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

please include this person’s e-mail here: Country Group Contact E-mail 936_2012 (Revised) 3 .O. 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.  Application Form – Basic Information API 936. Box or Number and Street) Cell Phone Number City. or exam organizer. State and Zip or Postal Code If you want your exam admission letter / score report to be sent to your employer. 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. trainer.

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

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

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

in any publicity. current or potential employers.. 4. Inspector agrees to indemnify API for any losses or damages resulting from the breach of the terms of this Agreement by the Inspector. 9. in consideration of the mutual covenants hereinafter stated. 5. The Inspector agrees not to make any misrepresentations concerning the Inspector’s certification status or the program. Inspector desires to obtain certification under the API ICP program. or for other promotional purposes without the prior written approval of API. The Inspector agrees not to perform any acts. 2. Now therefore. maintain. 7. API also may terminate the program at any time and for any reason deemed appropriate by API. Whereas. If API’s requirements are modified. 8. a corporation of the District of Columbia. However. with or without cause. Upon termination. 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. 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. or (2) violated any terms or conditions of this Agreement or any ICP policies or requirements. and the Applicant (the “Inspector”). or (3) by posting the changes on the API website. the parties agree as follows: 1. residing at the address noted below. 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. API agrees to take reasonable measures to ensure that any information that is released is accurate. or misrepresentations on the application or in documents submitted to API. or other interested parties concerning the inspector’s certification status.Inspector Certification Agreement . 20005. Inspector understands and agrees that API may modify the requirements for an inspector to obtain. which directly or indirectly assist a third-party in making any misrepresentation relating to the ICP program. API shall determine the date by which the new requirements become effective. API’s Individual Certification Programs (“ICP”) certify inspectors and other technical personnel that meet the guidelines and requirements specified in the program. D. remain certified. It is the responsibility of the Inspector to obtain this information by contacting API or by checking the API website for updates. 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. 6. Inspector agrees to comply with the modified requirements within the deadline specified by API. 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. 3.C. or (2) the Inspector’s last known e-mail address. Washington. It is the responsibility of the Inspector to notify API of address changes. or upon expiration/termination of the Inspector’s certification. The Inspector authorizes API to release information to regulatory agencies. If any action or proceeding is brought by API to enforce. of any rights or authority conferred by this Agreement. omissions. 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. Whereas. Inspector agrees to comply with all of the program policies and requirements. The Inspector agrees and understands that API may terminate an inspector’s certification if API determines that the inspector has: (1) made material errors. API shall be entitled to recover reasonable attorney's fees and costs provided that it is the prevailing party. The Inspector shall not use any trademark of API or name of API including any abbreviation thereof. or to be recertified. advertising. Inspector agrees to return all certification documents to API within 30 days. 936_2012 (Revised) 7 .1 (Effective on Date of Inspector’s Certification) This Agreement is between the American Petroleum Institute (hereinafter “API”). N.W. Inspector agrees and understands that API shall be the sole judge of whether the Inspector has the appropriate qualifications to become certified. protect or establish any right or remedy with respect to this Agreement or with respect to the subject matter of this Agreement. having an office at 1220 L Street.

6. The Inspector warrants that he is not located in. property. and waive any objections to the jurisdiction and venue thereof. 19. The parties agree that any action. The parties consent to the jurisdiction and venue of such courts. 11. 18. 14. 12. USA. and 8 survive termination of this agreement. agency. 16. The Inspector agrees to pay all sales. Inspector shall have no authority to act or contract on behalf of API. 4.10. 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. or joint venture of any kind has been created. No waiver by API of any default. 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. 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. 13. shall be deemed to extend to any prior or subsequent default. or under the control of.S. and other taxes now or hereafter imposed by any government body or authority in any way measured by this Agreement. or controversy arising hereunder or relating hereto shall be brought exclusively in the federal or state courts located in District of Columbia. misrepresentation. without regard to the rules regarding conflicts of law. 15. 17. The Inspector agrees to comply strictly with all U. No oral statements or representations not herein contained shall have any force and effect. It is expressly understood between the parties hereto that no association. 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. use. USA. or any portion of it. 7. employer/employee relationship. claim. certify that I have read and fully comprehend this form in its entirety and agree to comply with the conditions specified above. This instrument contains the entire and only agreement between the parties. API makes no express or implied warranties regarding the ICP program or potential benefits of the certification to the Inspector. or a national or resident of any embargoed countries. apparent agency. Paragraphs 2. partnership. 3. or breach of warranty or covenant hereunder or affect in any way any rights arising by virtue of any prior or subsequent such occurrence. export laws relating to this program. regardless of whether intentional. excise. or any services related thereto. I. or proceeding based upon any matter. suit. 5. misrepresentation. the undersigned. Applicant’s name (please print) _____________________________ E-mail: _________________________ ___________________________________ Signature of Applicant _________________ Date Applicant’s address: ______________________________________________ ______________________________________________ API Reviewer’s Initials: ____________ 936_2012 (Revised) 8 . or breach of warranty or covenant hereunder. This Agreement shall be governed by and construed in accordance with the laws of the District of Columbia.

and (2) API shall be the sole judge of whether the Applicant has the appropriate qualifications to become certified. 14. or a national or resident of any embargoed countries. 12. or takes the exam and fails it. export laws relating to this program. as API requires the original of the notarized page. starting with the first exam administration the applicant registers for. Recertification applications must be mailed. API agrees to evaluate the applicant’s qualifications to determine if the Inspector satisfies the requirements of the ICP program. Recertification applications received by API within this extension term will be processed. 9. 10. minus a processing fee. If API’s requirements are modified. It is the responsibility of the Applicant to obtain this information by contacting API or by checking the API website. 7. 6. remain certified. It is the responsibility of the Applicant to notify API of address changes. API grants each applicant three consecutive attempts during the 12-month period to sit and pass the test. 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. The Applicant agrees to comply strictly with all U. 4. Inspectors who do not apply for recertification within three months after the current certification expiration date will be decertified. All requests for refunds must be submitted in writing by mail.Inspector Application Agreement . or be recertified. If an applicant fails to appear for the test. e-mail or by fax to API no later than 6 months from the date payment was received by API. 5. API shall determine the date by which the new requirements become effective. they must start the application process again.00 late fee will be required. 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. or (2) the Applicant’s last known e-mail address. 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. If the applicant does not obtain a certification within this period of time and still wishes to obtain the certification. 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. only if API receives the refund request prior to the exam application deadline.2 (for Initial and Renewal Certification) (Effective upon Receipt of Application) The applicant agrees to the following conditions: 1. Applicants must pass the exam within these three consecutive exam administrations. 3. or (3) by posting the changes on the API website. or renew the certification at any time. For normal processing API must receive recertification applications prior to the current certification’s expiration date. it will count as an official attempt. Applicant understands and agrees that API may modify the requirements for an applicant to obtain. The Applicant agrees to pay the applicable fees. 8. Applicant agrees to comply with the modified requirements within the deadline specified by API. or under the control of. including re-submission of a full fee and a complete new application. 13. No refunds will be made if an applicant has taken the test or did not show up without prior notice. maintain. The Applicant warrants that he is not located in. 2. 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. 11. comply with all of the program requirements and submit any supplemental information or documents deemed necessary by API to verify an applicant’s qualifications. but a $150. API may extend the certification term for 3 (three) months after the expiration date. An applicant is entitled to a full refund of the application fee.S. 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. Requests for refunds received after this period cannot be fulfilled. 936_2012 (Revised) 9 . Inspectors will remain authorized during that period of time. cancels his/her appearance and reschedules.

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

bank. (2) for electronic payments not drawn on a U. including all applicable withholding taxes.  PAYING BY CREDIT CARD CAN EXPEDITE THE PROCESSING OF YOUR APPLICATION AND PAYMENT TO ENSURE YOUR PLACE IN THE EXAMINATION. 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.00) Late Penalties Bank Fee (if wired) Wire Transfer to: TD Bank 1030 15th St NW Washington. Please include a copy of the wire / electronic transaction.API 936 . API Member $350.C.00 Non Member $500. bank a fiftydollar ($50) handling fee must be added at the time payment is made. 936_2012 (Revised) 11 . You are responsible for all taxes.00 PAYMENT INSTRUCTIONS   All payments must be made in United States currency. Checks must be drawn on a U.PAYMENT INFORMATION Applicant’s Name: _________________________________________ Exam ID # (If previously assigned): API member rate applies to full-time. and banking fees (be sure to add the fees to your payment).S. 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. non-contract employees of API-member companies. For payments by electronic transfer: (1) you are responsible for all electronic transfer.S. banking or other service fees. Applicant’s name(s) must be included on the check.H. A. Applicant’s name(s) must be included on the transaction document.

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

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

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