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653 NewApp 2012 PDF
653 NewApp 2012 PDF
Application Instructions
1. This application is a writable PDF. Please make sure to download the application document and save it on your computer. You can then open the application, type in your information, and print the application forms. (Any application filled in while viewing it online will not be saved, nor will it be sent to API electronically.) All applications must be mailed to API. 2. Fill out all pages of this application completely. 3. Please enter your name as it appears in your passport / government-issued ID / drivers license. 4. If you have previously applied to API and been assigned an API ID number, include it every place that your name appears. 5. Be sure to include a unique and current e-mail address. All API correspondence including your admission letter and exam score report will be sent to the e-mail address you provide. 6. Make note of the applicable documents to study as listed on the Publications Effectivity Sheet. The publications for ICP certification exams may be ordered through IHS (www.global.ihs.com) or TechStreet (www.techstreet.com) 7. You must include a verified Employment Reference Form (ERF). The ERF may be validated either by a public notary or by your employer. See Page 7 for full instructions. 8. Read and sign BOTH Inspector Agreements 9. Include the certification fee. See Page 2 for ICP Financial Policies. We will not process any application until full payment is received. 10. Be sure to keep a copy of the completed application that you mail to API, including copies of your ERF, diplomas, employer letter, etc. 11. When you have completed your application see checklist at the back of this packet to ensure you have included all the information and documents necessary.
INFORMATION FOR THE DAY OF THE EXAM: You are allowed to have only the following in the test room: API permitted test reference materials, sharpened No. 2 pencils, an eraser and a calculator (simple function only, nonprogrammable). Anything else could be confiscated by the test staff. Any additions to the reference materials are not allowed. This includes training materials, any pages inserted in your codebooks, preprinted and inserted labels, and handwriting in the blank/half-blank pages of the codebooks. Small notes in the margins are permitted. Violations will result in the test staff confiscating pages of reference materials.
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API must RECEIVE your ORIGINAL application by mail on or before the application deadline. All payments must be made in United States currency. Paying by credit card provides the best opportunity to ensure that payment is received and processed by API in the timeliest manner. Checks must be drawn from a US bank. You are responsible for all taxes, banking or other service fees, including all applicable withholding taxes. If your company is going to pay the fee make sure they know the deadline and allow plenty of time for the company to make payment. If paying by wire transfer please submit a copy of the electronic transaction document with your application. The applicants name MUST be included on the wire transaction document. If the copy is not included with the application please e-mail a copy to inspector@api.org as soon as possible to allow time to identify the payment and schedule you for the exam.
Refund Policy
All requests for refunds must be submitted to API in writing by mail, e-mail or fax
and requested within 6 months of the date of the payment. For refund requests made before the application deadline: API will refund the initial certification fee less $100.00 for processing. For refund requests made after the application deadline: API will refund 50% of the initial certification fee. Reschedule fees are nonrefundable. For refund requests made after the date of your examination: No refunds will be issued whether you took the examination or not.
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___________________________________________________________________________________________ FIRST MIDDLE LAST NAME (please spell it the same way as it appears on your passport / drivers license)
Country
Employer Data
Employer
If you want your exam admission letter / score report to be sent to your employer, trainer, or exam organizer, please include this persons e-mail here:
Country
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Additional Information
API 653, Aboveground Storage Tank Inspector Certification Program
1. Mailing and Directory Addresses -- Please check the appropriate boxes regarding your preference for mailing and directory addresses. Please be sure to check one box only for each question. At which address do you wish to receive your certificate? Are you interested in being included in the on-line API Inspector Directory, when you obtain your certification? Which address do you want shown in the ICP Directory listing? 2. Do you currently have an active API certification? If yes, enter your certification number and expiration date. If you answer yes, you need not complete the Education and Training Form. Yes Home Yes Home No Work No Work
Are you currently a full-time, non-contract employee of an API member company? If yes, please enter the company name.
4.
Please check the boxes that correctly describe your organization. Please be sure to check one box on each side. Industry Organization type
Please check the boxes that correctly describe your employment status. Please be sure to check one box only.
Full-time employee of an owner/user Full-time employee of an inspection agency/other company Independent contractor
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Name
Location
Year Graduated
Name
Location
Year Graduated
Name
Duration of Studies
Field of Study
Year Graduated
Name
Duration of Studies
Field of Study
Year Graduated
Name
Duration of Studies
Field of Study
Year Graduated
College / University
Name
Duration of Studies
Major
Degree Type
Dates Attended
Name
Duration of Studies
Major
Degree Type
Dates Attended
Name
Duration of Studies
Major
Degree Type
Dates Attended
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Employment History
API 653, Aboveground Storage Tank Inspector Certification Program
(Last three employers or at least the last five years)
1. Name and Address of Employer (Current) Employer Mailing Address (Number and Street) City, State and Zip Code Job Title / Description of Responsibilities
2.
Name and Address of Employer Employer Mailing Address (Number and Street) City, State and Zip Code Job Title / Description of Responsibilities
3.
Name and Address of Employer Employer Mailing Address (Number and Street) City, State and Zip Code Job Title / Description of Responsibilities
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All paperwork documenting the applicants work experience MUST be original documents. Photocopied, scanned, or faxed documents will not be processed. The Employment Reference Form attached to this application must verify the required length of experience based on your level of education. This experience must have been acquired within the last 10 years. Please make copies of the ERF and provide one form for each employer if it is necessary to meet the requirements. API requires that the supervisor signs any ERF that is submitted. Supervisors may only sign for the experience acquired while at their company. This signature must be validated by a notary public, Commissioner of Oaths or similarly licensed official. API requires proof of the validating authority such as a notary stamp, a copy of the license, etc.
Alternative Method of ERF Verification If a notary is not available in your country then ALL THREE OF THE FOLLOWING REQUIREMENTS MUST BE MET to complete and verify the documentation of your employment: 1. The ERF must be signed by a supervisor. 2. The ERF must be stamped with a company stamp instead of the notary stamp
3. In addition to the ERF the applicant must provide an employment confirmation
letter. This letter must be submitted on company letterhead, and signed by an individual other than your supervisor - a higher company official such as department manager, director, vice-president. The letter must confirm that the applicant is employed in an inspector capacity and include a detailed description of the job responsibilities.
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Beginning Date
Ending Date
SUPERVISORS: Please fill in the blanks below . Your signature on this page v alidates that while working for your company and during the period indicated abov e the applicant has acquired the following experience:
This box must be completed. Please fill in all that applies for the CURRENT employer.
Activity
INSPECTION of Aboveground Storage Tanks Design of Aboveground Storage Tanks Construction of Aboveground Storage Tanks Operation of Aboveground Storage Tanks Repair of Aboveground Storage Tanks
Dates
From ______________To___________________ From _____________To___________________ From _____________To___________________ From _____________To___________________ From ______________To___________________
ALL APPLICANTS MUST HAVE THE AREA BELOW COMPLETED AND VALIDATED SUPERVISORS NAME (PLEASE PRINT) __________________________________
__________________________________________ _______________________
Supervisor's Signature Date Subscribed and sworn to before me the ___________________ day of ________________, ______. Notary Signature My commission expires _________________________
Notary Public
Notary or Company Stamp or Seal
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*NOTE: An additional sitting fee will be required at the Edmonton location in June & December.
You will receive information, prior to the exam date, from ABSA / API, with payment instructions.
North America:
Anchorage, AK Atlanta, GA Baton Rouge, LA Corpus Christi, TX * Edmonton, AB (Canada) Houston, TX Los Angeles, CA Oakland, CA Oklahoma City, OK Philadelphia, PA St. Paul, MN
Other Locations:
Abu Dhabi, UAE Al-Khobar, Saudi Arabia Bogota, Colombia Cairo, Egypt Chennai, India Doha, Qatar Kuala Lumpur, Malaysia Mumbai, India Port of Spain, Trinidad Singapore, Singapore United Kingdom (Contact API for city info)
If a location of your choice is not listed above please contact API for more information. If you are testing at an API-approved special site, please include the location and/or group here:_________________________________________ City, Country
> > THIS FORM MAY ALSO BE USED TO RESCHEDULE A TEST << If rescheduling, please remember to include the re-test fee.
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3.
4.
5.
6.
7.
8.
9.
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10. The Inspector agrees to comply strictly with all U.S. export laws relating to this program. The Inspector warrants that he is not located in, or under the control of, or a national or resident of any embargoed countries. 11. This agreement shall not and is not intended to benefit or to grant any right or remedy to any person or entity that is not a party to this Agreement. 12. This instrument contains the entire and only agreement between the parties. No oral statements or representations not herein contained shall have any force and effect. 13. Paragraphs 2, 3, 4, 5, 6, 7, and 8 survive termination of this agreement. 14. It is expressly understood between the parties hereto that no association, agency, apparent agency, employer/employee relationship, partnership, or joint venture of any kind has been created. Inspector agrees not to refer to himself as APIs agent nor refer to the relationship between the parties as a joint venture or partnership or in any manner inconsistent with this Agreement. Inspector shall have no authority to act or contract on behalf of API. 15. No waiver by API of any default, misrepresentation, or breach of warranty or covenant hereunder, regardless of whether intentional, shall be deemed to extend to any prior or subsequent default, misrepresentation, or breach of warranty or covenant hereunder or affect in any way any rights arising by virtue of any prior or subsequent such occurrence. 16. API makes no express or implied warranties regarding the ICP program or potential benefits of the certification to the Inspector. 17. The Inspector agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by any government body or authority in any way measured by this Agreement, or any portion of it, or any services related thereto. 18. Inspector understands and agrees that Inspector is not granted any rights under the program or this Agreement until API has determined that the Inspector has satisfied all of the program requirements and has issued a Certificate to the Inspector. The Inspectors certification shall be effective on the date that is noted on the Certificate and shall be effective for a period of three years unless terminated pursuant to the terms of this Agreement. 19. This Agreement shall be governed by and construed in accordance with the laws of the District of Columbia, USA, without regard to the rules regarding conflicts of law. The parties agree that any action, suit, or proceeding based upon any matter, claim, or controversy arising hereunder or relating hereto shall be brought exclusively in the federal or state courts located in District of Columbia, USA. The parties consent to the jurisdiction and venue of such courts, and waive any objections to the jurisdiction and venue thereof.
I, the undersigned, certify that I have read and fully comprehend this form in its entirety and agree to comply with the conditions specified above. Applicants name (please print) _____________________________ E-mail: _________________________
_________________ Date
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2.
3.
4. 5. 6. 7. 8. 9.
10. API may extend the certification term for 3 (three) months after the expiration date. Inspectors will remain authorized during that period of time. Recertification applications received by API within this extension term will be processed, but a $150.00 late fee will be required. 11. Inspectors who do not apply for recertification within three months after the current certification expiration date will be decertified. 12. Circumstances such as heavy work schedule or work in other countries do not relieve the applicant of the responsibility to file a timely renewal application. 13. Applicant understands and agrees that API may modify the requirements for an applicant to obtain, maintain, or renew the certification at any time. If APIs requirements are modified, API shall determine the date by which the new requirements become effective. Applicant agrees to comply with the modified requirements within the deadline specified by API. API agrees to attempt (but assumes no duty) to notify Applicant of significant changes to the program by either giving notice: (1) at the Applicants last known address, or (2) the Applicants last known e-mail address, or (3) by posting the changes on the API website. It is the responsibility of the Applicant to notify API of address changes. The failure of API to notify Applicant of a renewal date or modification of the program does not relieve the Applicant of the responsibility to file a timely renewal application or to comply with new certification requirements. It is the responsibility of the Applicant to obtain this information by contacting API or by checking the API website. 14. The Applicant agrees to comply strictly with all U.S. export laws relating to this program. The Applicant warrants that he is not located in, or under the control of, or a national or resident of any embargoed countries.
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15. The Applicant agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by any government body or authority based on in any way measured by this Agreement, or any portion or it, or any services related thereto. 16. Applicant warrants and represents to all information that is being submitted pursuant to this is complete and accurate. Applicant understands that API is relying upon the accuracy of this information in evaluating the Inspectors qualifications. Applicant agrees to indemnify API for any claims, losses, or damages resulting from the Applicant submitting inaccurate or misleading information.
I, the undersigned, certify that I have read and fully comprehend this form in its entirety and agree to abide by the policies and regulations specified above.
E-mail: ___________________________
_________________ Date
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API Member
$600.00
Non Member
$800.00
PAYMENT INSTRUCTIONS
All payments must be made in United States currency. Checks must be drawn on a U.S. bank. You are responsible for all taxes, banking or other service fees, including all applicable withholding taxes. Applicants name(s) must be included on the check. For payments by electronic transfer: (1) you are responsible for all electronic transfer, A.C.H. and banking fees (be sure to add the fees to your payment); (2) for electronic payments not drawn on a U.S. bank a fiftydollar ($50) handling fee must be added at the time payment is made. Please include a copy of the wire / electronic transaction. Applicants name(s) must be included on the transaction document.
PAYING BY CREDIT CARD CAN EXPEDITE THE PROCESSING OF YOUR APPLICATION AND PAYMENT TO ENSURE YOUR PLACE IN THE EXAMINATION.
Credit Card Type: Card Number: Visa American Express Expiration Date: _____________________________________________
Initial Certification Fee Reschedule / Retest Fee
MasterCard
_______________________________________
($150.00)
Late Penalties Bank Fee (if wired)
TOTAL SUBMITTED
(Reference: Applicants Name and SS-2100-D9200-7110) Your application will not be processed if this page is not completed.
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API 653 Exam Administration -- Publications Effectivity Sheet FOR: March 28, 2012 and September 26, 2012
Listed below are the effective editions of the publications required for this examination on the date(s) shown above.
API Recommended Practice 571, Damage Mechanisms Affecting Fixed Equipment in the Refining Industry,
First Edition, December 2003. Product code API CERT 653_571 (includes only the portions specified below) ATTENTION: Only the following mechanisms to be included:
4.2.7 - Brittle Fracture 4.2.16 - Mechanical Fatigue 4.3.2 - Atmospheric Corrosion 4.3.3 - Corrosion under insulation (CUI) 4.3.8 - Microbiologically Induced Corrosion (MIC) 4.3.9 - Soil Corrosion 4.3.10 - Caustic Corrosion 4.5.1 - Chloride Stress Corrosion Cracking (Cl-SCC) 4.5.3 - Caustic Stress Corrosion Cracking (Caustic Embrittlement) 5.1.1.11 - Sulfuric Acid Corrosion
API Recommended Practice 575, Inspection of Atmospheric and Low-Pressure Storage Tanks, Second Edition, May 2005. Product Code API CERT 575 API Recommended Practice 577 Welding Inspection and Metallurgy, First Edition, October 2004. Product Code API CERT 577 API Standard 650, Welded Tanks for Oil Storage, Eleventh Edition, June 2007 with Addendum 1 (Nov 2008) and Addendum 2 (Nov 2009). Product Code API CERT 650 API Recommended Practice 651, Cathodic Protection of Aboveground Petroleum Storage Tanks, Third Edition, January 2007. Product Code API CERT 651 API Recommended Practice 652, Lining of Aboveground Petroleum Storage Tank Bottoms, Third Edition, October 2005. Product Code API CERT 652 API Standard 653, Tank Inspection, Repair, Alteration, and Reconstruction, Fourth Edition, April 2009 with Addendum 1 (Aug 2010). Product Code API CERT 653 American Society of Mechanical Engineers (ASME), Boiler and Pressure Vessel Code, 2010 Edition. i. ii. ASME Section V, Nondestructive Examination, Articles 1, 2, 6, 7 and 23 (section SE-797 only) Section IX, Welding and Brazing Qualifications (Section QW only)
Product Code for the ASME package API CERT 653 ASME. Package includes only the above excerpts necessary for the exam. API and ASME publications can be ordered through either: >> IHS Documents (www.global.ihs.com); phone 1-800-854-7179
or
API members are eligible for a 30% discount on all API documents; exam candidates are eligible for a 20% discount on all API documents. When calling to order, please identify yourself as an exam candidate and/or API member. Prices quoted will reflect the applicable discounts. No discounts will be made for ASME documents.
Note: API and ASME publications are copyrighted material. Photocopies of API and ASME publications are not permitted. CD-ROM versions of the API documents are issued quarterly by Information Handling Services (IHS) and TechStreet and are allowed. Be sure to check your CDROM against the editions noted on this sheet.
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CHECKLIST
1. 2. 3. 4. 5. 6. 7. 8. 9. All pages of the application completed Valid e-mail address included so we can contact you All copies of diplomas attached ERF has a notary or company stamp Employment letter attached if necessary BOTH Inspector Agreement forms signed Certification Fee (payment page filled in completely) Copy of transaction documentation if paying by wire Copy of completed application made for your records
MAIL ORIGINAL APPLICATION TO: API Individual Certification Programs 1220 L Street, NW Washington DC 20005 (Phone: 202-682-8064) Please include candidates name(s) on all payments. IF PAYING BY CHECK OR MONEY ORDER, MAIL APPLICATION TO: API Individual Certification Programs P.O. Box 1425 Merrifield, VA 22116 TO SEND CHECKS BY COURIER, PLEASE ADDRESS PACKAGE TO: API Attn: John Robertson 1220 L Street, NW Washington, DC 20005 Phone 202-682-8064
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