME VIII ASME IX D15.1 D1.5

D15.1

D1.5

4. METHOD OF PAYMENT
Total: ____________________ Bill Me Bill PO (Staple PO to front page of application) Check or money order #__________________________ VISA MC AMEX Diners Discover

CERTIFIED WELDING SUPERVISOR

Both parts: A and B

SENIOR CERTIFIED WELDING INSPECTOR

Both parts: A and B AWS B2.1: 2009; AWS B4.0:2007; AWS QC1:2007; and ASNT SNT-TC-1A:2006 editions only- Open Book

RADIOGRAPHIC INTERPRETER
Part A General Part C Code specific Part B Practical All parts: A, B and C

CC#: ____________/____________/____________/___________ EXP DATE: _______/_______/_______ SIGNATURE _________________________________________________________

SUPPLEMENTAL INSPECTION EXAM (SIE/ENDORSEMENT)

AWS D1.1/D1.1M Structural Steel: 2006 or 2008 edition th API-1104 Pipelines: 20 edition with 2007 errata and addenda AWS D1.2 /D1.2M Structural Aluminum: 2003 or 2008 edition AWS D1.5/D1.5M Bridge: 2008 edition AWS D15.1 Railroad: 2007 edition ASME Section IX , B31.1 (both 2007), B31.3 (2006) ASME Section VIII, Div. 1 and Section IX (both 2007)

AWS USE ONLY

Date: ________________ Acct #: _______________ Amt$: _______________ PAID / OWE QCC / CWS / RI / SIE

Certification Re-exam App 4/20/09

LAST NAME:
6. PERSONAL INFORMATION
ADDRESS

FIRST NAME:

ADDRESS (CONTD)

APT NO.

CITY AND STATE / PROVINCE / COUNTRY

ZIP CODE

HOME TELEPHONE NUMBER DATE OF BIRTH MM/DD/YY

WORK TELEPHONE NUMBER U.S. SOCIAL SECURITY NUMBER x x x x x

MOBILE TELEPHONE NUMBER

E-MAIL ADDRESS (CONFIRMATION NOTIFICATION WILL BE SENT TO THIS ADDRESS)

7. ASSOCIATIONS TYPE OF BUSINESS CHECK ONE BOX

A. B. C. D. E. F. G. H. I. J. K. L. N. O. P. Q. R. S. T. U. V. X. Contract Construction Chemicals, Allied Products Petroleum & Coal Industries Primary Metal Industries Fabricated Metal Products Machinery except electrical Electrical equipment, supplies, electrodes Transport equipment, air, aerospace Transport equipment, automotive Transport equipment, boats, ships Transport equipment, railroad Utilities Misc. repair services inc. welding Education services inc. schools, libraries Engineering & architectural services Misc. business services inc. laboratories Governmental (federal, state, local) Other Structural Steel Fab Misc Steel Fab Misc Mtrl Fab Meas & Anly Inst

JOB CLASSIFICATION CHECK ONE BOX

01. President, owner, partner, officer 02. Manager, director, superintendent 03. Sales 04. Purchasing 05. Engineer welding 06. Engineer other 07. Inspector, tester 08. Supervisor, foreman 09. Welder, welding or cutting operator 10. Architect, designer 11. Consultant 12. Metallurgist 13. Research and development 14. Technician 15. Educator 16. Student 17. Librarian 18. Customer service 19. Other 20. Engineer- Design 21. Engineer- Manufacturing 22. Quality Control

YOUR TECHNICAL INTERESTS FILL IN ORDER OF PRIORITY (1,2,3,ETC.)

1. 2. A. B. C. D. E. F. G. H. I. J. K. L. M. N. O. P. Q. R. S. T. U. V. W. X. Y. Z. Robotics Computerization of Welding Ferrous metals Aluminum Nonferrous metals except aluminum Advanced materials, intermetallics Ceramics High energy beam processes Arc Welding Brazing and soldering Resistance welding Thermal spraying Cutting NDE Safety and health Bending and shearing Roll forming Stamping and punching Aerospace Automotive Machinery Marine Piping and tubing Pressure vessels and tanks Sheet Metal Structures Other Automation

M. Welding distributorship & retail trade

W. Elct & Eltr Mac

Welding Inspector Exam application 8/10/2010

550 NW LeJeune Rd Miami, Fl 33126 (800) 443-9353 or (305) 443-9353, ext. 273
FAXED APPLICATIONS ARE NOT ACCEPTED

VISUAL ACUITY RECORD

Certification # (if applicable) : ______________________ MEMBER # (if applicable) : ______________________

LAST NAME : _______________________________________________ FIRST NAME : _______________________________________________

If scheduled to take an AWS certification exam, site location: ________________________________Date___________________ TO APPLICANTS: This form must be submitted for all Welding Inspector and Radiographic Interpreter applications. Applicants for the Certified Welding Educator only are not required to complete this form. Before submitting this form with your application to AWS, be sure to keep a copy for your records. If youre unable to supply a completed Visual Acuity Record with your application prior to a submission deadline, you may forward this form to the Certification Department separately. Exam applicants may submit completed Visual Acuity Records on exam day. AWS will not release exam results and/or certification renewal without a completed Visual Acuity Record on file. You must use the services of an Ophthalmologist, Optometrist, Medical Doctor, Registered Nurse or Certified Physicians Assistant to administer your required eye examination. The examination must occur within the seven months prior to the scheduled date of the applicants examination and/or certification expiration date. All applicants must pass an eye examination, with or without corrective lenses, to prove near vision acuity on Jaeger J2 at 12 in. or greater (30.5 cm). All applicants shall take a color perception test. Eye examination results must be documented on this visual acuity form supplied by the AWS Certification Department. No other forms will be accepted. AWS will not accept visual acuity test results that are incomplete or do not comply with regulations. THE FOLLOWING THREE SECTIONS ARE TO BE COMPLETED BY THE EYE EXAMINER 1. Please verify the customers close vision acuity to Jaeger J2 specifications at a distance of 12 inches or greater (30.5 cm): (please check one of the following) Both eyes require corrected vision to J2 Only one eye needs corrected vision to J2 No correction is required. 2. Through a color perception examination, is the applicant colorblind? (please check one of the following) No, customer is not colorblind Yes, customer is colorblind. 3. PLEASE PRINT CLEARLY CUSTOMER NAME: _____________________________________________ DATE OF EYE EXAMINATION: ______________________ EXAMINER NAME: ______________________________________________TELEPHONE NUMBER: ( ) ________-___________
AWS use only

W W O
AWS use only

C B

EXAMINER ADDRESS: _________________________________________________________________________________________ CITY: ____________________________________ ST/PROVINCE: _____________ ZIP: _____________COUNTRY: _____________ EXAMINER PROFESSIONAL STATUS BY (please check only one): Ophthalmologist Optometrist Medical Doctor Registered Nurse Certified Physicians Assistant

EXAMINER SIGNATURE: _____________________________________ STATE/PROV. LICENSE NUMBER: ______________________

Cert-Visual Acuity Record (1638.doc) 6/25/07