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Application Instructions
1. This application is a writable PDF. BE SURE to download the document and save it on your computer, before filling it out. Open the saved application, type in your information, and print the application forms to be mailed to API. (Any application filled in while viewing it online will not be saved, nor will it be sent to API electronically.) All original applications must be mailed to API. 2. Fill out all pages of the application completely. 3. Please enter your name as it appears in your govt.-issued ID / passport / drivers license. 4. If you have previously applied to API and been assigned an API ID number, include it every place that your name appears. 5. Be sure to include a unique and current e-mail address. All API correspondence including your admission letter and exam score report will be sent to the e-mail address you provide. 6. Make note of the applicable documents to study as listed on the Publications Effectivity Sheet. The publications for ICP certification exams may be ordered through IHS (www.global.ihs.com) or TechStreet (www.techstreet.com). See pages 16 and 17 for important information regarding exam publications. 7. You must include a verified Employment Reference Form (ERF). The ERF may be validated either by a public notary or by your employer. See Page 7 for full instructions. 8. Read and sign BOTH Inspector Agreements 9. Include the certification fee. See Page 2 for ICP Financial Policies. We will not process any application until full payment is received. 10. Be sure to keep a copy of the completed application that you mail to API, including copies of your ERF, diplomas, employer letter, etc. 11. When you have completed your application see checklist at the back of this packet to ensure you have included all the information and documents necessary. INFORMATION FOR THE DAY OF THE EXAM: You are allowed to have only the following in the test room: API permitted test reference materials, sharpened No. 2 pencils, an eraser and a calculator (simple function only, nonprogrammable). Anything else could be confiscated by the test staff. Any additions to the reference materials are not allowed. This includes training materials, any pages inserted in your codebooks, preprinted and inserted labels, and handwriting in the blank/half-blank pages of the codebooks. Small notes in the margins are permitted.
API and ASME publications are copyrighted material. Making copies of the publications is illegal. If the proctors determine that your documents are illegal copies, the documents will be confiscated.
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Refund Policy All requests for refunds must be submitted to API in writing by mail, e-mail or fax and requested within 6 months of the date of the payment. For refund requests made before the application deadline: API will refund the initial certification fee less $100.00 for processing. For refund requests made after the application deadline: API will refund 50% of the initial certification fee. Reschedule fees are nonrefundable. For refund requests made after the date of your examination: No refunds will be issued whether you took the examination or not.
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FIRST MIDDLE LAST NAME (please spell it the same way as it appears on your passport / drivers license)
Country
Employer
If you want your exam admission letter / score report to be sent to your employer, trainer, or exam organizer, please include this persons e-mail here:
Country
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Additional Information
API 653, Aboveground Storage Tank Inspector Certification Program
1. Mailing and Directory Addresses -- Please check the appropriate boxes regarding your preference for mailing and directory addresses. Please be sure to check one box only for each question. At which address do you wish to receive your certificate? Are you interested in being included in the on-line API Inspector Directory, when you obtain your certification? Which address do you want shown in the ICP Directory listing? 2. Do you currently have an active API certification? If yes, enter your certification number and expiration date. If you answer yes, you need not complete the Education and Training Form. Home Yes Home Yes Work No Work No
4.
Please check the boxes that correctly describe your organization. Please be sure to check one box on each side. Industry Organization type
Please check the boxes that correctly describe your employment status. Please be sure to check one box only.
Full-time employee of an owner/user Full-time employee of an inspection agency/other company Independent contractor
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Name
Location
Year Graduated
Name
Location
Year Graduated
Name
Duration of Studies
Field of Study
Year Graduated
Name
Duration of Studies
Field of Study
Year Graduated
Name
Duration of Studies
Field of Study
Year Graduated
College / University
Name
Duration of Studies
Major
Degree Type
Dates Attended
Name
Duration of Studies
Major
Degree Type
Dates Attended
Name
Duration of Studies
Major
Degree Type
Dates Attended
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Employment History
API 653, Aboveground Storage Tank Inspector Certification Program
(Last three employers or at least the last five years)
1.
Mailing Address (Number and Street) City, State and Zip Code Job Title / Description of Responsibilities
Employers Telephone
2.
Mailing Address (Number and Street) City, State and Zip Code Job Title / Description of Responsibilities
Employers Telephone
3.
Mailing Address (Number and Street) City, State and Zip Code Job Title / Description of Responsibilities
Employers Telephone
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All paperwork documenting the applicants work experience MUST be original documents. Photocopied, scanned, or faxed documents will not be processed. The Employment Reference Form attached to this application must verify the required length of experience based on your level of education. This experience must have been acquired within the last 10 years. Please make copies of the ERF and provide one form for each employer if it is necessary to meet the requirements. API requires that the supervisor signs any ERF that is submitted. Supervisors may only sign for the experience acquired while at their company. This signature must be validated by a notary public, Commissioner of Oaths or similarly licensed official. API requires proof of the validating authority such as a notary stamp, a copy of the license, etc.
Alternative Method of ERF Verification If a notary is not available in your country then ALL THREE OF THE FOLLOWING REQUIREMENTS MUST BE MET to complete and verify the documentation of your employment: 1. The ERF must be signed by a supervisor. 2. The ERF must be stamped with a company stamp instead of the notary stamp 3. In addition to the ERF the applicant must provide an employment confirmation letter. This letter must be submitted on company letterhead, and signed by an individual other than your supervisor - a higher company official such as department manager, director, vice-president. The letter must confirm that the applicant is employed in an inspector capacity and include a detailed description of the job responsibilities.
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Beginning Date
Ending Date
SUPERVISORS: Please fill in the blanks below. Your signature on this page validates that while working for your company and during the period indicated above the applicant has acquired the following experience:
This box must be completed. Please fill in all that applies for the CURRENT employer.
Activity
INSPECTION of Aboveground Storage Tanks Design of Aboveground Storage Tanks Construction of Aboveground Storage Tanks Operation of Aboveground Storage Tanks Repair of Aboveground Storage Tanks From From From From From ______
Dates
To To To To To ___________________
ALL APPLICANTS MUST HAVE THE AREA BELOW COMPLETED AND VALIDATED SUPERVISORS NAME (PLEASE PRINT )
Supervisor's Signature
Date
Subscribed and sworn to before me the ____________________ day of _______________ , ______. Notary Signature My commission expires ________________
Notary Public
Notary or Company Stamp or Seal
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North America:
Anchorage, AK Atlanta, GA Baton Rouge, LA Corpus Christi, TX Edmonton, AB (Canada) Houston, TX Indianapolis, IN Los Angeles, CA Oakland, CA Oklahoma City, OK Philadelphia, PA
Other Locations:
Abu Dhabi, UAE Al-Khobar, Saudi Arabia Cairo, Egypt Chennai, India Chia, Colombia Doha, Qatar Kuala Lumpur, Malaysia Mumbai, India Port of Spain, Trinidad Safat (Kuwait City), Kuwait Singapore, Singapore United Kingdom (Contact API for city info)
If a location of your choice is not listed above please contact API for more information. If you are testing at an API-approved special site, please include the location and/or group here: _________________________________________ City, Country
> > THIS FORM MAY ALSO BE USED TO RESCHEDULE A TEST << If rescheduling, please remember to include the re-test fee.
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FOREIGN LANGUAGE WAIVER for ICP CERTIFICATION EXAMS OUTSIDE OF UNITED STATES
(Complete this form only if testing in a language other than English.)
Please complete and sign the form below to take the API exam in a Foreign Language. This form is sufficient for all your attempts within a given program until you obtain your certification. If you do not submit this form, or the form is incomplete, you will take the exam in English. Please note: Translations are not available for all languages or all programs, and API does not guarantee that your requested translation will be available. Make sure to visit the API website and confirm language availability prior to applying. I, ___________________________________________________ ID # _________ (Please print your full name above. If you hold another certification with API please include that number ) request to take the following examination in a foreign language: API program: ______________________________________ Location: __________________________________________ Language requested: _______________________________
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3.
4.
5.
6.
7.
8.
9. The Inspector shall not use any trademark of API or name of API including any abbreviation thereof, in any publicity, advertising, or for other promotional purposes without the prior written approval of API.
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10. The Inspector agrees to comply strictly with all U.S. export laws relating to this program. The Inspector warrants that he is not located in, or under the control of, or a national or resident of any embargoed countries. 11. This agreement shall not and is not intended to benefit or to grant any right or remedy to any person or entity that is not a party to this Agreement. 12. 13. 14. This instrument contains the entire and only agreement between the parties. No oral statements or representations not herein contained shall have any force and effect. Paragraphs 2, 3, 4, 5, 6, 7, and 8 survive termination of this agreement. It is expressly understood between the parties hereto that no association, agency, apparent agency, employer/employee relationship, partnership, or joint venture of any kind has been created. Inspector agrees not to refer to himself as APIs agent nor refer to the relationship between the parties as a joint venture or partnership or in any manner inconsistent with this Agreement. Inspector shall have no authority to act or contract on behalf of API. No waiver by API of any default, misrepresentation, or breach of warranty or covenant hereunder, regardless of whether intentional, shall be deemed to extend to any prior or subsequent default, misrepresentation, or breach of warranty or covenant hereunder or affect in any way any rights arising by virtue of any prior or subsequent such occurrence. API makes no express or implied warranties regarding the ICP program or potential benefits of the certification to the Inspector. The Inspector agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by any government body or authority in any way measured by this Agreement, or any portion of it, or any services related thereto.
15.
16. 17.
18. Inspector understands and agrees that Inspector is not granted any rights under the program or this Agreement until API has determined that the Inspector has satisfied all of the program requirements and has issued a Certificate to the Inspector. The Inspectors certification shall be effective on the date that is noted on the Certificate and shall be effective for a period of three years unless terminated pursuant to the terms of this Agreement. 19. This Agreement shall be governed by and construed in accordance with the laws of the District of Columbia, USA, without regard to the rules regarding conflicts of law. The parties agree that any action, suit, or proceeding based upon any matter, claim, or controversy arising hereunder or relating hereto shall be brought exclusively in the federal or state courts located in District of Columbia, USA. The parties consent to the jurisdiction and venue of such courts, and waive any objections to the jurisdiction and venue thereof.
I, the undersigned, certify that I have read and fully comprehend this form in its entirety and agree to comply with the conditions specified above. Applicants name (please print) _______________________________ E-mail:
Date
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15. The Applicant agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by any government body or authority based on in any way measured by this Agreement, or an y portion or it, or any services related thereto. 16. Applicant warrants and represents to all information that is being submitted pursuant to this is complete and accurate. Applicant understands that API is relying upon the accuracy of this information in evaluating the Inspectors qualifications. Applicant agrees to indemnify API for any claims, losses, or damages resulting from the Applicant submitting inaccurate or misleading information.
I, the undersigned, certify that I have read and fully comprehend this form in its entirety and agree to abide by the policies and regulations specified above.
Signature of Applicant
Date
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API Member
$600.00
Non Member
$800.00
PAYMENT INSTRUCTIONS
All payments must be made in United States currency. Checks must be drawn on a U.S. bank. You are responsible for all taxes, banking or other service fees, including all applicable withholding taxes. Applicants name(s) must be included on the check. For payments by electronic transfer: (1) you are responsible for all electronic transfer, A.C.H. and banking fees (be sure to add the fees to your payment); (2) for electronic payments not drawn on a U.S. bank a fiftydollar ($50) handling fee must be added at the time payment is made. Please include a copy of the wire / electronic transaction. Applicants name(s) must be included on the transaction document.
PAYING BY CREDIT CARD CAN EXPEDITE THE PROCESSING OF YOUR APPLICATION AND PAYMENT TO ENSURE YOUR PLACE IN THE EXAMINATION.
Credit Card Type: Card Number: Visa American Express Expiration Date: MasterCard
($150.00)
Late Penalties Bank Fee (if wired)
TOTAL SUBMITTED
(Reference: Applicants Name and SS-2100-D9200-7110) Your application will not be processed if this page is not completed.
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If yes: Name of training provider _______________ Will the exam publications be provided to you by the training company? YES NO
If the exam publications will not be provided, how will you obtain the necessary exam materials?
Include proof of legal purchase: a) Company subscription ID ___________________________________________________ Note: Companies with an API subscription may print the relevant ICP documents for their employees only. Exam attendees are not allowed to bring in subscription documents from companies other than their own. Such documents maybe confiscated during the exams. b) Receipt or invoice number c) If other, please include how publications were acquired
* API members are eligible fora 30% discount on all API documents; exam candidates are eligible fora 20% discount on all API documents. When calling to order, please identify yourself as an exam candidate and/or API member. Prices quoted will reflect the applicable discounts. No discounts can be made for ASME documents. If you have questions regarding the authenticity of your documents, please contact API. If you know of any training company or organization distributing unauthorized copies of ICP exam materials, please contact API immediately with this information.
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API 653 Exam Administration -- Publications Effectivity Sheet FOR: March 27, 2013 and September 25, 2013
Listed below are the effective editions of the publications required for this exam for the date(s) shown above.
Please be advised that API and ASME documents and publications are copyrighted materials. Reproducing these documents without API permission is illegal. If exam proctors determine that your documents are illegal copies, the illegal documents will be confiscated from you prior to the exam.
API Recommended Practice 571, Damage Mechanisms Affecting Fixed Equipment in the Refining Industry,
CHECKLIST
1. 2. 3. 4. 5. 6. 7. 8. 9. All pages of the application completed Valid e-mail address included so we can contact you All copies of diplomas attached ERF has a notary or company stamp Employment letter attached, if necessary Foreign Language Waiver signed, if necessary BOTH Inspector Agreement forms signed Publications Questionnaire completed Certification Fee (payment page filled in completely)
10. Copy of transaction documentation if paying by wire 11. Copy of completed application made for your records
IF PAYING BY CREDIT CARD, MAIL ORIGINAL APPLICATION TO: API Individual Certification Programs 1220 L Street, NW Washington DC 20005 (Phone: 202-682-8064) Please include candidates name(s) on all payments.
IF PAYING BY CHECK OR MONEY ORDER, MAIL ORIGINAL APPLICATION TO: API Individual Certification Programs P.O. Box 1425 Merrifield, VA 22116
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