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D.

QUALIFICATION REFERENCE
APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3.

Qualification references may be submitted by the following, who have expertise in the corrosion field:

Registered or chartered engineers


Present and/or previous supervisor(s) of the applicant
Present and/or previous professors/instructors of the applicant
NACE International certificate holders. (For Corrosion Specialist and Specialty Area applicants, one Qualification
Reference must hold a NACE Certificate at the level being applied for or higher, a P.E. registration, ICorr
Professional Member or international equivalent.)

D.1

Applicants full name:

D.2

Certification category applied for:

D.3

Name, title, company name, address, and phone number of person who is familiar with the work experience of
the applicant:

Phone:
REFERENCE: The applicant is applying for professional recognition by NACE International. Applicants for certification
must meet specific requirements; please see the list of these requirements on the following page. Evaluation of an
applicants qualifications also depends on assessment of professional experience by references. It is requested that you
complete Items D.4 through D.13 on this form and return it to the applicant so they can submit to NACE International.
D.4

I hold NACE Certification as a:


_____ Certified

No.

_____ I am a Registered engineer (or equivalent)


_____ State/Province: ________________

Branch:__________

No:__________

Leave space blank if this section is not applicable


D.5

I have known the applicant for _____ years. What is/was the nature of the association?
Current Supervisor
_____
Current Client
_____
Current Co-worker
_____
Current Professor/Instructor _____
Other _____(Please specify)

D.6

D.8

D.9

_____
_____
_____
_____

From personal knowledge, my assessment of the applicants character and personal reputation is that it is
Excellent

D.7

Previous Supervisor
Previous Client
Previous Co-worker
Previous Professor/Instructor

Average

Below average

From personal knowledge, I know that the applicant has been engaged in corrosion work for ___years.
(corrosion work being defined as work in the field of corrosion at any level; the investigation of corrosion
causes and mechanisms; and/or the investigation, design, and implementation of corrosion control procedures,
and/or the teaching of corrosion-related science.)
Based on this personal knowledge, I know that the quality of the applicants work in the field of corrosion is
Excellent
Average
Below average
The applicant is proficient in the following phases of corrosion :

D.10

Would you employ, or recommend the employment of, the applicant for employment in the phase of corrosion
work you have described in Item D. 9?
Yes
No

D.11

Please describe any major projects/activities in which the applicant has been involved in the field of corrosion
work. Describe only those where you had personal knowledge of the applicants work. Please indicate the
degree of responsibility exercised by the applicant, the complexity of the project/activity, the degree of
knowledge/skill required, etc. (Attach a separate sheet)

D.12

Additional remarks or amplifying information:

D.13

My signature below indicates that I have personal knowledge and expertise in the corrosion field upon which to
evaluate the applicants professional capabilities.

Signature:

Date:

Printed Name:
Please return completed form to applicant who should then upload completed form under certification applications. To
log in, go to http://web.nace.org. Otherwise, return completed form to: NACE International, Certification Department,
Attn Marie Newton, 1440 South Creek Drive, Houston, TX 77084 USA

Latest NACE certification requirements can be found on the web at:


http://web.nace.org/departments/education/programs.aspx