ASNT Level Ill Certification Application For ISNT, India Ifyou have previousy been given an ASNT Identification Number: 8h eneaion ber, please 46342. enter itin this box Personal Data wai coniticaton information to: [] Home (] Work — Letr _Miss _Mrs _Ms NN tom B04 , Reg Paty REsmpency PRAT Kop GuTARAT or booze TNODA wor PRARTHANA TECunscal SERTEC EOD “Suevey av. 13, Plot pw. RATEeT = Crureeg Shem INDIA Fees ailtees are listed in US dollars. Save on certification tees now by becoming an ASNT member. See page 7 fr al the benetits members enjoy. | Basic Examination Total | From page 2 Method Examination Total From page 2 aS International Surcharge For all non-US Residents, 40| 40 i mr: ig nom 3 rng Membership Option Se ew, 6S Total Fees | SSO | Less transfer in (if applicable Include copy of transfer letter) Total bus | SLO Payment Payment must accompany application Personal Creait Cardi] Company Crecst Gard crest (ee Card Holder's Name [Money Order 1 Visa (please print) ClFunds Transter C] mastercard Credit Card Bling Adaross Cl Amesean Exoress {Goge Nurofen dots prele Expiration Date Usa Card Holder's Signature Dat “credit Card Identitcation Number: isa testeCardDecover: The trent numbers pte onthe signalure pane on the back othe card lclowing he acount number rnerean Exprese: Tho fouedigt numa is prod above Yo aout number onthe nt ofthe caro. appa 1of8 ow. 420.2018,Examination Scheduling This application is valid only for ASNT examinations held by the indian Sociaty for Non-Destructive Testing (ISNT) Use the tables below to designate the examinations you would Ike to lake. Please observe the application deacline date for tna examination location and dates you are choosing. Nete: This application is valid for intial certification and {or recertification by examination. To renew without further examination (by poins), you must use the ASNT Level ll Renewal Application Location: Mamallapuram, india Application Deadline: June 29, 2015 Exam Dates: September 21-23, 2015, Examination Dat ‘The ASNT Level ll examination for each test metheds wl be given on any one date and time as shown in the tales be!ow. Candidates should iently tie examinations they wish to take by checking the appropriate Meme Non-Member and NewFetake boxes for each examination being requested ard placing fhe appropiate ee in he far ight column of fe table. They must thon attend the examination on that date at et timo. All examinations are conducted inthe English language ony MONDAY, September 21: Sa go | es ss | "seo e (WT) Magnetic Particle | 0800-4000 ET a | o [es (PT) Liquid Penetrant 1200 - 1400 Ser |e) oO oO [260 (ML) Magnetic Flux Leakage 1200 - 1400 oO o i ao ex (VD) Visual 1600 - 1800 a a oa | |G) infrarearthermal 1600 - 1800 o [o a =a 1 Day Examination sustotat: [44S TUESDAY, September 22: aminaonnane | Samiaton [ASNT Members Ties | sa | “sme | Sa | ree (Ba) NDT Ba (0800 - 1200 a o Q a = (UT) Ultrasonic 11400 - 1800 a oa ao o aa WEDNESDAY, September 2: an Examination Name Beargnaton [anne ie (NR) Neutron Radiographic | 0800 - 1200 o 5 (RT) Radiographic (0800-1200 o = (Ut)leak 1400 - 1800 a 5 (ET) Electromagnetic 1400 - 1800 a = (VA) Vibration Analysis “1400 - 1800 a = (AE) Acoustic Emission +1400 - 1800 oO = (Place this Total in the "Basie and Method AAS Examination" Total box on page 1) {Sum of al3 day's subtotals) You may ake aoventageof ASNT Member pring now By Becoming an ASNT member er enewing your membership wih this apleatin, sop-0ent 2018 ev. 4292018Education & Experience Requirements ASNT Level ll applicants must satisty one of the following eligblty cterta * Graduated trom a minimum four-year collage or university curiculum with a degree in engineering or a physical ‘clence, plus one year {12 months) of experiance in nondestructive testing in an assignment comparable to that of an Leve! Il in the applicable test method(s), as defined in ASNT's Recommended Practice Nov 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 experenco In nondestructive testing in an assignment comparable to that of an Level Il in the applicable test methods), as defined ASNT's Recommended Practice No. SNT-TC-1A, latest ecition, OR * Four years (48 months) of experience in an assignment at least comparable to that of an Level Ii in the applicable test methodis]. as defined in ASNT's Recommended Practice No. SNT-TC-1A, latest elton, If you do not satisfy the above criteria for the method{s) in which you are applying, please do not submit an application. Applications received from ineligible applicants will be returned to the applicant in accordance with the ‘Transfer / Cancellation / Refund Policy. !t is your responsibility to determine your own eligibility, Each time new exemination 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. Fecenifying 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. All documentation must be in English or accompanied by an English translation, T List the name and address of the institution where your highest eee euesucationsy level of education was obtained as it relates to your ASNT ‘Achievement Ceriitication, ration SONA OR eA y High senoe! Diploma EB more years of College in a < Saaaeacanad Engineering or Science RELA (12-year Technical/College Degree See Major Course of Suuty — Catna annk DIN] 4-year College Degree ——>S> coe BSS Ti tenaran eran her, of Scene appt sore Rev. 428.2015,Experience Photocopy this page es necessary to lst your experience history. List positions in order by most recent (including Proseat employer) You must supply documentary evidence of Level I or equivalent experience to meet the minimum Piperisnee requirements in the method{s) for which you are applying, The Statement Option form at the bottom of this page is acceptable as documentary evidence of work experiance. If Statement Option below is not completed by employer, you will need to submit other documentation ‘supporting your work experienc ‘Acceptable (other) documentation can include: employer or thi-party certificates or certification records, human resources records, a signed statement from the employer or responsible Level ill, a signed statement from an ASNT [evel ll oF ACCP Professional Level Il, of, for selt-empioyed personnel, signed statements from at least two (2) customers. Ill or ACGP Professional Level Il, or, for sell-employed personnel, signed statements from at least wo (2) Customers. All documentation must be in Engiish or accompanied by an English translation. (tne supporting documents MUST sat: “ave quaiteaton cr Love jb dutes 2. NomoarSteonths working Lov! lor comparable of hat ofa Leve Cher susgortng documents that aro NOT accepts ‘er or Tesing Nonempioyer sued quaificaions we yes (63484 = secsctempomen NNVO te Se Gane, San baw — ESTEE Taal ave Wea camo Pranon Tealatat sersees Ue pel EnpaeGnipe Cmadtane oS Ye Sarin names SCRERT EE WO VS PUSTRNE SUT wR PTS TET GAIA TA SPECS G9 ORAL mee VAS SE rest ae tar TOS Preombanaud pom Ccheok experience (moriths performing-fork with Level ll qualifications) by method as related to above employer. AE _fotmonthe 18 _fofmonths LT _#otmonhs AT _#etmontne mL __sotmonths VA _ fof monthe ET _fotmantts NR __gotmonths PT _#otmontha UT __fof months MT __Wot months VT _# of months Briefly describe below the NDT tasks the candidate named above performed at this location for each of the methods checked. List the document(s) that are attached to this application as evidence of this engagement, BesAce Z Rant @4 Wrek- Sl= Cord Why Bert OP, MT Goel FG PT Statement Option othe above named canes empoyg sea voponstie agent ofthe above named candte's Siler oa a somes he cag Se eter shen above toe and cored MET it 6g\ro\s ErayehapssSipepaen Sonat Dale 7 RR TAYE GAD bo Prammasnsindh: om ERR Es as ES “ASNT ID # Wappmcaiey sop Bint 40t8 ev. 252015Transfer / Cancellation / Retund Policy [AI ASNT examinations are required to be taken within one fealendar year from the date on the orginal Leter of Notifeation or Letter of Approval sent to the applicant. One transfer i parmited tun that year, subject. to. the fagminiaive feos detailed below. Falure to take examinations whvn that one-year peri wil result in fortetture fal fees fo ASNT. “The tranater of cancellation deadline is wo (2) calondar wooks Dior to the week of a scheduled examination. Translers oF teancallatone received before the deadline wil bo subject to 2 $75 acrinstaive tee PER EXAMINATION. A transterting anglican! must remit tose adminisraive fogs to ASNT by the ‘ppliealon deadine for the rescheduled examination. No fexamination attendance will be pormitod unis all feos are paid. Canceling applican's will receive a. refund less all aministatve fs. No transfers or cancliations wll be accepted alter the above transler deadline. Falure to show up ("No Shows”) for Schadiled examinations wil rest in forfeture ofthe fees for the missed examinations If an examination epplieaon is received and tho applicant is found to be unguaified to take the examination, a retund wil bbe "issued less an adminetraive fee of $75 PER EXAMINATION. All requests fo transfers or cancellations must be submitted in ‘witing to ASNT and bo signed by the person registred for the ‘examination, A signed fax iransmital i acceptable. ‘The Intemational Surcharge and Membership / Administrative Fees are non-relundaole ang nen-traneferabe. No exceptions will be made to the above policy. a Statements and Signature By snare on hs epposton, fone by ASNT, | age m 200 by ie Gado of Eves evel il Personal Corti by ASNT 2 ong 2 Mosrins's Coraicts Fuser, ungertand the rot! ASNT 18 fxepand or reoto any Cotten rated #1 awe he prvloges fhoten gene ome | understand tht cedietons shin may result om thi eppcaon| Inert atts that al fats er this epacaton ar tro are coret ant ‘0 nttmation nich might be detimertal has boon wiied. ASNT ‘nay make ary ingufes necessary To determine my qualfeations for ‘erosion, agree fo aos by he decision cf ASNT Weave othe ‘Sfenting of any Cemtontone 32 apo or haan. For valuable corlderaton, the undersigned, having mad epolcaon for Carsieaion as Laval il etore ASNT, does hereby release end ‘Grover discharge The Ameran Scoly For Nondestwucive Test, {an One Corporation, fom anf an al ebitoa, dame, Soman, of ‘causes cf ation whatsoever, which now pesto” which ray Pereaer Sse on eecount ote underlpretsactvies henctort as Level conte by ASNT “Te undersigned futher acknowledges that ths rlease ic being gven| aga preequste fer having Med appieation for consideration by dour ‘Tho undecsigned turner rprasents thst # ret ete by ASNT, then ths releasa and dcherge shall neve a force and eet, omerais, Upon ceeteaon as Seton above, th olease shal be cing or the nderegned aed ne. Arsarcan “Sooty” for Nondedcthe Testing, Ie ané ary ar all agents of ASNT connector wh such ceeston rocess, | nave fe and undeistand the tons, careelition and Fatund poly ard unerstand na ll arpleaten cocumrts submited {0 AEN bedome the property of ASNT | gies not to lease confdertal examination materals or parcoate lnitauauenttstseng protons. 1 understand tht | am sequtea tinfr ASNT of mater tha fot hry ccapaciyy i coninve to. tli” the requrements. of my Ceheafonts). Fate to co so may recut in tia suspension ‘vocation ot my satoatens] By ASNT | authice ASNT to publsh my name. oy, sata, county, fst rnathod, lev, expeaton dates of certfcston() and any psstla ‘Rsponson or evocation of sare atons) by ASNT. (Enola) ‘Signature of Applieant Nayan BH NYAS Print Name of Apaioant aa ts 6\20VC Submit Application Me Mail this application with payment and supporting documents to: ‘The Indian Society for Nondestructive Testing Module No. 60 & 61, Third Floor Garment Complex Sidco Tiru-Vi-Ka Industrial Estate Guindy, Chennal 600 032 India septbien, 508 For inquities about this application, contact Dr Shyamsunder Mandayam at +91-44- 42038175 or [email protected] Goto www.asnt.org for information about ASNT certification ou 23.2015,Code of Ethics for Level Ill Personnel Certified by ASNT Preemie Tora 6 sareguae he io, heath eopary, and ware of he ble, co manta intgry’ and high stander of axl cha Pracices athe rsession of rendestutive testing, the flow ng Fes cf prfessorel conduct shal be riding upan every prcon Issued a cortiente by ASNT as 2 Lev! ‘rte The Laval lwo nods a oaifeate ls charge with having hnoviedgo of ‘he sutorse of the reasonable rues and ‘eauletons heresies proved for tor concuc as ASNT vel, an aco shat oe lair ash thor povsone and Lunderstane tem. Such hrowedga chal encompass the Undortanding that Be pracice oF soncearuetve testing Under tis coreaton fea prvlege, as opposed to @ ht, and te Lovell shal be font ad cana starts for witen respanees to. ie Ethics Commitos. of the Corian Waragement Soars 1.2, Tho-Level ll ere to here shat vidual who has been ieued a corifeate by the Ametean Soctly tr Nerdestueive.Tesing, Inc. pursuant >. herettore publshod reauromenta, lee, ard procedures for such Eotfeaton. Tne Code af Ethics @ being wpon all avis so ctied 2 on Sa i eee 0 wh oa ty pas ales eames esac ea eee eee een pear eepeee eeceeeescy Boge pean eames a SMe age Sesion ety Sas Coat rerio nae Senta tente 2a: fesnel tte oh ewiow > at “a Sate aera ieee peeled gear ergetay seperate Coan ett tt ope fe Saree taal cant ts Seaeecinienreneetd Bee een ieee ect mercer eecoaes| song moereatnicnees et ey ee eee leer eae + palit re erie ra Sue healer eee overseer yet Ee coeia mace mee Sse am comer cace ceov eae tenteee eres ato Toto cae Di haat mae Pages ofa adoquato knowledge of the fats in isua, upon Saowground 0 tovinealcompatnce inthe eubjet ae ‘nd upon honest conviction athe eccuacy and preety of Se tenon. Contes of inorost EX" Tne Lovell shall conscentously avoid conic of interest wth the empeyer or crt but when unevocaa. hal ‘eahwth dacase the ercunstorers to the empojer or 152, Tho Lov shal empty form the clent or enpoyer ot any business asscoatons, Imeress, or cicumsances ‘len gould fuenoe hiner judgment or the cuaty ol [enoes fo he clon or employe. 153. Tho Level I shal not atoept compeneston, nancial of hers, tom move than one pany for sences on the Same prolect, or for services pentaning to the same protec, “nls the ecastances are uly Gctosed to, end aged 1, al Presto parses or te ay authovtaod agar. 154, Tho Lavell shat not gol or soca tnanea er siher ‘sable eorsigerton rom mater or equient supois lorspocryng or prosuet 55, Tho Laval Il shal hl Sole: scoop! gratuites, drat or Inairecty, trom eonvastas, te agents, or oor parce ean wit the elent or employer comectan wth work fer whch Pelshe responsible. 58, AS an olcted relaned, 7 employed puble otc ne Coval linha capanty aes suble ol) smal tot uo or approve work that was porters by hneehersa or Sndar hishor dveston, on behll of nother employe: oF Solistatonot Employment Gi. Tho Love! I eM not pay, soot, noe oar, aeeby or Iraecty, any. bribe ar commission lor potessoral employment win the exception of payment of the vsval onmasion fer seourng saanad potions tough scons tpbyment agence. 6.2, The Level Il shall 03k proessional employment on th basis of qulicaion ard compelonce for” proper ‘ssomplshnent of work 1.3 Tho Lave Il shal no flay of perm mierpresentation of Izhor, or Riser assooiio, ecadomlo & profesional (gallon Holshe sll not merepresent or exaggerate the dogtoo of responsibly ino: forthe subject ater of po ascgnmonss 6.4, Brochures of cher presertationsineldart othe eolctaton of enpoyment shat aol_mirepresen porinent fas ongeming employers. empoyees, astocates, ort ‘ontures, or past accompishmants weh he ere snd upose of swtarcing qualfiatons end wo, Improper Conduct Tit The Level shal ot sign docoments for werk for wich ‘ete does rat have personal protessona know and Great Techn tuporstory cor! an responsibly 7.2, Tha Lovell ehal nat knowingy esscete wh seit tho use of, hiner name oft ame na busines vane Dy any person afi whieh Halse kone. Mas reason fo Svs egegng buss oy proestona pactes Unauthorized Practice [Any ilaton of tis cove shall be deemed tobe an unauthorized pratt and Upon proper compart. vestigation, due process Fang and ruing of the etves” Commitee of tho ASNT Cention Management Cousel in sooordance wih procedures Feretore established ad puclshed, sanctions may be eppled to he nelveualls) in volaten Fulngs of Other Jurtsctons Convcton ot 2 faony while ASNT csciieston ls valid oe te ‘eveatono eusponsin af « Protessinal Eginers Lisenee by Srother jresoton or sist wings by er oessonal Sssocinans may be Grounds fr 4 charge Of waon oF ie Coe Fev. 423.2015.ASNT In idual Membership Application & Renewal Form venengmation a ONAN _ 682454991 FirstName Tai Phone Send Membership Materials to: O Home Fics Former Member: \EFVas ONo Join now for immediate and signitcant savings on + Acoess tothe largest netwrk of NDT contacts and businessos ‘examination fees. Save 875 per metnos, worimde + Materials Evaluation, the authoritative monthly journal on NOT. + Local Section afliation, provides educational and business Networking opportunities ain recetication points tor ASNT membership, Align with your certification period and consider joining fortive years a recoWve maximum aavinge + The quarterly newsletter for NOT practitioners: ‘The NDT Technician Comes io bata network fr you tobe connected when it + Recetifcation points for membership. ‘comes to your NDT career + Discounts on natonal conferences and symposium registration Siay informed throughout your cerificalion petied by + Members Only access org provides publication ‘eintairing membership along with your cerication ne WOT rea Maza O° Provides pubieatione and networking functions + Serva on ASNT commits: be par ofa group that may efoct ASNT momoership koops you informed ofthe latetin technology in addition to savings on certification exams. ‘change or the industry ES einen Become part of the foremost nondestructive testing + 25% discount on all items purchased from our Society and be fully connected to the NDT world. Pubications Cataloy or Shop ASNT enino at wav agnor Membership Options Perna tere ile eee Te pea ening amber your merboshpexplaten dato must sneha Sk Path op sen explaton Son joing tenon ae hayes ue Retomaimat |-nowNonbs —Dues ath ArmA oe seu atzonsee ean Seniseireudea” | Doce Sevecimhen eens onoF Tecnica ‘One-Year © ses O S113 O 875 O $123 ee Two-Year © $125 0 s209 O Stas © sero senate Three-Year © s180 © $294 O s190 © sz04 ee eee Five-Year © s230 © 465 © 300 Ouse ly ‘Student, One-Year by mataniy orcas eral Nateoriterncriemo mtn $15 © ses O $15 © $63 ‘ay notbe hare yu Miltary Rank E-5 or lower $30 0 s78 © s20 0 sve Se, Ys cara "atts eimot be provid, Al pig auto shang New member des incu oe-ne $10 ccniseton tee Dues ae novel, nonrarsaatie. Ove nude ubeetgten hiss eaten ns oO Research in Nondestructive Evaluation (RNDE") Individual Subscription PNDE@ Is ASNTs quarterly research journal Servee retded tec ae Print Subscription - for current volume O $55 O $129 a Electronic Subscription - for current volume. O $55 Print and Electronic Subscription - a savings of $35 O 875 O si49 [Apri subject ocnange Total Members} Plea Amount $ fer total amount In mem hip box on page one and add to Total, Be sure to complete the questions on the next page. app sient Page Tots Rov. 420.2015Membership Profile 1. Year of Birth _ Ate 2. Gender \QHée 0 Female 3. Highest Education Level © Grades 1-12 © High Schoo! Diploma O Some College NO- 2-Year Associate Degree © 4-Year Underaraduate Degree O Master's Degree © Doctorate Degree 4, Years of Experience in NDT O15 “O50 O15 O16-20 O21 over ‘5. Number of people involved with NDT at your company O15 \O620 21-50 Ost-100 O over 100 6. Your Job Function - Choose the one that 7. Purchasing Responsibility (select all that apply) Irecommendiapprove the purchase of Se Bauiprertinstument Suptes Training & Study Materils/Programe O Services © Jem not involved in purchasing 8. With which NDT methoa(s) do you work? (select al that apply) ‘Acoustic Emission ‘Alternating Current Field Measurement ElectromagnetislEddy Current Ground Penetrating Rader Infeared & Thermal Laser © teak Tiquid Penetrant 000000 Pit deserves your rote. select ony ona) NDT Management Sales/Marketing 9. Choose the one business segment that best describes your company. (select only one) NDT Utilization Business \VO™ Aerospace/Aviation/Aircrat O Amusement Rides & Skiing O Automotive Chemical ¢ Petroleum Construction © Commercial Labs \-S™ Infrastructure (Roads & Bridges) © Electronics © marine NOT Supplier Business Consulting. ©. DistributorvManutacturers O Representative © Equipment © Research ° ° ° ° ° ° ° ° o0000 Medical Nuclear Optical Ordnance Pipeline Pulp’Paper Railroad ‘Semiconductor Utilities Robotics Supplies Training Computer Software Computer Hardware 10. Choose the primary type of NDT that you do. (select only one) Design and Failure Analysis © Quality Management O Researcher © Field Inspection © Engineor © AcademicfEdueator QO Incoming Inspection O Technician/inspector O Trainer/instructor © Coneuitant © Student © Product Life Extension ‘QA/QC Reliability © None of tho above 11. Highest Level of NDT quelification {select only one) None Level | Level I! Level Ii a000 Magnetic Fiux Leakage \2-Magnetic Particle ‘O _ Neutron Radiography \6™ Radiography \2-utrasonies © Vibration Analysis © visual For Questions Contact the Membership Department at: Phone 614.274,6003 applaient ° ° ° © Inservice, Plant/Operation Maintenance & Process Cont! \O-AsnT NOT Level ll ACCP Level Ii ACCP Level Ii IRRSP Toll Free 800.222.2768 (usicanads) Page 8018 ev. 423.2015