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IMCA Offshore Diving Supervisor Certification Scheme

Examination Application – Air Diving Supervisor
This form must be completed in full by the sponsoring company (i.e. the candidate’s current or most recent employer), signed by
that company’s nominated authorised signatory and sent directly to the IMCA Certification Schemes Administrator. All specified
attachments must be enclosed with the form and it shall be understood that additional documentation may sometimes be
requested.
The current fee is £150 per compulsory module plus £25 per optional module.
Three passport-sized photographs of the applicant will be required before a certificate is issued.

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Applicant Details:
Surname:

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Forename(s):

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Address:

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E-mail address:

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............................................................................................................................................... (optional)

Offshore Air Diver Experience
Diver training certificate number:

................................................................................................................

Issuing authority:

................................................................................................................

Years experience:

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Number of offshore commercial air dives:

...................................................................

Please attach a photocopy of the diver training certificate

Examination Application Form – Air Diving Supervisor (updated December 2006)

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........ Certification Schemes Administrator IMCA............... confirming competence in accordance with IMCA guidance on competence assurance and assessment............................................................................................................................... If the date of first appointment is more than two years ago............. I recommend that: ............................................................. Number of offshore surface dives supervised (since course): 4 Optional Legislation Modules Applied For  5 .................................... Safety Manager or person of similar or higher standing within the company) I confirm that I have personally seen the applicant’s logbook(s) and the originals of the attached documents and that I can verify that the information set out above is correct.................................................................................. UK Examination Application Form – Air Diving Supervisor (updated December 2006) Page 2 of 2 ......................................... On the basis of satisfactory offshore reports........................... Date: ............................................................................ Position: ....................................... Manurewa. Please attach a photocopy of the trainee air diving supervisor course completion certificate Date of first appointment (following course): .. Days worked as a Trainee Air Diving Supervisor (since course): ................................................................................................................. please also attach copies of logbook entries for the past two years............................................................... AB51 0XA...........3 Trainee Air Diving Supervisor Experience Training course date: ........................................................e... Please attach photocopies of all letters of appointment... ..................................... Kintore...... Company name and stamp: ........................................... Completed application forms should be submitted to: Mrs Vicki Graham...................................................................................................................................................................................................................................................... Signed: .... ..................... Aberdeenshire................. Address: .... British  Norwegian For completion by the company’s Nominated Authorised Signatory (i......................................................................... Name: .............................. (name) is a suitable candidate for Air Diving Supervisor........ Midmill... Supervised panel hours logged as Trainee Air Diving Supervisor (since course): ............................................................................................................................... Training course place: ................................................................