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Version 7/11

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Work Experience Form - SSPC Level 2 Protective Coating Inspector (PCI) Program
Please complete the follo ing! "pplicant Information First Name Last Name Middle Initial ______

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which process you will be applying for.
Work Experience

Process A-1 Take the PCI Level 1 Course Process A-2 Take the PCI Level 1 Course without Formal Training Process B-1 Bypass PCI Level 1 Course with Formal Training Process B-2 Bypass PCI Level 1 Course without Formal Training

2 years or 3,000 hrs of coatings inspection experience 3 years or 4,500 hrs of coatings inspection experience 2 years or 3,000 hrs of coatings inspection experience 4 years or 6,000 hrs of coatings inspection experience

SSPC is also re'(esting on this form that )o( list three professional references!
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