You are on page 1of 9

ACCP Application for Level II

and Level III JIS Z 2305
Certificate Holders
ASNT Identification Number
If you have previously been given an ASNT identification number, please enter it in this box:

Personal Data Mail certification information to:

Home

Work

Name
Print your name as you would like it to appear on your certificate: First, Middle or Middle Initial, Last

Home
Name of the building, house number, street, town/village

City

Prefecture/State/Province.

Postal Code

Phone

Fax

Email

City

State/Prov.

ZIP/Postal Code

Phone

Fax

Email

Country

Work
Organization Name

Address

Certifications Requested

Country

(check the boxes below to show which ACCP certifications are being requested)

NOTE: If the Pressure Equipment (PE) Sector is being requested, you must complete the PE Sector Experience Section on page 3.

Level II:
Test
Method

Industry Sector
(Select one or both)

Techniques
(Mark each Technique for which certification is sought)

MT

GI

PE

Yoke

Bench

PT

GI

PE

Solvent-Removable

Water-Washable

RT

GI

PE

X-Ray Only

X-Ray & RAM

UT

GI

PE

Welds Only

Castings/Forgings

Post-Emulsifiable

Level III:
Industry Sector
(Select one or both)
GI

Test Methods
(Level IIIs must be certified in all Techniques in each Test Method selected)
MT

PE

PT

RT

UT

Fees (All fees are listed in US dollars)
Certification Fee:
Mailing Surcharge:
Membership
Option:

(See page 2 to calculate your Certification Fee then place it here:)

$
$40.00

For all Non-US Residents (to cover International Mailing charges)
You can save on certification fees by becoming an ASNT
member. Complete the membership application on pages
8 & 9 and include the membership fee total here:

$

Fee Total:

$

Payment
Payment is to be submitted to the Japanese Society for Nondestructive Inspection (JSNDI) in a form suitable to JSNDI.
JSNDI PCP app

1 of 9

7/7/09

To determine your Certification Fees. do the following: 1) Count the number of Test Methods you applied for in the Certifications Requested table on page 1. then take advantage of the ASNT Member pricing. The International Surcharge is applied to all non-US residents to cover the additional cost of international mailings. The Technique fee is based on the number of NDT Techniques selected and whether or not you are a current ASNT Member. ACCP Level III ACCP Level III certification fees are made up of three items: an Application fee.00: $ _______Techniques x $125.00 = $ NOTE: If you are not currently an ASNT Member. do the following: 1) Count the number of Techniques you applied for in the Certifications Requested table on page 1. The Application fee is a fixed fee that is charged once per application.00 = $ 3) If you are NOT an ASNT member.00 = NOTE: If you are not currently an ASNT Member. The International Surcharge is applied to all non-US residents to cover the additional cost of international mailings. you can fill out the membership application on pages 8 & 9.00 $ $ Certification Fee Total (Total of Application and Technique Fees): $ 5) Go back to page 1 and place the Certification Fee Total above in the block titled "Certification Fees". Certification Fee Type Amount Application Fee: Member Technique Fee (From box on Line 2 above): Non-Member Technique Fee (From box on Line 3 above): $150. multiply that number by $125.Certification Fees ACCP Level II ACCP Level II certification fees are made up of three items: an Application fee. multiply that number by $50.00: _______Techniques x $50. the Technique fee and an International Surcharge. multiply that number by $95. the Test Method fee and an International Surcharge. To determine your Certification Fees.00 = $ 3) If you are NOT an ASNT member.00: _______Test Methods x $170. Certification Fee Type 5) Amount Application Fee: Member Test Method Fee (From box on Line 2 above): Non-Member Test Method Fee (From box on Line 3 above): $210. JSNDI PCP app 2 of 9 7/7/09 . then take advantage of the ASNT Member pricing. multiply that number by $170. you can fill out the membership application on pages 8 & 9. 4) Place the amount from the appropriate box above and place that amount in the table below as your Test Method Fees. 2) If you are a current ASNT member. The Test Method fee is based on the number of NDT Test Methods selected and whether or not you are a current ASNT Member. The Application fee is a fixed fee that is charged once per application.00: _______Test Methods x $95. 4) Place the amount from the appropriate box above and place that amount in the table below as your Technique Fees.00 $ $ Certification Fee Total (Total of Application and Test Method Fees): $ Go back to page 1 and place the Certification Fee Total above in the block titled "Certification Fees". 2) If you are a current ASNT member.

ASNT NDT. Attach Applicants must also provide a signature in the block below. Photocopy this page as necessary to document your experience. Levels. and list specific inspection functions performed as described above. Applicants wishing to certify in the Pressure Equipment Sector must fill out the form below and have it signed by a JSNDI. test methods. provide a summary of the type of work performed during this engagement. Printed Name Signature Date Position/Title ASNT NDT. Pressure Equipment Sector Experience ACCP certification in the Pressure Equipment (PE) Sector requires three (3) years of documented experience in pressurerelated inspection. passport Signature Block: photo here * The essential information (name. I understand that should the above information be found fraudulent. ACCP Professional Level III or JSNDI Level III Certification No. Position # Dates of Employment Start Date End Date Total Time (Months) Organization Name Employer Contact Name Organization Address City State/Prov. Include the inspection equipment used. I have reviewed this application and hereby attest that the experience times claimed by the above applicant are true and correct to the best of my knowledge. ZIP/Postal Code Phone Fax Email Country In the space below. 2) A valid (within 12 months) vision examination showing near visual acuity to Jaeger J-1 or equivalent. the level of responsibility. or Company AI* Certificate No. the applicant’s certification may be revoked and other penalties may apply. and 3) One (1) passport photograph. List positions in reverse chronological order. Hand-written translations are acceptable. JSNDI PCP app 3 of 9 7/7/09 . ACCP Professional Level III or an Authorized Inspector. *A photocopy of the AI’s currently valid certification card must be attached to this application when an AI signs off on the experience. which will be scanned and transferred electronically onto their ACCP wallet card.Document Submittals The following documents* must be submitted with this application: 1) A copy of your currently valid JIS Z 2305 NDT certificate issued by JSNDI. The signature must stay completely within the block with no overlap onto the block borders.) on all documents must be in English. etc. Techniques.

does hereby release and forever discharge The American Society For Nondestructive Testing. Levels and expiration dates of certification.Affirmation of the Applicable Code of Ethics for Personnel Certified by ASNT By signature on this application. if certified by ASNT. I understand the right of ASNT to suspend or revoke any Certificate granted if I abuse the privileges therein granted to me. I have read and understand the transfer. and any and all agents of ASNT in connection with such certification process. JSNDI PCP app 4 of 9 7/7/09 . having made application for Certification as Level II and/or Level III before ASNT. the undersigned. claims. cancellation and refund policy. test methods. demands. then this release and discharge shall have no force and effect. I agree to abide by the decision of ASNT relative to the granting of any Certifications as applied for herein. state. this release shall be binding on the undersigned and The American Society for Nondestructive Testing. Further. upon certification as set forth above. country. I authorize ASNT to publish my name. or causes of action whatsoever. cancellation and refund policy and understand that all application documents submitted to ASNT become the property of ASNT. Print Name of Applicant Signature of Applicant Date * The ACCP Level II and the ASNT Level III Codes of Ethics are shown on pages 6 & 7 respectively. I agree to abide by the applicable* Code of Ethics for Personnel Certified by ASNT so long as I maintain a Certificate. otherwise. an Ohio Corporation. Inc. I hereby attest that all facts on this application are true and correct and no information which might be detrimental has been withheld. For valuable consideration. The undersigned further represents that if not certified by ASNT. The undersigned further acknowledges that this release is being given as a prerequisite for having filed application for consideration by ASNT. city. I have read and understand the attached transfer. from any and all liabilities. I understand that certifications which may result from this application do not constitute any form of license. which now exist or which may hereafter arise on account of the undersigned’s activities henceforth as Level II and/or Level III certified by ASNT. ASNT may make any inquiries necessary to determine my qualifications for certification.

licensed nurse.Vision Requirements Candidate Name (please print): Eye Exam Date: Vision examinations shall be administered by a physician. but no less than 30. or by personnel approved by the employer’s Level III. ophthalmologist or optometrist. ACCP Professional Level III. The visual examination date must be within 12 months of the date that this application is signed.). or equivalent. or equivalent. at the distance specified on the chart for J-1 text. Near distance vision Candidates must have visual acuity in at least one eye capable of reading the Jaeger J1 test chart. I attest that the above named candidate has sufficiently demonstrated the ability to distinguish colors used in the applicable test method(s) as specified in employer procedures.5 cm (12in. The form below may be used to document this requirement. and that the candidate has: No Color Perception Deficiency Color Perception Deficiency (Specify): Signature of Eye Examiner Ophthalmologist/Optometrist Employer’s Level III Date Physician Registered Nurse Certificate No: Other (Approved by the Employer’s Level III): Expiration Date: Title: Employer Attestation (for Candidate Color Perception Deficiency) If the candidate has a color perception deficiency. I further attest that I administered a color perception examination on the candidate named above. the candidate’s ability to distinguish colors used in the applicable method(s) as specified by the employer must be confirmed by the employer or a designated and responsible agent of the employer (such as an ASNT Level III.5 cm (12in. Employer/Agent Signature Date Employer/Agent Name (print) ASNT ID (if applicable) Title JSNDI PCP app 5 of 9 7/7/09 . The candidate passed (check one) did NOT pass this examination with (check one) without correction. Attestation of Visual Acuity I attest that I have administered the following vision examinations to the candidate named above: Near distance visual acuity in at least one eye capable of reading the Jaeger J1 test chart.) Color vision You must be able to differentiate between the colors used in the NDT method(s) for which certification is required. but no less than 30. at the distance specified on the chart for J-1 text. or company Level III per SNT-TC-1A).

3.0 Penalty Violation of this Code of Ethics by any ACCP™ certified Level II person may be cause for disciplinary action against that person. a refund will be issued less an administrative fee of $75.2 Integrity: Perform all NDT activities honestly.5 Safety: Act in a safe and responsible manner while conducting NDT activities. property and welfare of the public. 2.0 Purpose 1.Refund Policy If a certification application is received and the applicant is found to be unqualified to be certified for the requested Level or Test Method(s). These rules are necessary to protect the life. Code of Ethics for ACCP™ Level II Personnel Certified by ASNT 1.1 Responsibility: Protect the safety. by performing all NDT activities to the best of his/her ability in accordance with properly established and approved procedures and only in situations for which qualified. JSNDI PCP app 6 of 9 7/7/09 . and results obtained. 2. The International Surcharge and Membership / Administrative Fees are non-refundable and non-transferable. 2.4 Improper Conduct: Refrain from work activities outside the area of certification without written approval of his/her supervisor.0 Code of Ethics 2. promptly informing same if such situations cannot be avoided. All reports of NDT activities shall faithfully and accurately reflect the tests conducted. No exceptions will be made to the above policy. ensuring that all required and necessary safety procedures are in place and are being used by one’s self and others under his/her jurisdiction.1 The following Code of Ethics is binding upon every individual who possesses a current ACCP™ Level II Certification.3 Conflict of Interest: Consciously avoid conflict of interest situations with employer or client. and to maintain the credibility of the ASNT Central Certification Program and the NDT profession.00 PER METHOD. each ACCP™ Level II certified individual agrees to: 2. 2. health and welfare of the public. procedures used. Accordingly. and treat the public. health. clients and employer in an impartial and ethical manner.

In the event a question arises as to the competence of an Level III to perform an assignment in a field of specific discipline which cannot be otherwise resolved to the Ethics Committee’s satisfaction. The Level III shall not sign documents for work for which he/she does not have personal professional knowledge and direct technical supervisory control and responsibility.2. 7/7/09 . his/her name or firm name in a business venture by any person or firm which he/she knows. or reasonably could. or other tribunal. financial or otherwise.4.5. 1. or under his/her direction. upon a background of technical competence in the subject matter.2. directly or indirectly.4.2. Be completely objective in any professional report. or other parties dealing with the client or employer in connection with work for which he/she is responsible. on behalf of another employer or client. on whose behalf he/she is speaking. and welfare of the public. by all interested parties or their duly authorized agents. In order to safeguard the life. Conflict of Interest 5. report. or for services pertaining to the same project. or misrepresentation. avoiding any omission which would. Undertake to perform assignments only when qualified by training and experience in the specific technical fields involved. criticisms. and 3. health. finding. or testimony. health. 4. employees. and by revealing the existence of any pecuniary interest he/she may have in these matters. Responsibility to the Public The Level III shall: 3. the Level III (in the capacity as a public official) shall not review or approve work that was performed by himself/herself. Improper Conduct 7.1. and the Level III shall be forthright and candid in statements or written responses to the Ethics Committee of the Certification Management Board. commission. 1. the Ethics Committee. Any violation of this code shall be deemed to be an unauthorized practice and upon proper complaint. The Level III will issue no statements. Rulings of Other Jurisdictions Conviction of a felony while ASNT certification is valid or the revocation or suspension of a Professional Engineer’s License by another jurisdiction or similar rulings by other professional associations may be grounds for a charge of violation of this Code. as opposed to a right. 9.1.6. Protect the safety. The Level III will publicly express no opinion on a JSNDI PCP app 7 of 9 5. The Level III who holds a certificate is charged with having knowledge of the existence of the reasonable rules and regulations hereinafter provided for his/her conduct as ASNT Level III. unless the circumstances are fully disclosed to. Brochures or other presentations incident to the solicitation of employment shall not misrepresent pertinent facts concerning employers. or permit the use of. Express an opinion as a technical witness before any court.1. either upon request of the Level III. unless he/she has prefaced the remark(s) by explicitly identifying himself/herself. directly or indirectly. He/she shall not misrepresent or exaggerate the degree of responsibility in or for the subject matter of prior assignments.6. 4.1. retained. and welfare of the public are not being protected. property.1. The Level III shall conscientiously avoid conflict of interest with the employer or client. The Level III shall not knowingly associate with.5. shall forthwith disclose the circumstances to the employer or client. 6.2. to maintain integrity and high standards of skills and practices in the profession of nondestructive testing. and shall serve the public. Solicitation of Employment 6. The Level III shall promptly inform the client or employer of any business associations. or past accomplishments with the intent and purpose of enhancing qualifications and work. and 3. any bribe or commission for professional employment with the exception of payment of the usual commission for securing salaried positions through licensed employment agencies. and 3.1. sanctions may be applied to the individual(s) in violation. and welfare of the public are not protected. 6. clients.4.1. health. 6.1. or statement involved. or his/her associates’. nor offer. and welfare of the public in the performance of professional duties. The Level III shall not solicit or accept gratuities. associates. 5. 8. by disclosing the identities of the party.Code of Ethics for Level III Personnel Certified by ASNT 1. lead to fallacious inference. interests. due process hearing and ruling of the Ethics Committee of the ASNT Certification Management Council in accordance with procedures heretofore established and published. The Level III shall not accept compensation. health. and agreed to. from more than one party for services on the same project. or by its own volition. nondestructive testing matter unless it is founded upon adequate knowledge of the facts in issue. 5. As an elected. The Level III shall seek professional employment on the basis of qualification and competence for proper accomplishment of work. Such knowledge shall encompass the understanding that the practice of nondestructive testing under this certification is a privilege. This Code of Ethics is binding upon all individuals so certified.3.1. or arguments on nondestructive testing matters connected with public policy which are inspired or paid for by an interested party.2. If necessary. sever relationship with the employer or client. Unauthorized Practice 8.1. and 3. and upon an honest conviction of the accuracy or propriety of the testimony. The Level III shall not solicit or accept financial or other valuable consideration from material or equipment suppliers for specifying their products. 5. The Level III shall not falsify or permit misrepresentation of his/her.1. or has reason to believe is engaging in business or professional practices of a fraudulent or dishonest nature. 3. may require him/her to submit to an appropriate inquiry by or on behalf of the Ethics Committee. Apprise the proper authority if it is evident that the safety.3. but when unavoidable. Public Statements 4. joint ventures. Inc.1. the following rules of professional conduct shall be binding upon every person issued a certificate by ASNT as a Level III. The Level III is obligated to act with complete integrity in professional matters for each client or employer as a faithful agent or trustee. investigation. rules. The Level III shall not pay. and 3. 6. Preamble 1. or employed public official. academic or professional qualification. only when such opinion is founded upon adequate knowledge of the facts in issue. 7.1. shall be honest and impartial. 7. their agents. and procedures for such certification. Integrity 2. and also shall be familiar with their provisions and understand them.1.3. 5. from contractors. pursuant to its heretofore published requirements. Should the case arise where the Level III faces a situation where the safety. The “Level III” as referred to herein is that individual who has been issued a certificate by the American Society for Nondestructive Testing.1. solicit. 2.1. he/she shall: 3.1. or circumstances which could influence his/her judgment or the quality of services to the client or employer. or parties. and upon honest conviction of the accuracy and propriety of the testimony.2. statement. and employer with devotion. Refuse to accept responsibility for the design. upon a background of technical competence in the subject matter.1. 5.

*Airmail service is restricted by availability or cost. Become part of the foremost nondestructive testing society and be fully connected to the NDT world. ASNT membership keeps you informed of the latest in technology in addition to savings on certification exams. О $149 All pricing subject to change.org provides publications and networking functions • Serve on ASNT committees. Dues include subscription to Materials Evaluation and The NDT Technician. Be sure to complete the questions on the next page.for current volume Electronic Subscription . You will be contacted if service cannot be provided. О $55 О $55 О $75 Print Subscription . For members outside North America: Unless airmail is specified.for current volume Print and Electronic Subscription . allow 3-4 months for delivery. Stay informed throughout your certification period by maintaining membership along with your certification. provides educational and business networking opportunities • The quarterly newsletter for NDT practitioners: The NDT Technician • Recertification points for membership • Discounts on national conferences and symposium registration • Members Only access at www. the authoritative monthly journal on NDT • Local Section affiliation. Align with your certification period and consider joining for five years to receive maximum savings. One-Year Must submit transcript or letter or enrollment Military Rank E-5 or lower О No • Access to the largest network of NDT contacts and businesses worldwide • Materials Evaluation.asnt. One-Year О Yes Former Member: Phone О О О О О О New members are those joining ASNT for the first time or members having more than a six month gap since expiration. О Office Join now for immediate and significant savings on examination fees. There is no better network for you to be connected when it comes to your NDT career. all materials will will be sent sea/surface mail. Save $75 per method. be part of a group that may effect change or the industry Earn recertification points for ASNT membership.asnt. Such rejoining members. nontransferable.org Membership Options New Member Dues Renewal Member Dues To qualify to pay as a renewing member. New member dues include a one-time $10 administration fee Dues are nonrefundable. your membership expiration date must be within six months. are subject to new member rate. Dues Renewal Member Two-Year Three-Year Five-Year Student.a savings of $35 О $129 Add a subscription to ASNT’s quarterly research journal. RNDE. Research in Nondestructive Evaluation (RNDE®) Individual Subscription With Airmail Service Included RNDE® is ASNT’s quarterly research journal.ASNT Individual Membership Application & Renewal Form Member Information Last Name First Name Send Membership Materials to: О Home M. Total Membership Amount $ Please enter total amount in membership box on page one and add to total.I. ASNT membership includes: • 25% discount on all items purchased from our Publications Catalog or Shop ASNT online at www. airmail may not be offered to your country. JSNDI PCP app 8 of 9 7/7/09 . All pricing subject to change. *Dues with Airmail *New Member *Dues with Airmail Service included Dues Service included $65 $125 $180 $290 $15 $30 О О О О О О $113 $209 $294 $465 $63 $78 О О О О О О $75 О О О О О О $135 $190 $300 $15 $30 $123 $219 $304 $475 $63 $78 Dues include subscriptions to Materials Evaluation and The NDT Technician.

Number of people involved with NDT at your company О1-5 О6-20 О21-50 О51-100 О over 100 О Aerospace/Aviation/Aircraft О Amusement Rides & Skiing О Automotive О Chemical & Petroleum О Construction О Commercial Labs О Infrastructure (Roads & Bridges) О Electronics О Marine NDT Supplier Business О Consulting О Distributor/Manufacturer's О Representative О Equipment О Research О О О О О О О О О Medical Nuclear Optical Ordnance Pipeline Pulp/Paper Railroad Semiconductor Utilities О О О О О Robotics Supplies Training Computer Software Computer Hardware 6. Purchasing Responsibility (select all that apply) 11.2768 (US/Canada) 9 of 9 7/7/09 . Years of Experience in NDT О1-5 О6-10 О11-15 О16-20 О21 & over 5.Membership Profile 1. Plant/Operation Maintenance & Process Control О Consultant О Student О Product Life Extension О QA/QC Reliability О None of the above 7. best describes your role.Choose the one that 10. Gender 9.274. Year of Birth 2. With which NDT method(s) do you work? (select all that apply) О Acoustic Emission О Alternating Current Field Measurement О Electromagnetic/Eddy Current О Ground Penetrating Radar О Infrared & Thermal О Laser О Leak О Liquid Penetrant О О О О О О О Magnetic Flux Leakage Magnetic Particle Neutron Radiography Radiography Ultrasonics Vibration Analysis Visual For Questions Contact the Membership Department at: Phone 614.222. (select only one) (select only one) О NDT Management О Sales/Marketing О Design and Failure Analysis О Quality Management О Researcher О Field Inspection О Engineer О Academic/Educator О Incoming Inspection О Technician/Inspector О Trainer/Instructor О In-service. Choose the primary type of NDT that you do. Highest Level of NDT qualification (select only one) I recommend/approve the purchase of: О Equipment/Instruments/Supplies О None О ASNT NDT Level III О Training & Study Materials/Programs О Level I О ACCP Level II О Services О Level II О ACCP Level III О I am not involved in purchasing О Level III О IRRSP 8.12 О High School Diploma О Some College О 2-Year Associate Degree О 4-Year Undergraduate Degree О Master's Degree О Doctorate Degree 4. (select only one) О Male О Female NDT Utilization Business 3.6003 JSNDI PCP app Toll Free 800. Highest Education Level О Grades 1 . Choose the one business segment that best describes your company. Your Job Function .