API 936 Refractory Personnel Certification Program

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 / driver’s license. 4. If you have previously applied to API and been assigned an API ID number, include it every place that your name appears in the application form. 5. Be sure to include a unique and current e-mail address. All API correspondence 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. Read and sign BOTH Inspector Agreements 8. Include the certification fee. See Page 2 for ICP Financial Policies. We will not process any application until full payment is received. 9. Be sure to keep a copy of the completed application that you mail to API. 10. 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: Sharpened No. 2 pencils, an eraser and a calculator (simple function only, non-programmable). Anything else could be confiscated by the test staff.

936_2012 (Revised)

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Paying by credit card provides the best opportunity to ensure that payment is received and processed by API in the timeliest manner.  For refund requests made after the date of your examination:  No refunds will be issued whether you took the examination or not.00 for processing. If the copy is not included with the application please e-mail a copy to inspector@api. Proof of payment must be included with your application. You are responsible for all taxes.  For refund requests made before the application deadline:  API will refund the initial certification fee less $100. If paying by wire transfer please submit a copy of the electronic transaction document with your application. including all applicable withholding taxes. Checks must be drawn from a US bank. Reschedule fees are nonrefundable.  For refund requests made after the application deadline:  API will refund 50% of the initial certification fee.ICP FINANCIAL POLICIES Payment Policy API cannot process any application until full payment is received. e-mail or fax and requested within 6 months of the date of the payment.org as soon as possible to allow time to identify the payment and schedule you for the exam.     API must RECEIVE your ORIGINAL application by mail on or before the application deadline. banking or other service fees. The applicant’s name MUST be included on the wire transaction document.   Refund Policy  All requests for refunds must be submitted to API in writing by mail. All payments must be made in United States currency. Candidates WILL NOT BE PERMITTED TO TAKE AN ICP EXAMINATION if payment has not been received AND processed by API. No exceptions will be made under any circumstances. 936_2012 (Revised) 2 . 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.

please include this person’s e-mail here: Country Group Contact E-mail 936_2012 (Revised) 3 . trainer. State and Zip or Postal Code If you want your exam admission letter / score report to be sent to your employer.O. Refractory Personnel Certification Program New – API Exam EXAM ID # (if previously assigned) ___________________________________________________________________________________________ FIRST MIDDLE LAST NAME (please spell it the same way as it appears on your passport / driver’s license) Home Address (Number and Street) Date of Birth (Month / Day / Year) City.  Application Form – Basic Information API 936. Box or Number and Street) Cell Phone Number City. State and Zip or Postal Code Home Telephone Number Country Personal Email (At least one UNIQUE E-MAIL REQUIRED) Employer Data Work Telephone Number Employer Business Email (Unique e-mail – not shared) Employer’s Address (P. or exam organizer.

At which address do you wish to receive your certificate? Are you interested in being included in the on-line API Inspector Directory. Please be sure to check one box only. Please be sure to check one box only for each question.Please check the appropriate boxes regarding your preference for mailing and directory addresses. Industry Organization type PETROLEUM CHEMICAL PAPER/PULP SERVING ALL INDUSTRIES OTHER 5. Expiration Date Expiration Date Expiration Date Yes No Are you currently a full-time. If you answer yes. Yes Home Yes Home No Work No Work Program / Certification Number Program / Certification Number Program / Certification Number 3.Additional Information API 936. please enter the company name. when you obtain your certification? Which address do you want shown in the ICP Directory listing? 2. you need not complete the Education and Training Form. Please check the boxes that correctly describe your organization. Mailing and Directory Addresses -. Do you currently have an active API certification? If yes. Full-time employee of an owner/user Full-time employee of an inspection agency/other company Independent contractor 936_2012 (Revised) 4 . Refractory Personnel Certification Program 1. 4. Please be sure to check one box on each side. OWNER-USER INDIVIDUAL CONTRACTOR INSPECTION COMPANY CONSULTING/CONSTRUCTION OTHER Please check the boxes that correctly describe your employment status. non-contract employee of an API member company? If yes. enter your certification number and expiration date.

State and Zip Code Job Title / Description of Responsibilities Date of Employment From: ____________________ To: ____________________ ____________________ Employer’s Telephone 2. State and Zip Code Job Title / Description of Responsibilities Date of Employment From: ____________________ To: ____________________ ____________________ Employer’s Telephone 936_2012 (Revised) 5 . Name and Address of Employer Employer Mailing Address (Number and Street) City. Name and Address of Employer (Current) Employer Mailing Address (Number and Street) City. Refractory Personnel Certification Program (Last three employers or at least the last five years) 1. Name and Address of Employer Employer Mailing Address (Number and Street) City.Employment History API 936. State and Zip Code Job Title / Description of Responsibilities Date of Employment From: ____________________ To: ____________________ ____________________ Employer’s Telephone 3.

CA Oklahoma City. Saudi Arabia Bogota. TX Edmonton. If you are testing at an API-approved special site. 2012) (Morning Exam Session) December 5. UAE Al-Khobar. Qatar Kuala Lumpur. June 6. Colombia Cairo. 2012 (Application Deadline – API must receive no later than March 21. Egypt Chennai. please include the location and/or group here:_________________________________________ City. GA Baton Rouge. MN Other Locations: Abu Dhabi. 2012) (Morning Exam Session) Application deadlines are firm — no exceptions will be made. India Port of Spain. AB (Canada) Houston. CA Oakland. LA Corpus Christi. Country > > THIS FORM MAY ALSO BE USED TO RESCHEDULE A TEST << If rescheduling. Singapore United Kingdom (Contact API for city info) If a location of your choice is not listed above please contact API for more information. India Doha. Trinidad Singapore. TX Los Angeles. Paul. North America: Anchorage. Malaysia Mumbai. PA St. 936_2012 (Revised) 6 . AK Atlanta. 2012 (Application Deadline – API must receive no later than September 19. please remember to include the re-test fee. OK Philadelphia.API 936 Test Registration Applicant’s Name: Exam ID # _________________________________________ (If previously assigned): Examination Locations and Dates Please indicate your preferred exam date and location listed below.

D. Whereas. The Inspector understands and agrees that the ICP Program is designed to assist users in identifying inspectors who have satisfied the minimum qualifications specified in the applicable industry standards and that API does not warrant or guarantee the competency of any inspector certified under this program. Inspector understands and agrees that API may modify the requirements for an inspector to obtain. omissions. with or without cause. N.. Inspector agrees to return all certification documents to API within 30 days. maintain. Whereas. It is the responsibility of the Inspector to notify API of address changes. protect or establish any right or remedy with respect to this Agreement or with respect to the subject matter of this Agreement. or misrepresentations on the application or in documents submitted to API. Washington. API does not warrant or guarantee the accuracy of any information that is released and specifically disclaims any liability relating to the release of this data. Inspector agrees and understands that API shall be the sole judge of whether the Inspector has the appropriate qualifications to become certified. Inspector agrees to comply with the modified requirements within the deadline specified by API. of any rights or authority conferred by this Agreement. or other interested parties concerning the inspector’s certification status.Inspector Certification Agreement . or (2) violated any terms or conditions of this Agreement or any ICP policies or requirements. remain certified. API agrees to attempt (but assumes no duty) to notify Inspector of significant changes to the program by either giving notice: (1) at the Inspector’s last known address. 2. API also may terminate the program at any time and for any reason deemed appropriate by API. and the Applicant (the “Inspector”). in consideration of the mutual covenants hereinafter stated. Upon termination. the parties agree as follows: 1. 6.C. Inspector agrees to comply with all of the program policies and requirements. a corporation of the District of Columbia. 3. Now therefore. having an office at 1220 L Street. in any publicity. 7. current or potential employers. API’s Individual Certification Programs (“ICP”) certify inspectors and other technical personnel that meet the guidelines and requirements specified in the program. API shall be entitled to recover reasonable attorney's fees and costs provided that it is the prevailing party. 5. 4. or upon expiration/termination of the Inspector’s certification. The Inspector agrees not to make any misrepresentations concerning the Inspector’s certification status or the program. The Inspector agrees and understands that API may terminate an inspector’s certification if API determines that the inspector has: (1) made material errors. or (2) the Inspector’s last known e-mail address. 9. or renew the certification at any time. The inspector agrees not to mislead customers or the public about the scope and purpose of this program. 20005. The Inspector authorizes API to release information to regulatory agencies. The failure of API to notify Inspector of a renewal date or modification of the program does not relieve the Inspector of the responsibility to file a timely renewal application or to comply with new certification requirements. API shall determine the date by which the new requirements become effective. If API’s requirements are modified. API agrees to take reasonable measures to ensure that any information that is released is accurate. It is the responsibility of the Inspector to obtain this information by contacting API or by checking the API website for updates. Inspector agrees to indemnify API for any losses or damages resulting from the breach of the terms of this Agreement by the Inspector. advertising. residing at the address noted below. Inspector desires to obtain certification under the API ICP program. 936_2012 (Revised) 7 . The Inspector understands and agrees that the Inspector’s certification will not be renewed unless the inspector satisfies all of the program requirements for renewal and submits the appropriate recertification application and renewal fee to API within the time frame specified by API.W. or (3) by posting the changes on the API website. The Inspector agrees not to perform any acts. The Inspector shall not use any trademark of API or name of API including any abbreviation thereof.1 (Effective on Date of Inspector’s Certification) This Agreement is between the American Petroleum Institute (hereinafter “API”). or for other promotional purposes without the prior written approval of API. or to be recertified. However. If any action or proceeding is brought by API to enforce. 8. which directly or indirectly assist a third-party in making any misrepresentation relating to the ICP program.

shall be deemed to extend to any prior or subsequent default. certify that I have read and fully comprehend this form in its entirety and agree to comply with the conditions specified above. property. Inspector agrees not to refer to himself as API’s agent nor refer to the relationship between the parties as a joint venture or partnership or in any manner inconsistent with this Agreement. employer/employee relationship. USA. and waive any objections to the jurisdiction and venue thereof. Applicant’s name (please print) _____________________________ E-mail: _________________________ ___________________________________ Signature of Applicant _________________ Date Applicant’s address: ______________________________________________ ______________________________________________ API Reviewer’s Initials: ____________ 936_2012 (Revised) 8 . and other taxes now or hereafter imposed by any government body or authority in any way measured by this Agreement. regardless of whether intentional. It is expressly understood between the parties hereto that no association. 14. The parties agree that any action. or a national or resident of any embargoed countries. I. apparent agency. No waiver by API of any default. This instrument contains the entire and only agreement between the parties. 17. 11. misrepresentation. The Inspector’s 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.10. or breach of warranty or covenant hereunder or affect in any way any rights arising by virtue of any prior or subsequent such occurrence. 5. excise. 3. or breach of warranty or covenant hereunder. 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. The Inspector agrees to comply strictly with all U. 16. The Inspector agrees to pay all sales. or any portion of it. 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. This Agreement shall be governed by and construed in accordance with the laws of the District of Columbia. without regard to the rules regarding conflicts of law. 13. suit. 4. Inspector shall have no authority to act or contract on behalf of API. 19. API makes no express or implied warranties regarding the ICP program or potential benefits of the certification to the Inspector. 18. USA. export laws relating to this program. The parties consent to the jurisdiction and venue of such courts. 7. agency. misrepresentation.S. or proceeding based upon any matter. the undersigned. use. Paragraphs 2. or controversy arising hereunder or relating hereto shall be brought exclusively in the federal or state courts located in District of Columbia. or any services related thereto. claim. No oral statements or representations not herein contained shall have any force and effect. The Inspector warrants that he is not located in. 12. and 8 survive termination of this agreement. or joint venture of any kind has been created. 15. or under the control of. partnership. 6.

All requests for refunds must be submitted in writing by mail. 7. or under the control of. or (2) the Applicant’s last known e-mail address. The Applicant warrants that he is not located in. Recertification applications must be mailed. and (2) API shall be the sole judge of whether the Applicant has the appropriate qualifications to become certified. or be recertified. Applicant understands and agrees that API does not represent or warrant that the submission of the fees and materials by the Applicant will result in the Applicant being certified under the program. The Applicant agrees to pay the applicable fees. Inspectors who do not apply for recertification within three months after the current certification expiration date will be decertified. e-mail or by fax to API no later than 6 months from the date payment was received by API.2 (for Initial and Renewal Certification) (Effective upon Receipt of Application) The applicant agrees to the following conditions: 1. 13. Inspectors will remain authorized during that period of time. Requests for refunds received after this period cannot be fulfilled. If API’s requirements are modified. API agrees to evaluate the applicant’s qualifications to determine if the Inspector satisfies the requirements of the ICP program. or renew the certification at any time. Applicant agrees to comply with the modified requirements within the deadline specified by API. 4.00 late fee will be required. it will count as an official attempt. 14. 2. 3. API grants each applicant three consecutive attempts during the 12-month period to sit and pass the test. as API requires the original of the notarized page.S. Recertification applications received by API within this extension term will be processed. Applicants must pass the exam within these three consecutive exam administrations. export laws relating to this program. An applicant is entitled to a full refund of the application fee. or a national or resident of any embargoed countries. For normal processing API must receive recertification applications prior to the current certification’s expiration date. Applicant understands and agrees that: (1) API will not issue an ICP certificate to the Applicant unless API determines that an Applicant meets all of the requirements and Applicant has submitted the applicable fees and documentation within the specified time frame. Each new application remains valid for a period of 12 months from the date of receipt by API. It is the responsibility of the Applicant to obtain this information by contacting API or by checking the API website. 10. The Applicant agrees to comply strictly with all U. remain certified. API may extend the certification term for 3 (three) months after the expiration date. starting with the first exam administration the applicant registers for. 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. 9. API agrees to attempt (but assumes no duty) to notify Applicant of significant changes to the program by either giving notice: (1) at the Applicant’s last known address. minus a processing fee.Inspector Application Agreement . 8. including re-submission of a full fee and a complete new application. 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. If an applicant fails to appear for the test. API shall determine the date by which the new requirements become effective. they must start the application process again. 6. No refunds will be made if an applicant has taken the test or did not show up without prior notice. 12. comply with all of the program requirements and submit any supplemental information or documents deemed necessary by API to verify an applicant’s qualifications. 5. or takes the exam and fails it. or (3) by posting the changes on the API website. 936_2012 (Revised) 9 . only if API receives the refund request prior to the exam application deadline. An applicant is entitled to a 50% refund of the application fee if the refund request is received by API within 6 months from the date payment was received by API and the candidate cancelled in advance of the examination date. cancels his/her appearance and reschedules. but a $150. Applicant understands and agrees that API may modify the requirements for an applicant to obtain. If the applicant does not obtain a certification within this period of time and still wishes to obtain the certification. It is the responsibility of the Applicant to notify API of address changes. maintain. 11.

losses. 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 Inspector’s qualifications. property. or any portion or it. use.15. or any services related thereto. certify that I have read and fully comprehend this form in its entirety and agree to abide by the policies and regulations specified above. 16. I. Applicant’s name (please print) ____________________________ E-mail: ___________________________ ___________________________________ Signature of Applicant _________________ Date API Reviewer’s Initials ________________ 936_2012 (Revised) 10 . The Applicant agrees to pay all sales. excise. Applicant agrees to indemnify API for any claims. and other taxes now or hereafter imposed by any government body or authority based on in any way measured by this Agreement. the undersigned. or damages resulting from the Applicant submitting inaccurate or misleading information.

 PAYING BY CREDIT CARD CAN EXPEDITE THE PROCESSING OF YOUR APPLICATION AND PAYMENT TO ENSURE YOUR PLACE IN THE EXAMINATION. A. banking or other service fees. Credit Card Type: Card Number: Visa American Express Expiration Date: _____________________________________________ Initial Certification Fee Reschedule / Retest Fee MasterCard Name as it appears on card Signature _______________________________________ E-mail address to send receipt: Check ($150. You are responsible for all taxes.00 Non Member $500.API 936 . bank a fiftydollar ($50) handling fee must be added at the time payment is made. DC 20005 USA ABA Routing # 054001725 Credit to: American Petroleum Institute Account # 4251303172 SWIFT: NRTHUS33 TOTAL SUBMITTED (Reference: Applicant’s Name and SS-2100-D9200-7110) Your application will not be processed if this page is not completed. bank. 936_2012 (Revised) 11 . non-contract employees of API-member companies.S. For payments by electronic transfer: (1) you are responsible for all electronic transfer. Applicant’s name(s) must be included on the check.00 PAYMENT INSTRUCTIONS   All payments must be made in United States currency. Applicant’s name(s) must be included on the transaction document. Checks must be drawn on a U.PAYMENT INFORMATION Applicant’s Name: _________________________________________ Exam ID # (If previously assigned): API member rate applies to full-time.S.H. and banking fees (be sure to add the fees to your payment). (2) for electronic payments not drawn on a U.00) Late Penalties Bank Fee (if wired) Wire Transfer to: TD Bank 1030 15th St NW Washington.C. Please include a copy of the wire / electronic transaction. including all applicable withholding taxes. API Member $350.

API Publications API Standard 936.org/Standards/C133.R-87 – State of the art report: Refractory Concrete 547. then “in” Inactive -.org/bookstorenet/.R-87 in “Search” field.astm.1R-89 – State of the art report: Refractory plastic and Ramming Mixes ASTM (American Society for Testing and Materials) Publications: C113-02 – Standard Test Method for Reheat Change of Refractory Brick (Available at http://www.concrete.Standard Test Method for Abrasion Resistance of Refractory Materials at Room Temperatures (Available at http://www.astm. To access these two titles go to http://www.org/Standards/C113.org/Standards/C181.htm) C133-97 – Standard Test Methods for Cold Crushing Strength and Modulus of Rupture of Refractories (Available at http://www.htm) 936_2012 (Revised) 12 . then select “ by” Order Code.astm.org/Standards/C704. 2012 Listed below are the effective editions of the publications required for this examination on the date(s) shown above. ACI (American Concrete Institute) Publications: These two documents are currently available as a .both documents should appear) 547. 3rd Edition.Publications Effectivity Sheet FOR: June 6. 2012 & December 5. Nov 2008 – Refractory Installation Quality Control Guidelines – Inspection and Testing Monolithic Refractory Linings and Materials.htm) C704-01 . (Type 547.pdf file through the ACI bookstore.htm) C181-09 – Standard Test Method for Workability Index of Fireclay and High-Alumina Plastic Refractories (Available at http://www.API 936 Exam Administration -.astm.

3. 4. IF PAYING BY CHECK OR MONEY ORDER. PLEASE ADDRESS PACKAGE TO: API Attn: John Robertson 1220 L Street. Box 1425 Merrifield. VA 22116 TO SEND CHECKS BY COURIER. 2. NW Washington. DC 20005 Phone 202-682-8064 936_2012 (Revised) 13 . NW Washington DC 20005 (Phone: 202-682-8064) Please include candidate’s name(s) on all payments. 5.O.CHECKLIST 1. MAIL APPLICATION TO: API Individual Certification Programs P. All pages of the application completed Valid e-mail address included so we can contact you 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. 6.

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