Instructor Application

Applicant Information

Date of Submission: NACE Member Number: NACE Certification Type & Number: NACE CIP LEVEL 3& 38479

Course(s) Applying for:

NACE CIP INSTRUCTOR

Have you taken course(s) in which you wish to teach?

NACE CIP LEVEL1,2
Yes, Score(if Known)____________ No

Personal Information
Applicant Full Name: SABARI RK

Best Phone Number to be Reached: +919176277113 Alternate Phone:

Preferred Email: sabariramasamyk@gmail.com Alternate Email: jotunindia.rk@gmail.com

Address Type: Work Home

Address (NO P.O. Boxes): 7A/14B rosammal street

City: Pallavaram State/ Province: Tamil Nadu Zip: 600043 Country: india

Date of Birth:  ___/___/____

25 07 1990 Citizenship: India Passport # (if current):

Fluent Languages spoken: English Spanish French Chinese Portuguese Japanese Other please specify: Tamil

Years of prior teaching or public speaking experience:

Availability & Limitation Information

Annual availability for instructional assignments 2-4 weeks per year 4-8 weeks per year 10+ weeks per year

Periods in year when not available

Usual number of weeks’ notice for acceptance

of assignments

Limitations to travel

Indicate any limitations to service as a

NACE instructor

Application Checklist
Signature:���������������������������������������������������� Completed application
Resume/ CV
SABARI RK
Printed Name:������������������������������������������������
Reference forms distributed to
07 25 1990
Date:___/___/____ three individuals
mm dd yy
The completed application should be submitted to:
naceinstructor@nace.org
Instructor Application—V_2.0
FM_EDU_59
Revised July 13, 2015
 Attestation
I Hereby:
nn Recognize and acknowledge that the proper control of corrosion can be critical to the safety and
welfare of the general public and industrial facilities.
nn Recognize and acknowledge that the control of corrosion is obligatory to maximize conservation of
our material resources, to reduce economic losses, and to protect the environment.
nn Recognize and acknowledge that the entire field of corrosion and its control encompasses the
application of the knowledge and experience of many diverse disciplines and levels of technical
competence with must often be consulted.
nn Recognize and acknowledge that only through continual associations and cooperation with other
in this field can the safest and most economical solutions be found to the many corrosion problems.
nn Recognize and acknowledge that the quality of my work reflects on the entire profession of
corrosion control.

For These Reasons, I:

nn Agree to give first consideration in my corrosion control work to public safety and welfare and to
protection of the environment.
nn Agree to apply myself with diligence and responsibility to the corrosion control work that lies within
my area of competence.
nn Agree to pursue my work with fairness, honesty, integrity and courtesy, ever mindful of the best
interests of the public, my employer, and of fellow workers.
nn Agree to not represent myself to be proficient or make recommendations in the phases of corrosion
control work in which I am not qualified by knowledge and experience.
nn Agree to avoid and discourage untrue, sensational, exaggerated, and/or unwarranted statements
regarding my work in oral presentations, written text, and/or advertising media.
nn Agree to treat as confidential my knowledge of the business affairs and/or technical process of
clients, employers, or customers when their interests so require.
nn Agree to inform clients or employers of any business affiliations, interests, and/or connections which
might influence my judgment.

I understand that my failure to comply with these requirements could result in

disciplinary action.
Signature:__________________________________________________________________________

Printed Name:______________________________________________________________________

Date:___/___/____
mm dd yy
 Instructor Reference Form

Applicant Information (This section to be completed by applicant)

Name of Instructor Candidate  
Course(s) Applying to Teach  

Reference Information (This section to be completed by reference)

Name  ___________________  Date ___/___ /___   Phone Number  ____________________
mm yy
Email  _______________________________________

Relationship to Candidate:
Check all that apply:
Professional: The applicant was/ is a coworker in the same organization
Professional: The applicant was/ is my supervisor
Professional: I have/ had supervisory responsibilities over the applicant
Professional: Other (Please specify)  
Client: (Please specify)  
Customer: (Please specify)  
Personal (not related)
Student of applicant (Please specify organization course offered)  
Other (Please specify)  

Describe your knowledge of the applicant’s technical capability in the subject matter:
(Attach additional sheets if necessary)  
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Rate the instructor candidate’s public speaking/presentation skills:

Attributes Poor Good Excellent
Professional Demeanor
Voice and Diction
Ability to Get Ideas Across

How long have you known the instructor candidate?  _________ Years
Return this form directly to:
Signature  __________________________________  Date  ___/___/____ Instructor Relations
mm dd yy
Coordinator
Thank you for completing this reference form.
Email: naceinstructor@nace.org

Mail: 15835 Park Ten Place

Houston, Texas 77084, USA
 Instructor Reference Form

Applicant Information (This section to be completed by applicant)

Name of Instructor Candidate  
Course(s) Applying to Teach  

Reference Information (This section to be completed by reference)

Name  ___________________  Date ___/___ /___   Phone Number  ____________________
mm yy
Email  _______________________________________

Relationship to Candidate:
Check all that apply:
Professional: The applicant was/ is a coworker in the same organization
Professional: The applicant was/ is my supervisor
Professional: I have/ had supervisory responsibilities over the applicant
Professional: Other (Please specify)  
Client: (Please specify)  
Customer: (Please specify)  
Personal (not related)
Student of applicant (Please specify organization course offered)  
Other (Please specify)  

Describe your knowledge of the applicant’s technical capability in the subject matter:
(Attach additional sheets if necessary)  
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�������������������������������������������������������������������������������������������������

Rate the instructor candidate’s public speaking/presentation skills:

Attributes Poor Good Excellent
Professional Demeanor
Voice and Diction
Ability to Get Ideas Across

How long have you known the instructor candidate?  _________ Years
Return this form directly to:
Signature  __________________________________  Date  ___/___/____ Instructor Relations
mm dd yy
Coordinator
Thank you for completing this reference form.
Email: naceinstructor@nace.org

Mail: 15835 Park Ten Place

Houston, Texas 77084, USA
 Instructor Reference Form

Applicant Information (This section to be completed by applicant)

Name of Instructor Candidate  
Course(s) Applying to Teach  

Reference Information (This section to be completed by reference)

Name  ___________________  Date ___/___ /___   Phone Number  ____________________
mm yy
Email  _______________________________________

Relationship to Candidate:
Check all that apply:
Professional: The applicant was/ is a coworker in the same organization
Professional: The applicant was/ is my supervisor
Professional: I have/ had supervisory responsibilities over the applicant
Professional: Other (Please specify)  
Client: (Please specify)  
Customer: (Please specify)  
Personal (not related)
Student of applicant (Please specify organization course offered)  
Other (Please specify)  

Describe your knowledge of the applicant’s technical capability in the subject matter:
(Attach additional sheets if necessary)  
�������������������������������������������������������������������������������������������������
�������������������������������������������������������������������������������������������������

Rate the instructor candidate’s public speaking/presentation skills:

Attributes Poor Good Excellent
Professional Demeanor
Voice and Diction
Ability to Get Ideas Across

How long have you known the instructor candidate?  _________ Years
Return this form directly to:
Signature  __________________________________  Date  ___/___/____ Instructor Relations
mm dd yy
Coordinator
Thank you for completing this reference form.
Email: naceinstructor@nace.org

Mail: 15835 Park Ten Place

Houston, Texas 77084, USA