TRAINING AND EXAMINATION SERVICES Document no.

Experience Verification Form TES 15K rev. 1

BGAS - CSWIP Page 1 of 2
----- Please carefully read the guidance on the reverse of this form, before completing the information -----

Candidate details
Name 1
Date of birth 2 Candidate ID 3
Course 4 Certificate grade 5

Candidate’s experience

Please indicate the length of your experience. 6 months

Please give a detailed statement of how you meet the scheme requirements (including dates). 7

BGAS candidates who seek the higher level certification should be first certified on lower levels. Please provide
details of your certification. 8
Certificate name and level 9 Certification body 10 Certified since 11 Expiry date 12

I confirm that I have read and comply with the pre examination entry requirements as laid down in the
BGAS-CSWIP Requirement Documents, latest version available on CSWIP website (www.cswip.com).
I understand that any fraudulent claim may result in the retraction of any certificate issued and any false
statement may result in the examination being invalidated.

Date Candidate’s signature 13

Please note - terms and conditions of your booking apply.

Verifier details 14
Name & job title 15
Company name 16
Supervision activity 17
E-mail 18

Declaration To the best of my belief, the candidate’s statement is correct at the time of signing.

Date Verifier’s signature & stamp 19

To support your experience claim please attach copy of your certificates and/or evidence of your education (if relevant).
 TRAINING AND EXAMINATION SERVICES Document no.:

Experience Verification Form TES 15K rev. 1

BGAS - CSWIP Page 2 of 2
Experience claim form – notes
1 The full name of candidate as stated on the original enrolment form (as it will be shown on the certificate).
2 Candidate’s date of birth in the following format DD/MM/YYYY (e.g. 20/08/1969).
3 The six-digit CSWIP identification number of the candidate (if known – this is usually indicated on the result notice).
4 Name of training & examination you wish to attend (e.g. ‘Paint inspector’).
5 Grade of certification sought (e.g. ‘Grade 2’ or ‘G2’). Your experience claim will be assessed against the criteria stipulated for this
certification grade.
6 Please indicate the length of relevant industrial experience you are claiming. The length MUST be in months. Experience maybe
acquired prior to or following success in the examination. In the event that the experience is sought following successful
examination, the results of the examination shall remain valid for two years.
7 Please describe how did you gained this experience (include also dates when was this experience gained). The experience shall be
gained in the method in which candidate seeks the certification in a relevant engineering environment. Your application will be
assessed to determine how relevant the background experience is, how was this experience gained and what is the length of the
experience you claim.
8 Candidates for higher certification grades are required to hold lower qualification levels first to gain relevant on-the-job experience.
This may be BGAS (or under some circumstances EN ISO based) certification.
9 Please provide the name and level/grade of your qualification as stated on the certificate. If you don’t hold any relevant certificate
yet, leave this section blank.
10 Please provide the name of awarding/certification body.
11 Please indicate the date when you initially gained this certification.
12 Please indicate the expiry date as shown on the certificate.
13 This form must be signed by the candidate. Handwritten signature is required. Alternatively, the graphical representation of real
signature (scanned signature) may be inserted. Other types of electronic signature are not accepted.
14 Each form must be reviewed by the verifier whose signature confirms the information given (re: experience) to be correct. The only
person to be classed a supervisor, will be the person who takes supervisory responsibility for the candidate on a working basis.
 Employed candidates usually have their experience verified by Employer, a Company Supervisor, QA/QC manager, third party
supervisor etc.
 Self-employed candidates usually have their experience verified by main contractor or client’s supervisor for whom work was
carried out during the time when experience was gained.
Verification by colleague who has no responsibility for the Candidates activity or verification by candidate’s subordinates is not
acceptable.
15 Name of verifier (as stated on his/her certificate or passport) and official employment job title.
16 Name of company where the verifier is employed.
17 Briefly outline – how was Verifier involved in candidate’s supervision and what sort of responsibility he/she had for the results of
tests carried out by candidate.
18 Verifier’s contact e-mail.
Note: The Verifier may be contacted and asked for further relevant details if there is any doubt whatsoever. Company e-mail
addresses are preferred; private e-mail addresses set-up for the purpose of communication with the certificating body will
not be accepted.
19 By signing the declaration, the verifier confirms accuracy of information provided. Verifier’s signature should be accompanied by
stamp. Handwritten signature is required. Alternatively, the graphical representation of real signature (scanned signature) may be
inserted. Other types of electronic signature are not accepted.
20 To support your experience claim please attach copy of your certificates and/or evidence of your education (if relevant).