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

273

CERTIFIED WELDING INSPECTOR AND CERTIFIED WELDING EDUCATOR COMBO EXAM APPLICATION

FAXED OR EMAILED APPLICATIONS ARE NOT ACCEPTED

AWS Member # (Company Memberships do not qualify):
LAST NAME FIRST NAME MI

1.PLEASE INDICATE THE EXAM LOCATION OF YOUR CHOICE:

ALLOW 3-4 WEEKS PROCESSING TIME. NOTIFICATION OF CONFIRMATION WILL BE EMAIED. 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. Check here if taking a non AWS seminar prior to the exam.
Name of Agency:_____________________________________________________ City, State:_________________________________ Date:___________________

3. PLEASE INDICATE THE FOLLOWING AWS SEMINAR OF YOUR CHOICE OR CHOOSE EXAMINATION ONLY BELOW: D1.1 SEMINAR WEEK PAK
(codebook 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)

Are you employed by an AWS SENSE program participating organization (must provide copy of certificate)? NO S.E.N.S.E. CWI and CWE Combo Examination Only Member Price: $470 Non-Member Price: $685

YES**

If yes, the Facility ID #:___________________________

2. PLEASE SELECT ONE OF THE FOLLOWING FOR YOUR CODE APPLICATION TEST SUBJECT (codebook not provided):
AWS D1.1 Structural Steel Code API-1104 Pipelines 20th edition AWS D1.2 Structural Aluminum Code *Code Clinic not available. AWS D1.5 Bridge Welding Code *Code Clinic not available. AWS D15.1 Railroad *Code Clinic not available. ASME Sections VIII (Div 1) & IX *Code Clinic not available. ASME Section IX, B31.1 and B31.3 *Code Clinic not available

API 1104 SEMINAR WEEK PAK (codebook not provided) 1. API 1104 Code Clinic (Mon. 1 PM 5 PM) 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)

FOR INDIVIDUAL CODE CLINICS/WORKSHOPS:

D1.1 Code Clinic (code book not provided): API-1104 Code Clinic (code book not provided): Welding Inspection Technology Workshop: Visual Inspection Workshop:

EXAMINATION ONLY (CODE BOOK NOT PROVIDED) **Exam Fees- Please visit our website

**For code book editions and other exam information please visit our website http://www.aws.org/certification/endorsebok

http://www.aws.org/certification/pricelist/
AWS USE ONLY
Acct #:

4. METHOD OF PAYMENT ALL CHECKS AND MONEY ORDERS MADE PAYABLE TO AWS.
PAYMENT MUST ACCOMPANY YOUR APPLICATION
Check or money order #_______________________ VISA MC AMEX Diners Discover Date:

__________________________

___________________________

CC#:__________/___________/___________/__________Exp:_____/_______
SIGNATURE___________________________________________

Amt $: __________________________

WI/WE Combo Exam Application

Page 1 of 5

March 5, 2012

NAME:
5. Applicants Information
ADDRESS

ACCOUNT NO.

ADDRESS (CONTD)

APT #

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)

6. Associations
Type of Business (check only ONE) A B C D E F G H I J K L M N O P Q R S Contract construction Chemicals & allied products Petroleum & coal industries Primary metal industries Fabricated metal products Machinery except elect. (incl. gas welding) Electrical equip., supplies, electrodes Transportation equip. - air, aerospace Transportation equip. - automotive Transportation equip. - boats, ships Transportation equip. - railroad Utilities Welding distributors & retail trade Misc. repair services (incl. welding shops) Educational Services (univ., libraries, schools) Engineering & architectural services (incl. assns.) Misc. business services (incl. commercial labs) Government (federal, state, local) Other 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 Job Classification (check only ONE) 01 02 President, owner, partner, officer Manager, director, superintendent (or assistant) Sales Purchasing Engineer welding Engineer other Inspector, tester Supervisor, foreman Welder, welding or cutting operator Architect, designer Consultant Metallurgist Research & development Technician Educator Student Librarian Customer service Other Engineer - design Engineer - manufacturing Quality Control 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

WI/WE Combo Exam Application

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March 5, 2012

NAME:
High school graduate or achieved GED certificate

ACCOUNT NO.

7. EDUCATION LEVEL MUST MEET THE FOLLOWING CRITERIA TO QUALIFY FOR CWI AND CWE CERTIFICATION EXAMINATION

Must document five (5) years and of work experience in the Qualifying Work Experience Section below. (Please refer to the AWS B5.1) Complete the CWE Welding Instructor Credentials Form Copy of a valid Certified Welder ID/Certification card or test record(s) of passing a valid Certified Welder test for the welding process(es) to be taught. For further information regarding the CWE program, please refer to the QC5-91.

8. ADDITIONAL EDUCATION AND EXPERIENCE (if applicable): Circle no. of years VoTech credits - MUST attach attended transcripts of welding related courses or diploma 0 1 2 3 4 Circle no. of years College credits - MUST attach attended transcripts of engineering-level courses or diploma 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

9. QUALIFYING WORK EXPERIENCE: RESUMES NOT ACCEPTED. THIS SECTION MUST BE COMPLETED.
PLEASE DUPLICATE THIS SECTION FOR EACH ADDITIONAL EMPLOYER IN ORDER TO MEET THE QUALIFYING WORK EXPERIENCE REQUIREMENTS FOR

CWI/ /CWE ELIGIBILITY.

_______ I understand that all work experience documented on this application may be verified with both past and present employers.
(Initials)

Company Name Company Street Address Supervisors Name Supervisors Email Address Applicants Job Title

Type of Business

Company Phone Number City, State, Zip Code

Title of Immediate Supervisor Department Employed From: (Mo.) (Yr.) To: (Mo.) (Yr.)

Job Responsibilities- Detailed Description Required*

WI/WE Combo Exam Application

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March 5, 2012

NAME:
10. EMPLOYMENT VERIFICATION

ACCOUNT NO.

** NOTE: THIS SECTION MUST TO BE COMPLETED BY A SUPERVISOR OR PERSONNEL MANAGER FROM THE MOST RECENT EMPLOYER. IF SELF-EMPLOYED OR 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. IF THE EMPLOYER IS NO LONGER IN BUSINESS, PLEASE INCLUDE A COPY OF THE W2 FORM.

Company Name: Company Address: City, State: I at

Company Phone:

Zip Code: , verify that

Employees Name (print)

Country: maintained employment to Date:

Date mm/dd/yyyy or Present

Supervisor/Personnel Managers Name (print) Company Name

from

Date mm/dd/yyyy

Signature:

Supervisor/Personnel Managers Name (print)

Month/Day/Year r

11. TESTIMONIAL: (this section MUST be completed or application will be rejected)

(Applicants must read and sign the following statement in front of a notary)

I hereby certify that I have read the standard requirements contained in AWS QC1, Standard for AWS Certification of Welding Inspectors. 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. 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.

Applicants Signature

Date

THE FOLLOWING IS TO BE COMPLETED BY A NOTARY PUBLIC Sworn to and subscribed before me this My commission expires day of Notary Public Signature
(seal and/or stamp is REQUIRED)

of year

*To view the AWS Policies and Fees, please visit our website at:
http://www.aws.org/certification/policiesfees/

WI/WE Combo Exam Application

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March 5, 2012

NAME:

ACCOUNT NO.

550 NW LeJeune Rd Miami, Fl 33126 (800) 443-9353 or (305) 443-9353, ext. 273

FAXED OR EMAILED APPLICATIONS ARE NOT ACCEPTED

CWE WELDING INSTRUCTOR CREDENTIALS

AWS CERTIFIED WELDER

CWE APPLICANTS: PLEASE HAVE THIS FORM COMPLETED BY YOUR TEACHING SUPERVISOR OR PERSONNEL MANAGER. MAY BE SUBSTITUED WITH A SIGNED WRITTEN
VERIFICATION LETTER. ALSO, A COPY OF A VALID AWS CERTIFIED WELDER ID/CERTIFICATION CARD OR ITS EQUAL, OR SHALL PASS A VALID TEST, FOR THE WELDING PROCESS TO BE TAUGHT MUST ACCOMPANY THIS FORM FOR NEW CWE APPLICANTS.

Name of Applicant: CHECK ONE OF THE FOLLOWING: University 4-YR College 2-YR College Vo-Tech Institution Name: Institution Address: City: ST/Prov.: Zip: Country: High School Private or Union Company

A. STATEMENT OF INSTRUCTIONAL METHODS REQUIRED AT THIS INSTITUTION

List the subjects/processes that you teach at your institution/company. For each subject/process, provide information on the duration of training and how much time is spent between classroom and laboratory. Describe how students in your courses are evaluated and what documentation is furnished to track the completion of instruction at your institution. Also describe how you as an instructor are evaluated.

B. CONFIRMATION OF INSTRUCTIONAL METHOD DELIVERY

The applicants administrator, direct supervisor or personnel manager shall provide a brief statement attesting to the accuracy of the above description of the applicants performance as a welding educator, followed by a formal recommendation for certification as an AWS Certified Welding Educator. ** NOTE: SELF-EMPLOYED OR CONTRACT APPLICANTS, IN LIEU OF THIS SECTION, MUST PROVIDE TWO LETTERS OF REFERENCE ON COMPANY LETTERHEAD FROM SEPARATE CLIENTS, ATTESTING TO THE NATURE OF WORK ASSIGNMENTS DURING THE PERIOD OF PERFORMANCE. IF THE EMPLOYER IS NO LONGER IN BUSINESS, PLEASE INCLUDE A COPY OF THE W2 FORM.

SUPERVISORS Name

(Print)

SIGNATURE

TITLE
(Print)

DATE

WI/WE Combo Exam Application

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March 5, 2012

550 NW LeJeune Rd Miami, Fl 33126 (800) 443-9353 or (305) 443-9353, ext. 273

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

W W O
AWS use only

C B

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

Visual Acuity Record 10/5/2010