AWS Maintenance Welder Certification Form – Fill Out and Use This PDF

MAINTENANCE OF WELDER CERTIFICATION

$10.00 fee must accompany this form

Last Name

First Name

MI

Email:

Social Security #

Certification #

Enter the date you most recently used the processes you would like to maintain.

Important: Failure to include dates below will result in payment being forfeited.

SMAW ____/____/____

GMAW ____/____/____

FCAW ____/____/____

GTAW ____/____/

Other __________________

____/____/____

Your certification is extended from the dates you have indicated.

Verification: I Employer / Test Supervisor / Customer certify that the above named welder used

(Circle One)

The processes on the dates indicated. Important: This form is NOT to be signed by the applicant.

If your address has changed in the last six months, please list below:

Street Address:

City:

State

Zip

YOUR CERTIFICATION IS IMPORTANT TO YOU AND TO US!

Use these forms before your expiration date to properly maintain your certification. Certifications in accordance with Supplement C or D9.1 for the Sheet Metal Welding Code require maintenance every 12 months. Certifications in accordance with D1.1 require maintenance every 6 months. Check the requirements of the standard that governs your certification to assure that maintenance is received by AWS at the proper intervals. The cost for renewal is $10.00. All checks and money orders must be made payable to AWS and mailed to: AWS 550 NW Lejeune Rd. Miami, FL 33126.

WE RECOMMEND SENDING YOUR FORM VIA US MAIL-RETURN RECEIPT REQUESTED.

AWS Use Only

Site Code __________________ Date Recv’d ________________ Amt ________________ Acc’t __________________

Method of Payment

Check #

Visa

MC

AMEX

Diners

Discover

Credit Card #

Exp. Date

Signature

Cert-Maintenance of Welder Certification-EP-4/10/08