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eS Aneto Nes SIE RE-EXAM APPLICATION (800) 443-9363 or (305) 442-9363, ext. 273, CAWI, CWI, CWE or CWI/CWE Faxed or emailed applications are NOT accepted Lastname FirstName mi sole Izlale| INID indicate the exam location of your choice Confirmation wilbe emalled in Sa weeks from recast 1 Ste code tam bate ciystte *sutmison Deine 2° Se ode fam Date cya *submison dead 3° te coe: fam one cayiste +submison Deane NOTE: ifthe ft choice snot avaiable, registration wil ndeate the nest avaiable choice site, 00 NOT make any hotel or fight arrangements untl you have received you exam cortimation letter fom the Certcation Department via emal_* Refer to AWS Poles and Fees. Seminar and bam Schecule Aus Member [2.Choose the part(s) for retest iftaking non-AWS seminar porto exam, please answer the following: —|E}far-A~rundmertal Name of Azeney. [Diver race art ¢-Code Apoiation Seminar date | nero (CW! Body of Knowledge ‘BIAMerican with Disabilities Act Accommadations: Ci by checking this box | am requesting special accommodations due to a disability. AWS is committed to complying fully with the ADA. A copy of the accommodations request form can be found at our website Will you be using a glucose meter during your exam? Yes] NoL] ‘a\visual Acuity Form ‘A current Visual Acuity Form must be completed and submitted with this application. Click here for a copy of the form. 5.Photo Requirements Do not send photo ifa current one is already on file within the last 12 months, otherwise click here. GiRefer to the AWS Pricelist section CLINICS/SEMINARS/WORKSHOPS, when selecting one of the categories listed below. ID ciisemiar week (01a Focus ED cw sear ek (aP 130 Foes) [adc eSeminar (Onne couse) scan Presemiar (Onn couse [Llow oesernar (nine couse) seins ett tin 32 moths ern event -ooks ot nude) [Cl examnvarion ontr [7iMtethod of payment: Fulloaynient must accompany this epplieation For Re-Evam Brice AWS USEONLY, Diccheck or money order i — vise Come Damex D oiscover fn ccr_—____/___. on amt Checks and mene orders mode payable to AWS Name 8. Personal information AWS Member # dares 04 |-BirL,.1 wlelollgl Iwiels ir] Isitl-Is[21,[ [6 KE 1315) darss cont) aot Cityand State/Province County Zipcode Sl) Wwialal lo IR le iG 10/3131 6) Home Telephone Number Work Telephone Number Mobile Telephone Number Olé 5 |- 19 [7/3] 7/63/03 Die ofS example November 393952) US: Soil Security Number fost on 2a [mia og 9 Taal xxx [x]x E-Mail Adéress (Confirmation notification wil be sent to this address) Slo [ele lal-[al@lalmla[: [z- Ic lon SAREE ‘Type of Business (check only ONE) Job Classification (check only ONE) ‘Technical Interests (check ALL that apply) ‘ALi contract construction 1 President, owner, partner, officer pre wrt 8 Lchemicals & allied products Petroleum & coal industries Primary metal industries F LoMachinery except elect. inl gas welding) 6 [lelectrcal equip, supplies, electrodes # [Transportation equip. - air, aerospace | transportation equip. automotive 1 transportation equip. - boats, shins K transportation equi. t Qlutilities ME Welding distributors & retail trade rallroad N DMs. repair services (incl. welding shops) 0 Decucational services (unbraresschoos) Dlengineering & architectural services (ine. ans.) Disc. business services ( labs) 8 Cicovernment (federal, state, local) s Dlother (02 JManager,cirector, superintendent (or assistant) oa{] sales 04] Purchasing osfeférsineer—weaing ost Engineer — other 070 inspector, tester 08 supervisor foreman 0917] Welter, wedrecrctngoneratr 10L] architect, designer 1300 consuitant 120] metaturgst 130 Research & development 14D Technician 15(0 eeucator 160] student 170 uration 18[1 Customer service ssQother 20 Engineer design 2n(Z{ engineer - manufacturing 220 ously contro CHBonterousexcept aluminum Chadvanced materaliintermetalis Deeramis {ih eneray Processes fe wen Brazing & Soldering Cipesstance Welding Crihermal say aorne sey enn pe Tie Cres Veel 8 Tans GiStructures pot forming iets iSempne pncing CiBending & shearing Giewone scr fre Bote: Datonaton Browtes Deamon! Weng Retest Anolication for CAWI. CWI. CWE or CWI/CWE 1098 Page 2 0f3 February 5. 2018 Name AWS Member # 110, Terms and Conditions: Please check, date, and sign below. Certified Welding Inspector/Certfied Welding Educator (QC1 Standard for the AWS Certification of Welding Inspectors [QC AWS Standard for the Certification of Welding Educators 5.1 Specification for the Qualification of Welding Inspectors, | hereby certiy that I have read the standard requirements contained in the certification programs indicated above. Further, | agree to comply with the existing requirements and any subsequent requirements that may be instituted by AWS. Ihave read and agree to the terms and conditions set forth in the AWS Policies and Fees form. | certify that the information | have included on this application is true. | understand that any false statements will nulify this application. | give AWS permission to verity this information. | agree to comply with the provisions set forth in the Standard concerning the administration of my examination and certification. Upon obtaining my certification, | give AWS the right to reveal my certification status asit relates to my validity and expiration date. | further understand that any required information that is incomplete or missing will cancel this registration. Furthermore, | certify that | have not obtained any exam materials, have no prior knowledge of the AWS exam questions or answers, and have not and will not accept any solicitation for the AWS exam questions or answers from anyone at any time before, during, or after the exam as stated on the Exam Security Agreement and General Terms of Use (Please click and read this link prior to accepting the Terms and Conditions. You will be required to sign this form on exam day). | understand that a violation of this oath may be grounds for invalidation of my certification and may be grounds for expulsion from any future testing. pate F/I / 201d Applicant's Signature Retest Anolication for CAWI. CWI. CWE or CWI/CWE 1098 Page 3of 3 February 5, 2018