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Application Form –
SSPC Coating Application Specialist (CAS) -
Level 2 Certification Program (Full Status)
Send COMPLETE Application Packet to the SSPC Training Coordinator listed below:
Jeannine Bodack Phone: 877-281-7772 ext 2204
40 24th Street, Sixth Floor Fax: 412-281-9995
Pittsburgh, PA 15222-4656 Email: bodack@sspc.org
Please take note: By completing this form it does not register you
for the scheduled certification exam. You must pay by check or
credit card first before you are officially registered to take the
exam.
Job Title
Current Employer
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Mailing Address of Current Employer
Telephone Fax
Initial: __________ SSPC Coating Application Specialist (CAS) - Level 2 Certification Program (Full
Status) Form and Instructions.
I do hereby certify that I have read and met the above prerequisites for the Coating Application Specialist (CAS) -
Level 2 Certification Program (Full Status).
Signed:
Printed Name and Title:
Date Submitted:
I acknowledge that failure to report accurate, complete information will delay my application. Omission or
falsification of information or failure to answer all questions truthfully will result in withholding or denial of
qualification status. Initial: __________
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Employer
Title
Address
Job Duties
(attach detailed
description if more
room needed) **AS
REQUIREMENTS
LISTED ABOVE
Employed From: To:
# of hours worked
Reason for Leaving
Employer
Title
Address
Job Duties
(attach detailed
description if more
room needed) **AS
REQUIREMENTS
LISTED ABOVE
Employed From: To:
# of hours worked
Reason for Leaving
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Pre Req Item #3 – Training History
Describe formal training courses you have completed in the charts below.
Additional approved applicator training includes SSPC, NCCER, IUPAT application specialist training,
community college, apprenticeship or trade school courses in the sciences or math or English or equivalent
meeting the SSPC ACS-1/NACE 13 standard’s Body of Knowledge.
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Accepted formal training includes:
1. Current SSPC courses that meet the accepted formal training requirements are:
SSPC has added seven new modules to help contractors meet the Full Body of Knowledge as outlined in
SSPC ACS-1/NACE 13: The modules can be purchased on a CD individually or you can purchase all 7
together on one CD.
The CD will provide you with a complete plan on how to successfully provide the training to your workers
on the topics below.
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The CD Contains:
* Student Manual
* Written Exam
* Written Exam Answer Key
* Instructor Manual (Describes how to teach the supplement)
* Slide Presentation
Specialty Modules:
Introductory Price.....$99 each or $499 for ALL SEVEN (7) modules!
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