This will be helpful in keeping records of your work experience and

professional development (see reverse side) over the next certification period.

WORK EXPERIENCE

Acceptable work experience is documented work experience in the field of corrosion which includes either: (a) the
investigation of corrosion causes and mechanisms, or (b) the investigation, design and implementation of corrosion
control procedures, or (c) the teaching of corrosion related science.

Please make and use as many copies of this form as needed to document your work experience since your last
certification.

WORK EXPERIENCE DOCUMENTATION FORM

From To Total # of Job

Month/Year Month/Year Months in Information
this Job
Job Title:
____/_____ ____/_____ __ Months Company Name:
Please describe your corrosion related duties in this job:

Job Title:
____/_____ ____/_____ __ Months Company Name:
Please describe your corrosion related duties in this job:

Job Title:
____/_____ ____/_____ __ Months Company Name:
Please describe your corrosion related duties in this job:

Job Title:
____/_____ ____/_____ __ Months Company Name:
Please describe your corrosion related duties in this job:

TOTAL NUMBER OF DOCUMENTED MONTHS OF CORROSION WORK EXPERIENCE:

Name: _________________________________ ___________________________________________

(Print) (Signature)
 PROFESSIONAL DEVELOPMENT
Acceptable professional development education activities include: corrosion related courses, seminars, workshops, technical
meeting attendance, technical committee service, technical community service, technical paper presentation/authorship, study of
corrosion-related technical papers, and company-sponsored corrosion-related programs.

All professional development counted must be since last recertification. Total hours cannot be in any one category.
NAME/DESCRIPTION DATE(S) # OF
HOURS

CORROSION RELATED COURSES

SEMINARS

WORKSHOPS

TECHNICAL MEETING ATTENDANCE

TECHNICAL COMMITTEE/COMMUNITY SERVICE

TECHNICAL PAPER PRESENTATION/AUTHORSHIP

STUDY OF CORROSION-RELATED TECHNICAL PAPERS

Reading your Materials Performance Journal will count as acceptable hours.

COMPANY-SPONSORED CORROSION RELATED PROGRAMS

TOTAL NUMBER OF HOURS

PRINT NAME: ___________________________________________________________________________________