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NACE Level 2 Certificate Reference Form

This document is a qualification reference form for applicants seeking certification from NACE International Institute. The form is to be completed by a reference for the applicant to verify their experience in corrosion inspection field work. The reference must hold certain qualifications like being a registered engineer or previous supervisor of the applicant. The reference is asked to assess the applicant's character, reputation, years of experience in coatings inspection, quality of work, proficiency in inspection phases, and describe major projects involving the applicant's inspection work.

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Rizwan Nazir
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430 views3 pages

NACE Level 2 Certificate Reference Form

This document is a qualification reference form for applicants seeking certification from NACE International Institute. The form is to be completed by a reference for the applicant to verify their experience in corrosion inspection field work. The reference must hold certain qualifications like being a registered engineer or previous supervisor of the applicant. The reference is asked to assess the applicant's character, reputation, years of experience in coatings inspection, quality of work, proficiency in inspection phases, and describe major projects involving the applicant's inspection work.

Uploaded by

Rizwan Nazir
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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D.

QUALIFICATION REFERENCE
(Pleasemakeasmanycopiesofthisformasnecessarytoprovidethe
appropriatenumberofQualificationReferencesneeded)

APPLICANT:CompleteItemsD.1,D.2,andD.3thenforwardthisformtothepersonyouhavelistedin
ItemD.3.AskthispersontocompletetheremainderoftheformandreturnitdirectlytoNACE
InternationalInstitute.

Qualificationreferencesmaybesubmittedbythefollowing,whichhaveexpertiseinthecorrosionfield
andcanverifytherequiredfield/instrumentationexperience:

Registeredorcharteredengineers
Presentand/orprevioussupervisor(s)oftheapplicant
P.M.ofthereferredProject
NACEInternationalInstitutecertificateholders(ForCIPLevel3applicants,oneQualification
ReferencemustholdaNACEInstituteCertificateatthelevelbeingappliedfor.)

D.1 ApplicantsFullName:

D.1A NACEMemberID#:

D.2 Certificationcategoryappliedfor:

D.3 Name,title,companyname,address,andphonenumberofpersonwhoisfamiliarwiththe
workexperienceoftheapplicant:

Phone:

REFERENCE:TheapplicantisapplyingforprofessionalrecognitionbyNACEInternationalInstitute.
Applicantsforcertificationmustmeetspecificrequirements;pleaseseethelistoftheserequirements
onthefollowingpage.Evaluationofanapplicantsqualificationsalsodependsonassessmentof
professionalexperiencebyreferences.ItisrequestedthatyoucompleteItemsD.4throughD.13onthis
formandreturnitdirectlytoNACEInstitute.

D.4 IholdNACEInstituteCertificationasa:
(Leavethissectionblankifthissectionisnotapplicable)

Certified No.

IamaRegisteredEngineer(orequivalent)

State/Province: Branch: No:


D.5 Ihaveknowntheapplicantforyears.Whatis/wasthenatureoftheassociation?

CurrentSupervisor PreviousSupervisor

CurrentClient PreviousClient

CurrentCoworker PreviousCoworker

CurrentProfessor/Instructor PreviousProfessor/Instructor

Other(Pleasespecify)

D.6 Frompersonalknowledge,myassessmentoftheapplicantscharacterandpersonalreputation
isthatitis:

Excellent Average Belowaverage

D.7 Frompersonalknowledge,Iknowthattheapplicanthasbeenengagedinthefieldofcoatings
relatedfieldworkforyears.(Definedascoatingsrelatedfieldworkinanindustrialsettingwhere
protectivecoatingsareinspected).

D.8 Basedonthispersonalknowledge,Iknowthatthequalityoftheapplicantsworkinthefieldof
Coatingsis

Excellent Average Belowaverage

D.9 Theapplicantisproficientinthefollowingphasesofcoatingsinspection:

D.10 Wouldyouemploy,orrecommendtheemploymentof,theapplicantforemploymentinthe
phaseofcoatinginspectionyouhavedescribedinItemD.9?

Yes No

NACEInternationalInstituteCertificationProgram

D.11 PleasedescribeINYOUROWNWORDSanymajorprojects/activitiesinwhichtheapplicanthas
beeninvolvedinthefieldofcoatingsinspectionwork.Describeonlythosewhereyouhad
personalknowledgeoftheapplicantswork.Pleaseindicatethedegreeofresponsibility
exercisedbytheapplicant,thecomplexityoftheproject/activity,thename/sandtype/softhe
project/s,thedegreeofknowledge/skillrequired,etc.
(Youcanattachaseparatesheetifyouwish,orifyouneedmorespace).

**THED.11SECTIONMUSTBECOMPLETEDBEFORETHE
APPLICATIONCANBESUBMITTEDFORREVIEW**

D.12 Anyadditionalremarksyouwouldliketoaddconcerningthisapplicant:

D.13 MysignaturebelowindicatesthatIhavepersonalknowledgeandexpertiseinthecorrosion
fielduponwhichtoevaluatetheapplicantsprofessionalcapabilities.

Signature: Date:

PrintedName:

Thecompletedformcanbereturnviaemailorregularmail:

NACEInternationalInstitute
CertificationDepartment
15835ParkTenPlace
Houston,TX77084USA

Email:[email protected]

NACEInternationalInstituteCertificationProgram

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