Cathodic Protection Application and Work Experience

Internal Corrosion Technologist Application

DEFINITION: A certified Internal Corrosion Technologist for Pipelines should have a thorough understanding of electrochemical and corrosion principles and should be capable of performing the field tests required to appropriately monitor an internal corrosion control program. This person should have sufficient knowledge and experience to determine corrective action for intermediate-level internal corrosion problems within a pipeline system and be able to select a mitigation method suitable for use on pipeline systems (taking into account all applicable variables related to a particular system). They should also be able to support the development and implementation of an internal corrosion integrity management program. (To obtain certification, application must be submitted to NACE Headquarters within 5 years from successful completion of the Internal Corrosion Technologist exam.) Please Note – This Is Not A Class Or Exam Registration. Please contact the NACE Registrar (281/228-6223) for class or exam registration.

NACE Member:  Yes  No Member #

Applicant's Name:

Home Address:

Company Name:

Company Address:

Country: Zip/Postal Code:

Phone: Home Business Fax

SIGNATURE: DATE:

REQUIREMENTS NECESSARY TO ACHIEVE CERTIFICATION To achieve this certification, qualified individuals have two options: CLASSROOM TRAINING - NACE Internal Corrosion for Pipelines or EXAM ONLY OPTION APPLICATION PROCEDURE It is strongly recommended that Exam Only candidates submit a completed application for certification at least 60 days in advance so that work experience requirements and education prerequisites can be verified. Application approval by the Application Review Board is required for certification. PREREQUISITES High School Diploma and 4 yrs internal corrosion work. It is also recommended that students have taken the NACE Basic Corrosion Course and have had high school chemistry. RECERTIFICATION REQUIREMENTS Every three (3) years. Recertification requires a minimum of 2 years work experience in internal corrosion and 8 hours per year (24 hrs total) of professional development hours.

MAKE A COPY OF ALL PAGES OF THIS APPLICATION FOR YOUR RECORDS AFFIRMATION I affirm that:

1. I understand that I am solely responsible for making sure that all necessary work experience documentation is complete and submitted in good order to NACE Headquarters. 2. I understand that if I knowingly provide, or cause to be provided, any false information in connection with my recognition under the NACE International Training and Certification Program, that it will be grounds for action against my standing in the program. 3. I understand that the name of the category within the NACE International Internal Corrosion Training and Certification Program is Internal Corrosion Technologist. 4. NACE has a firm policy regarding the use of its logos and certification numbers and titles. The certification number and category title may be used only by NACE Internal Corrosion Technologists, and may not be used by any other persons. All active IC card holders are permitted to use the term “NACE Internal Corrosion Technologist” and their certification number on business cards. This example illustrates how this information can be used by a NACE Internal Corrosion Technologist. John Smith NACE Internal Corrosion Technologist, Cert. No. 9650 ACE Inspections, Inc., Knoxville, TN NACE Internal Corrosion Technologists who are members in good standing of NACE International may display the NACE Logo for the purpose of identifying the individual as having achieved a NACE Certification. I understand that violation of these rules will result in action against my standing in the program on the basis of violation of the NACE International Internal Corrosion Program Attestation. 5. I (re)affirm the NACE International Internal Corrosion Certification Program attestation and agree to abide by its provisions as long as I hold any level of recognition under the program.

Signed: Date:

THIS DOCUMENT MUST BE SIGNED AND RETURNED WITH APPLICATION RETAIN A COPY OF THIS DOCUMENT FOR YOUR RECORDS ATTESTATION I hereby:

(1) Recognize and acknowledge that the proper control of internal corrosion can be critical to the safety and welfare of the general public and industrial facilities.

(2) Recognize and acknowledge that the control of internal corrosion is obligatory to maximize conservation of our material resources, to reduce economic losses, and to protect the environment.

(3) Recognize and acknowledge that the entire field of internal corrosion and its control encompasses the application of the knowledge and experience of many diverse disciplines and levels of technical competence which must often be consulted.

(4) Recognize and acknowledge that only through continual association and cooperation with others in this field can the safest and most economical solutions be found to the many internal corrosion problems.

(5) Recognize and acknowledge that the quality of my work reflects on the entire profession of internal corrosion control.

For these reasons I:

(1) Agree to give first consideration in my internal corrosion work to public safety and welfare and to protection of the environment.

(2) Agree to apply myself with diligence and responsibility to the internal corrosion work that lies within my area of competence.

(3) 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.

(4) Agree to not represent myself to be proficient or make recommendations in phases of internal corrosion work in which I am not qualified by knowledge and experience.

(5) Agree to avoid and discourage untrue, sensational, exaggerated, and/or unwarranted statements regarding my work in oral presentations, written text, and/or advertising media.

(6) 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.

(7) Agree to inform clients or employers of any business affiliations, interests, and/or connections which might influence my judgment.

(8) Agree to uphold, foster and contribute to the achievement of the objectives of NACE International.

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

Signature:

Printed Name:

THIS DOCUMENT MUST BE SIGNED AND RETURNED WITH APPLICATION RETAIN A COPY OF THIS DOCUMENT FOR YOUR RECORDS NAME:

PLEASE CHECK APPROPRIATE BOX (choose only one):

I AM APPLYING FOR INTERNAL CORROSION FOR PIPELINES (Internal Corrosion Technologist) CLASS & EXAM SCHEDULED FOR:

(Please list city/dates of course you are planning to attend) ______

I AM APPLYING FOR INTERNAL CORROSION FOR PIPLINES (Internal Corrosion Technologist) EXAM ONLY SCHEDULED FOR:

(Please list city and date of exam you are planning to attend) ______

I HAVE SUCCESSFULLY COMPLETED THE INTERNAL CORROSION TECHNOLOGIST EXAM

(Date of exam completion: ______)

Note: Application for Internal Corrosion Technologist certification must be made within five (5) years from date of successful completion of exam.

REQUIREMENTS FOR INTERNAL CORROSION TECHNOLOGIST CLASS & EXAM or EXAM ONLY

This course/certification is geared toward the technologist level for individuals with:

 4 years experience including some background and experience in corrosion and pipeline operations.

 High school diploma

 NACE Basic Corrosion course and high school chemistry (recommended)

 2 years internal corrosion work experience in a pipeline environment

 Bachelor’s degree in one of the following disciplines: Chemistry, Biology, Microbiology, Chemical Engineering, Metallurgical Engineering

 NACE Basic Corrosion course (recommended)

Please provide the necessary internal corrosion work experience in accordance with above requirements. INDIVIDUALS HAVE FIVE (5) YEARS FROM DATE OF SUCCESSFUL COMPLETION OF THE INTERNAL CORROSION TEHCNOLOGIST EXAM TO APPLY FOR INTERNAL CORROSION TECHNOLOGIST CERTIFICATION. S A M P L E Form 1: Summary of Internal Corrosion Related Work Experience

Instructions: Make and use as many copies of this form as needed. Please provide all information requested. Forms must be printed legibly in black ink or typed. Illegible information can delay the application process. For assistance with this form, contact the Education Division at NACE International Headquarters. Applicant Information: Name: A. Sample Phone: 409/111-4321 Company: ZZZ Coating Inspection Inc. Fax: 409/111-1234 Address: 987 Gage Avenue

City: Millspec State/Province: TX Zip/Postal Code: 77987 Country: USA Please summarize below the information on each copy of Form 2, Individual Job Documentation. List your experience beginning with the most recent, followed by less recent experience.

From To Number of Month/Year Month/Year Months in this Job Task Company Name job 1/92 1/95 36 Handling, ZZZ Gas Co. installation and removal of corrosion coupons and probes 12/89 12/91 24 Conducting on AAA Tank Installers site field tests (e.g., bacteria, pH, dissolved gases, alkalinity, etc.) 12/87 12/89 24 Gather ABC CP Design necessary data to conduct preliminary integrity case study / / / / / /

Applicant Affidavit: I understand that if I knowingly provide false information in connection with my recognition under this program, it will be grounds for disciplinary procedures.

Signed: XXX Date: Form 1: Summary of Internal Corrosion Related Work Experience DEFINITION:

A certified Internal Corrosion Technologist for Pipelines should have a thorough understanding of electrochemical and corrosion principles and should be capable of performing the field tests required to appropriately monitor an internal corrosion control program. This person should have sufficient knowledge and experience to determine corrective action for intermediate-level internal corrosion problems within a pipeline system and be able to select a mitigation method suitable for use on pipeline systems (taking into account all applicable variables related to a particular system). They should also be able to support the development and implementation of an internal corrosion integrity management program.

Instructions: Make and use as many copies of this form as needed. Please provide all information requested. Forms must be printed legibly in black ink or typed. Illegible information can delay the application process. For assistance with this form, contact the Education Division at NACE International Headquarters. Applicant Information: Name: Phone: Company: Fax: Address:

City: State/Province: Zip/Postal Code: Country: Please summarize below the information on each copy of Form 2, Individual Job Documentation. List your experience beginning with the most recent, followed by less recent experience.

From To Number of months Month/Year Month/Year in this job Job Task Company Name / / / / / / / / / / / / / / / / / / / /

Applicant Affidavit: I understand that if I knowingly provide false information in connection with my recognition under this program, it will be grounds for disciplinary procedures.

Signed: Date:

MAKE A COPY OF ALL PAGES OF THIS APPLICATION FOR YOUR RECORDS WORK EXPERIENCE FORM 2: INDIVIDUAL JOB EXPERIENCE Page ____ of ____

Use one of these forms for each period of work experience (“job”) you wish to document. Make and use as many copies of this form as you need. Please provide the information requested per the directions and definitions provided. ______Job Information

Applicant’s Name: ______Who can NACE contact to verify this experience

Job Title: ______Name: ______

Company: ______Company: ______

From: Month ______Year ______Address: ______

To: Month ______Year ______State/Province: ______

Zip/Postal Code: ______Phone: ______

Fax: ______E-mail: ______

C.2 WORK EXPERIENCE FORM 2: INDIVIDUAL JOB EXPERIENCE Page ___ of ___

Describe in detail what are/were your internal corrosion related duties in this job. (Do not write on the back of this form). You may attach additional single sided sheets.

THIS SECTION MUST BE COMPLETED Your application will be returned if this space is left blank

______

Signed: Date: ______Internal Corrosion Technologist Education and Training

DEFINITION:

A certified Internal Corrosion Technologist for Pipelines should have a thorough understanding of electrochemical and corrosion principles and should be capable of performing the field tests required to appropriately monitor an internal corrosion control program. This person should have sufficient knowledge and experience to determine corrective action for intermediate-level internal corrosion problems within a pipeline system and be able to select a mitigation method suitable for use on pipeline systems (taking into account all applicable variables related to a particular system). They should also be able to support the development and implementation of an internal corrosion integrity management program.

Please check applicable path of qualification: Path 1

 4 years internal corrosion work experience in a pipeline environment as documented in this application

 High school diploma or GED.

 NACE Basic Corrosion course (recommended)

 high school chemistry (recommended)

OR Path 2

 2 years internal corrosion work experience in a pipeline environment as documented in this application

 Bachelor’s degree in one of the following disciplines (please complete degree information below)

Chemistry Biology Microbiology Chemical Engineering Metallurgical Engineering

 NACE Basic Corrosion course (recommended) DEGREE INFORMATION

Name of College or University Degree Received Date Awarded Student ID Number

______

______D. QUALIFICATION REFERENCE

DEFINITION: A certified Internal Corrosion Technologist for Pipelines should have a thorough understanding of electrochemical and internal corrosion principles and should be capable of performing the field tests required to appropriately monitor an internal corrosion control program. This person should have sufficient knowledge and experience to determine corrective action for intermediate-level internal corrosion problems within a pipeline system and be able to select a mitigation method suitable for use on pipeline systems (taking into account all applicable variables related to a particular system). They should also be able to support the development and implementation of an internal corrosion integrity management program.

APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International.

Qualification references may be submitted by the following, who have expertise in the corrosion field: . Registered or chartered engineers . Present and/or previous supervisor(s) of the applicant . Present and/or previous professors/instructors of the applicant . NACE International certificate holders. (For Corrosion Specialist and Specialty Area applicants, one Qualification Reference must hold a NACE Certificate at the level being applied for or higher, a P.E. registration, ICorr Professional Member or international equivalent.)

D.1 Applicant’s full name:

D.2 Certification category applied for:

D.3 Name, title, address, and phone # of person who is familiar with the work experience of the applicant:

Phone: REFERENCE: The applicant is applying for professional recognition by NACE International. Applicants for certification must meet specific requirements; please see the list of these requirements on the following page. Evaluation of an applicant’s qualifications also depends on assessment of professional experience by references. It is requested that you complete Items D.4 through D.13 on this form and return it directly to NACE. D.4 I hold NACE Certification as a: _____ Certified No.

_____ I am a Registered engineer (or equivalent)

_____ State/Province: ______Branch:______No:______

Leave space blank if this section is not applicable

D.5 I have known the applicant for _____ years. What is/was the nature of the association?

Current Supervisor _____ Previous Supervisor _____ Current Client _____ Previous Client _____ Current Co-worker _____ Previous Co-worker _____ Current Professor/Instructor _____ Previous Professor/Instructor _____ Other _____

D.6 From personal knowledge, my assessment of the applicant’s character and personal reputation is that it is Excellent Average Below average

D.7 From personal knowledge, I know that the applicant has been engaged in Internal corrosion work for ___years. (See definition of “Internal Corrosion work” at top of this page.) D.8 Based on this personal knowledge, I know that the quality of the applicant’s work in the field of internal corrosion is Excellent Average Below average

D.9 The applicant is proficient in the following phases of internal corrosion:

D.10 Would you employ, or recommend the employment of, the applicant for employment in the phase of internal corrosion work you have described in Item D. 9? Yes No

D.11 Please describe any major projects/activities in which the applicant has been involved in the field of internal corrosion work. Describe only those where you had personal knowledge of the applicant’s work. Please indicate the degree of responsibility exercised by the applicant, the complexity of the project/activity, the degree of knowledge/skill required, etc. (Attach a separate sheet)

D.12 Additional remarks or amplifying information:

D.13 My signature below indicates that I have personal knowledge and expertise in the internal corrosion field upon which to evaluate the applicant’s professional capabilities.

Signature: Date:

Printed Name:

Return completed form to: NACE International, Certification Department, Attn Marie Newton, 1440 South Creek Drive, Houston, TX 77084-4906 USA

Certification Title Work Experience and Education requirements for Certification Corrosion Technician 2 years corrosion work experience Cathodic Protection Tester 6 months cathodic protection work experience (recommended) Cathodic Protection Technician 3 years cathodic protection work experience Cathodic Protection Technologist 8 years cathodic protection work experience Corrosion Technologist 4 years corrosion work experience Internal Corrosion Technologist 4 years internal corrosion work experience and familiar with pipeline operations OR 2 years internal corrosion work experience with a degree in one of the following: Chemistry, Biology, Microbiology, Chemical Engineering, Metallurgical Engineering Senior Corrosion Technologist 8 years corrosion work experience OR 4 years work experience with a bachelors degree in engineering or physical science Specialty Areas Senior Corrosion Technologist certification OR 4 years coating experience with a  Material Selection Design bachelors degree in engineering or physical sciences AND an advanced degree in  Chemical Treatment engineering or physical sciences that required a qualification exam.  Protective Coating Specialist 12 years coatings work experience OR 8 years w/SSPC Coatings Certification, NACE Coating inspector certification or Frozio certification.  Cathodic Protection  12 years cathodic protection work experience, including 4 years in responsible charge PLUS 2-year post-high school training in Math AND Science from an approved Technical/Trade School OR  6 year of cathodic protection work experience, including 4 years in responsible charge PLUS 4-year Physical Science or Engineering Degree OR  4 years cathodic protection work experience in responsible charge PLUS one of the following:  Bachelor’s degree in Engineering or Physical Sciences AND an advanced degree in Engineering or Physical Science that required a qualification exam  PE, PEng, or equivalent  EIT registration or equivalent Corrosion Specialist Specialty Area certification is required

D. QUALIFICATION REFERENCE DEFINITION: A certified Internal Corrosion Technologist for Pipelines should have a thorough understanding of electrochemical and internal corrosion principles and should be capable of performing the field tests required to appropriately monitor an internal corrosion control program. This person should have sufficient knowledge and experience to determine corrective action for intermediate-level internal corrosion problems within a pipeline system and be able to select a mitigation method suitable for use on pipeline systems (taking into account all applicable variables related to a particular system). They should also be able to support the development and implementation of an internal corrosion integrity management program. APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International.

D.7 From personal knowledge, I know that the applicant has been engaged in Internal corrosion work for ___years. (See definition of “Internal Corrosion work” at top of this page.)

D.8 Based on this personal knowledge, I know that the quality of the applicant’s work in the field of internal corrosion is Excellent Average Below average D.9 The applicant is proficient in the following phases of internal corrosion:

D.10 Would you employ, or recommend the employment of, the applicant for employment in the phase of internal corrosion work you have described in Item D. 9? Yes No

Signature: Date:

Printed Name:

D. QUALIFICATION REFERENCE

DEFINITION: A certified Internal Corrosion Technologist for Pipelines should have a thorough understanding of electrochemical and internal corrosion principles and should be capable of performing the field tests required to appropriately monitor an internal corrosion control program. This person should have sufficient knowledge and experience to determine corrective action for intermediate-level internal corrosion problems within a pipeline system and be able to select a mitigation method suitable for use on pipeline systems (taking into account all applicable variables related to a particular system). They should also be able to support the development and implementation of an internal corrosion integrity management program. APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International.

D.8 Based on this personal knowledge, I know that the quality of the applicant’s work in the field of internal corrosion is Excellent Average Below average

D.9 The applicant is proficient in the following phases of internal corrosion: D.10 Would you employ, or recommend the employment of, the applicant for employment in the phase of internal corrosion work you have described in Item D. 9? Yes No

Signature: Date:

Printed Name:

D. QUALIFICATION REFERENCE

DEFINITION: A certified Internal Corrosion Technologist for Pipelines should have a thorough understanding of electrochemical and internal corrosion principles and should be capable of performing the field tests required to appropriately monitor an internal corrosion control program. This person should have sufficient knowledge and experience to determine corrective action for intermediate-level internal corrosion problems within a pipeline system and be able to select a mitigation method suitable for use on pipeline systems (taking into account all applicable variables related to a particular system). They should also be able to support the development and implementation of an internal corrosion integrity management program.

APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International.

D.8 Based on this personal knowledge, I know that the quality of the applicant’s work in the field of internal corrosion is Excellent Average Below average

D.9 The applicant is proficient in the following phases of internal corrosion: D.10 Would you employ, or recommend the employment of, the applicant for employment in the phase of internal corrosion work you have described in Item D. 9? Yes No

Signature: Date:

Printed Name:

Return completed form to: NACE International, Certification Department, Attn Marie Newton, 1440 South Creek Drive, Houston, TX 77084-4906 USA. You may also contact her at 281-228-6211 or by e-mail at [email protected].

Certification Title Work Experience and Education requirements for Certification Corrosion Technician 2 years corrosion work experience Cathodic Protection Tester 6 months cathodic protection work experience (recommended) Cathodic Protection Technician 3 years cathodic protection work experience Cathodic Protection Technologist 8 years cathodic protection work experience Corrosion Technologist 4 years corrosion work experience Internal Corrosion Technologist 4 years internal corrosion work experience and familiar with pipeline operations OR 2 years internal corrosion work experience with a degree in one of the following: Chemistry, Biology, Microbiology, Chemical Engineering, Metallurgical Engineering Senior Corrosion Technologist 8 years corrosion work experience OR 4 years work experience with a bachelors degree in engineering or physical science Specialty Areas Senior Corrosion Technologist certification OR 4 years coating experience with a  Material Selection Design bachelors degree in engineering or physical sciences AND an advanced degree in  Chemical Treatment engineering or physical sciences that required a qualification exam.  Protective Coating Specialist 12 years coatings work experience OR 8 years w/SSPC Coatings Certification, NACE Coating inspector certification or Frozio certification.  Cathodic Protection  12 years cathodic protection work experience, including 4 years in responsible charge PLUS 2-year post-high school training in Math AND Science from an approved Technical/Trade School OR  6 year of cathodic protection work experience, including 4 years in responsible charge PLUS 4-year Physical Science or Engineering Degree OR  4 years cathodic protection work experience in responsible charge PLUS one of the following:  Bachelor’s degree in Engineering or Physical Sciences AND an advanced degree in Engineering or Physical Science that required a qualification exam  PE, PEng, or equivalent  EIT registration or equivalent Corrosion Specialist Specialty Area certification is required NOTE:

Any individual whose check for any fee is returned to NACE International as “uncollectible” for any reason will have to submit a new payment plus a “Returned Check Service Charge” of $25.00. Upon collection of the payment, the application process will resume.

Examination fees must be paid before any examination may be taken, and processing fees must be paid before an application will be reviewed.

Once submitted, the Application Fee is non-refundable and non-applicable to any other NACE International product or service. Examination fees are refundable if a refund is requested before an examination is taken. Once a particular examination has been taken, the fee for that examination is non-refundable and non-applicable to any other NACE International product or service.

A.6 Parallel Path to Certification

Courses to be used toward parallel path to Corrosion Technician, Corrosion Technologist or Senior Corrosion Technologist must have been taken within five years of the date the application is received at Headquarters. Proof of the courses should be submitted along with this application.

A.7 Qualification References

A qualification reference is a person who will vouch for your technical competence. Two Qualification References are required, four are recommended. You are asked to give the names of persons (unrelated to you and not more than one from your company) who have personal knowledge of your corrosion experience and abilities or of your teaching in a corrosion-related field. Acceptable references are registered engineers, present supervisor, present clients, previous supervisors, previous clients, professors and instructors, and NACE International Certificate holders of at least the same category for which you are applying.

NOTE 1: For Corrosion Technicians with only two years work experience, references from the same company may be accepted. However, this should be avoided if at all possible.

NOTE 2: For Corrosion Specialist and Specialty Area applicants, one Qualification Reference must hold a NACE Certificate at the level being applied for or higher, a P.E. registration, ICorr Professional Member or international equivalent.

NOTE 3: You are to send these individuals a Qualification Reference form (Item D), which they must complete and return directly to NACE International. This is your responsibility. You should follow up with these people to ensure that they correctly complete and return the Qualification Reference forms in a timely manner.

Name #1 Name #2 Name #3 Name #4

(Optional) Please describe below any information which you wish to be considered by the Application Review Board (such as, but not limited to: education [college, trade school], publications on corrosion subjects, other technical papers or books that you have authored or co-authored, any patents you have obtained as a direct result of your efforts, etc.). You may attach a maximum of two, single sided pages of additional information if you desire. Attachments of more than two single-sided pages will not be reviewed.

If you have any questions, please contact Marie Newton in our Certification department at 281-228-6211 or by e-mail at [email protected].

MAKE A COPY OF ALL PAGES OF THIS APPLICATION FOR YOUR RECORDS