653 Newapp 2012 Inspector API

7/27/2019 653 Newapp 2012 Inspector API

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653_2012 (Revised) 1

API 653 Aboveground Storage Tank Inspector

Certification Program

Application Instructions

1. This application is a writable PDF. Please make sure to download the application document

and save it on your computer. You can then open the application, type in your information,and print the application forms. (Any application filled in while viewing it online will not besaved, nor will it be sent to API electronically.) All applications must be mailed to API.

2. Fill out all pages of this application completely.

3. Please enter your name as it appears in your passport / government-issued ID / driver’slicense.

4. If you have previously applied to API and been assigned an API ID number, include it everyplace that your name appears.

5. Be sure to include a unique and current e-mail address. All API correspondence includingyour 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 EffectivitySheet. The publications for ICP certification exams may be ordered through IHS(www.global.ihs.com) or TechStreet (www.techstreet.com)

7. You must include a verified Employment Reference Form (ERF). The ERF may be validatedeither 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 anyapplication 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 ensureyou have included all the information and documents necessary.

INFORMATION FOR THE DAY OF THE EXAM:

Youareallowedtohaveonlythefollowinginthetestroom:APIpermittedtestreferencematerials,sharpenedNo.2pencils,aneraserandacalculator(simplefunctiononly,non-programmable).Anythingelsecouldbeconfiscatedbytheteststaff.

Anyadditionstothereferencematerialsarenotallowed.Thisincludestrainingmaterials,anypagesinsertedinyourcodebooks,preprintedandinsertedlabels,andhandwritingintheblank/half-blankpagesofthecodebooks.Smallnotesinthemarginsarepermitted.Violationswillresultintheteststaffconfiscatingpagesofreferencematerials.



653_2012 (Revised) 2

ICP FINANCIAL POLICIES

Payment Policy

API cannot process any application until full payment is received. No exceptions will be

made under any circumstances. Candidates WILL NOT BE PERMITTED TO TAKE AN ICPEXAMINATION if payment has not been received AND processed by API. Proof of paymentmust be included with your application.

API must RECEIVE your ORIGINAL application by mail on or before the applicationdeadline.

All payments must be made in United States currency.

Paying by credit card provides the best opportunity to ensure that payment is receivedand processed by API in the timeliest manner.

Checks must be drawn from a US bank. You are responsible for all taxes, banking or other service fees, including all applicable withholding taxes.

If your company is going to pay the fee make sure they know the deadline and allowplenty of time for the company to make payment.

If paying by wire transfer please submit a copy of the electronic transaction documentwith your application. The applicant’s name MUST be included on the wire transactiondocument. If the copy is not included with the application please e-mail a copy [email protected] as soon as possible to allow time to identify the payment and schedule

you for the exam.

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 non-

refundable.

For refund requests made after the date of your examination:

No refunds will be issued whether you took the examination or not.



653_2012 (Revised) 3

Application Form – Basic Information

API 653, Aboveground Storage Tank Inspector Certification Program

New – API Exam EXAM ID #(if previously assigned)

___________________________________________________________________________________________FIRST MIDDLE LASTNAME (please spell it the same way as it appears on your passport / driver’s license)

Home Address (Number and Street) Date of Birth (Month / Day / Year)

City, State and Zip or Postal Code Home Telephone Number

Country Personal Email(At least one UNIQUE E-MAIL REQUIRED)

Employer DataWork Telephone Number

Employer Business Email (Unique e-mail – not shared)

Employer’s Address (P.O. Box or Number andStreet)

Cell Phone Number

City, State and Zip or Postal Code If you want your exam admission letter / score reportto be sent to your employer, trainer, or examorganizer, please include this person’s e-mail here:

Country Group Contact E-mail



653_2012 (Revised) 4

Additional Information


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? Home Work

Are you interested in being included in the on-line API Inspector Directory, when you obtain your certification?

Yes No

Which address do you want shown in the ICP Directory listing? Home Work

2. Do you currently have an active API certification? Yes No

If yes, enter your certification number and expiration date. If youanswer yes, you need not complete the Education and Training Form.

Program / Certification Number Expiration Date



3. Are you currently a full-time, non-contract employee of an API member company?

Yes No

If yes, please enter the company name.

4. Please check the boxes that correctly describe your organization. Please be sure to checkone box on each side.

Industry Organization type

PETROLEUM OWNER -USER

CHEMICAL I NDIVIDUAL CONTRACTOR

PAPER /PULP I NSPECTION COMPANY

SERVING ALL I NDUSTRIES CONSULTING/CONSTRUCTION

OTHER OTHER

5. Please check the boxes that correctly describe your employment status. Please be sure tocheck one box only.

Full-time employee of an owner/user

Full-time employee of an inspection agency/other company

Independent contractor



653_2012 (Revised) 5

Education and Training


Please attach copies of your school / university diplomas.

High School / Secondary School

Name Location Year Graduated

Name Location Year Graduated

Trade / Vocational School

Name Duration of Studies Field of Study Year Graduated



College / University

Name Duration of Studies Major Degree Type Dates Attended





653_2012 (Revised) 6

Employment History


(Last three employers or at least the last five years)

1. Name and Address of Employer (Current) Date of Employment

Employer

From:

___________________

Mailing Address (Number and Street)To:

____________________

City, State and Zip Code ____________________ Employer’s Telephone

Job Title / Description of Responsibilities

2. Name and Address of Employer Date of Employment

Employer From:

____________________


____________________

City, State and Zip Code ____________________ Employer’s Telephone


3. Name and Address of Employer Date of Employment

Employer From:

____________________


____________________

City, State and Zip Code ____________________

Employer’s Telephone




653_2012 (Revised) 7

Verification Requirements for

Employment Reference Forms (ERF)

All paperwork documenting the applicant’s work experience MUST be originaldocuments. Photocopied, scanned, or faxed documents will not be processed.

The Employment Reference Form attached to this application must verify the required lengthof experience based on your level of education. This experience must have been acquiredwithin the last 10 years. Please make copies of the ERF and provide one form for eachemployer if it is necessary to meet the requirements.

API requires that the supervisor signs any ERF that is submitted. Supervisors may only signfor the experience acquired while at their company. This signature must be validated by anotary 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 FOLLOWINGREQUIREMENTS 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.



653_2012 (Revised) 8

Employment Reference Form (ERF)


Applicant’s Full Name:

API ID (if known)

Company:

Name of Supervisor Title

Address Telephone Number

Affirms that

Name of Applicant

Worked for

Company

fromBeginning Date

toEnding Date

SUPERVISORS: Please fill in the blanks below . Your signature on this page v alidates that whileworking for your company and during the period indicated abov e the applicant has acquired thefollowing experience:

This box must be completed. Please fill in all that applies for the CURRENT employer.

Activity DatesLength of ExperienceWith This Employer

INSPECTION of Aboveground Storage TanksFrom ______________To___________________

Design of Aboveground Storage Tanks From _____________To___________________

Construction of Aboveground Storage Tanks From _____________To___________________

Operation of Aboveground Storage Tanks From _____________To___________________

Repair of Aboveground Storage Tanks From ______________To___________________

ALL APPLICANTS MUST HAVE THE AREA BELOW COMPLETED AND VALIDATED

SUPERVISOR’S 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 CompanyStamp or Seal



653_2012 (Revised) 9

API 653 Test Registration

Applicant’s Name: _________________________________________

Exam ID # (If previously assigned):

Examination Locations and Dates

Please indicate your preferred exam date and location listed below.

March 28, 2012 (Application Deadline – API must receive no later than January 18, 2012 )

September 26, 2012 (Application Deadline – API must receive no later than July 11, 2012 )

Application deadlines are firm — no exceptions will be made.

*NOTE: An additional sitting fee will be required at the Edmonton location in June & December. You will receive information, prior to the exam date, from ABSA / API, with payment instructions.

North America:

Anchorage, AK * Edmonton, AB (Canada) Oklahoma City, OK

Atlanta, GA Houston, TX Philadelphia, PA

Baton Rouge, LA Los Angeles, CA St. Paul, MN

Corpus Christi, TX Oakland, CA

Other Locations:

Abu Dhabi, UAE Cairo, Egypt Kuala Lumpur,Malaysia

Singapore, Singapore

Al-Khobar, Saudi Arabia Chennai, India Mumbai, India United Kingdom(Contact API for city info)

Bogota, Colombia Doha, Qatar Port of Spain, Trinidad

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.



653_2012 (Revised) 10

Inspector Certification Agreement - 1

(Effective on Date of Inspector’s Certification)

This Agreement is between the American Petroleum Institute (hereinafter “API”), a corporation of the District of Columbia, having an office at 1220 L Street, N.W., Washington, D.C. 20005, and the Applicant (the “Inspector”), residingat the address noted below.

Whereas, API’s Individual Certification Programs (“ICP”) certify inspectors and other technical personnel that meet the

guidelines and requirements specified in the program.Whereas, Inspector desires to obtain certification under the API ICP program.

Now therefore, in consideration of the mutual covenants hereinafter stated, the parties agree as follows:

1. Inspector agrees to comply with all of the program policies and requirements. Inspector agrees and understands thatAPI shall be the sole judge of whether the Inspector has the appropriate qualifications to become certified, remaincertified, or to be recertified.

2. The Inspector agrees not to make any misrepresentations concerning the Inspector’s certification status or the program. The Inspector agrees not to perform any acts, which directly or indirectly assist a third-party in making anymisrepresentation relating to the ICP program.

3. The Inspector understands and agrees that the ICP Program is designed to assist users in identifying inspectors who

have satisfied the minimum qualifications specified in the applicable industry standards and that API does notwarrant or guarantee the competency of any inspector certified under this program. The inspector agrees not tomislead customers or the public about the scope and purpose of this program.

4. The Inspector authorizes API to release information to regulatory agencies, current or potential employers, or other interested parties concerning the inspector’s certification status. API agrees to take reasonable measures to ensurethat any information that is released is accurate. However, API does not warrant or guarantee the accuracy of any

information that is released and specifically disclaims any liability relating to the release of this data.

5. The Inspector understands and agrees that the Inspector’s certification will not be renewed unless the inspector satisfies all of the program requirements for renewal and submits the appropriate recertification application and renewal fee to API within the time frame specified by API.

6. Inspector understands and agrees that API may modify the requirements for an inspector to obtain, maintain, or renew the certification at any time. If API’s requirements are modified, API shall determine the date by which the

new requirements become effective. Inspector agrees to comply with the modified requirements within the deadlinespecified by API. API agrees to attempt (but assumes no duty) to notify Inspector of significant changes to the program by either giving notice: (1) at the Inspector’s last known address, or (2) the Inspector’s last known e-mailaddress, or (3) by posting the changes on the API website. It is the responsibility of the Inspector to notify API of address changes. The failure of API to notify Inspector of a renewal date or modification of the program does not

relieve the Inspector of the responsibility to file a timely renewal application or to comply with new certificationrequirements. It is the responsibility of the Inspector to obtain this information by contacting API or by checking theAPI website for updates.

7. If any action or proceeding is brought by API to enforce, protect or establish any right or remedy with respect to thisAgreement or with respect to the subject matter of this Agreement, API shall be entitled to recover reasonableattorney's fees and costs provided that it is the prevailing party. Inspector agrees to indemnify API for any losses or damages resulting from the breach of the terms of this Agreement by the Inspector.

8. The Inspector agrees and understands that API may terminate an inspector’s certification if API determines that theinspector has: (1) made material errors, omissions, or misrepresentations on the application or in documentssubmitted to API, or (2) violated any terms or conditions of this Agreement or any ICP policies or requirements. APIalso may terminate the program at any time and for any reason deemed appropriate by API. Upon termination, with

or without cause, of any rights or authority conferred by this Agreement, or upon expiration/termination of theInspector’s certification, Inspector agrees to return all certification documents to API within 30 days.

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.



653_2012 (Revised) 12

Inspector Application Agreement - 2(for Initial and Renewal Certification)

(Effective upon Receipt of Application)

The applicant agrees to the following conditions:

1. API agrees to evaluate the applicant’s qualifications to determine if the Inspector satisfies the requirements of the ICP

program. Applicant understands and agrees that: (1) API will not issue an ICP certificate to the Applicant unless APIdetermines that an Applicant meets all of the requirements and Applicant has submitted the applicable fees and documentation within the specified time frame, and (2) API shall be the sole judge of whether the Applicant has theappropriate qualifications to become certified, remain certified, or be recertified.

2. The Applicant agrees to pay the applicable fees, comply with all of the program requirements and submit anysupplemental information or documents deemed necessary by API to verify an applicant’s qualifications. Applicantunderstands and agrees that API does not represent or warrant that the submission of the fees and materials by theApplicant will result in the Applicant being certified under the program.

3. Each new application remains valid for a period of 12 months from the date of receipt by API. API grants eachapplicant three consecutive attempts during the 12-month period to sit and pass the test, starting with the first examadministration the applicant registers for. Applicants must pass the exam within these three consecutive exam

administrations. If an applicant fails to appear for the test, cancels his/her appearance and reschedules, or takes the

exam and fails it, it will count as an official attempt.

4. If the applicant does not obtain a certification within this period of time and still wishes to obtain the certification, they

must start the application process again, including re-submission of a full fee and a complete new application.

5. All requests for refunds must be submitted in writing by mail, e-mail or by fax to API no later than 6 months from thedate payment was received by API. Requests for refunds received after this period cannot be fulfilled.

6. An applicant is entitled to a full refund of the application fee, minus a processing fee, only if API receives the refund request prior to the exam application deadline.

7. An applicant is entitled to a 50% refund of the application fee if the refund request is received by API within 6 monthsfrom the date payment was received by API and the candidate cancelled in advance of the examination date.

8. No refunds will be made if an applicant has taken the test or did not show up without prior notice.

9. For normal processing API must receive recertification applications prior to the current certification’s expiration date.Recertification applications must be mailed, as API requires the original of the notarized page.

10. API may extend the certification term for 3 (three) months after the expiration date. Inspectors will remain authorized during that period of time. Recertification applications received by API within this extension term will be processed, but a $150.00 late fee will be required.

11. Inspectors who do not apply for recertification within three months after the current certification expiration date will bedecertified.

12. Circumstances such as heavy work schedule or work in other countries do not relieve the applicant of the responsibility

to file a timely renewal application.

13. Applicant understands and agrees that API may modify the requirements for an applicant to obtain, maintain, or renewthe certification at any time. If API’s requirements are modified, API shall determine the date by which the new

requirements become effective. Applicant agrees to comply with the modified requirements within the deadlinespecified by API. API agrees to attempt (but assumes no duty) to notify Applicant of significant changes to the program by either giving notice: (1) at the Applicant’s last known address, or (2) the Applicant’s last known e-mailaddress, or (3) by posting the changes on the API website. It is the responsibility of the Applicant to notify API of

address changes. The failure of API to notify Applicant of a renewal date or modification of the program does notrelieve the Applicant of the responsibility to file a timely renewal application or to comply with new certificationrequirements. It is the responsibility of the Applicant to obtain this information by contacting API or by checking theAPI website.

14. The Applicant agrees to comply strictly with all U.S. export laws relating to this program. The Applicant warrants thathe is not located in, or under the control of, or a national or resident of any embargoed countries.



653_2012 (Revised) 13

15. The Applicant agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by anygovernment body or authority based on in any way measured by this Agreement, or any portion or it, or any servicesrelated 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 Inspector’squalifications. Applicant agrees to indemnify API for any claims, losses, or damages resulting from the Applicantsubmitting inaccurate or misleading information.

I, the undersigned, certify that I have read and fully comprehend this form in its entirety and agreeto abide by the policies and regulations specified above.

Applicant’s name (please print) ____________________________ E-mail: ___________________________

___________________________________ _________________

Signature of Applicant Date

API Reviewer’s Initials ________________



653_2012 (Revised) 15

API 653 Exam Administration -- Publications Effectivity Sheet

FOR: March 28, 2012 and September 26, 2012

Listed below are the effective editions of the publications required for this examination on the date(s) shown above.

API Recommended Practice 571, Damage Mechanisms Affecting Fixed Equipment in the Refining Industry,First Edition, December 2003. Product code API CERT 653_571 (includes only the portions specified below)

ATTENTION: Only the following mechanisms to be included:

4.2.7 - Brittle Fracture4.2.16 - Mechanical Fatigue4.3.2 - Atmospheric Corrosion4.3.3 - Corrosion under insulation (CUI)4.3.8 - Microbiologically Induced Corrosion (MIC)4.3.9 - Soil Corrosion4.3.10 - Caustic Corrosion4.5.1 - Chloride Stress Corrosion Cracking (Cl-SCC)4.5.3 - Caustic Stress Corrosion Cracking (Caustic Embrittlement)5.1.1.11 - Sulfuric Acid Corrosion

API Recommended Practice 575, Inspection of Atmospheric and Low-Pressure Storage Tanks, SecondEdition, May 2005. Product Code API CERT 575

API Recommended Practice 577 – Welding Inspection and Metallurgy, First Edition, October 2004. ProductCode API CERT 577

API Standard 650, Welded Tanks for Oil Storage, Eleventh Edition, June 2007 with Addendum 1 (Nov 2008)and Addendum 2 (Nov 2009). Product Code API CERT 650

API Recommended Practice 651, Cathodic Protection of Aboveground Petroleum Storage Tanks, ThirdEdition, January 2007. Product Code API CERT 651

API Recommended Practice 652, Lining of Aboveground Petroleum Storage Tank Bottoms, Third Edition,October 2005. Product Code API CERT 652

API Standard 653, Tank Inspection, Repair, Alteration, and Reconstruction, Fourth Edition, April 2009 withAddendum 1 (Aug 2010). Product Code API CERT 653

American Society of Mechanical Engineers (ASME), Boiler and Pressure Vessel Code, 2010 Edition.

i. ASME Section V, Nondestructive Examination, Articles 1, 2, 6, 7 and 23 (section SE-797 only)

ii. Section IX, Welding and Brazing Qualifications (Section QW only )

Product Code for the ASME package API CERT 653 ASME. Package includes only the above excerpts necessaryfor the exam.

API and ASME publications can be ordered through either:

>> IHS Documents (www.global.ihs.com); phone 1-800-854-7179

or >> TechStreet (www.techstreet.com); phone 1-800-699-9277

API members are eligible for a 30% discount on all API documents; exam candidates are eligible for a 20% discounton 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 will be made for ASME documents.

Note: API and ASME publications are copyrighted material. Photocopies of API and ASMEpublications are not permitted. CD-ROM versions of the API documents are issued quarterly byInformation Handling Services (IHS) and TechStreet and are allowed. Be sure to check your CD-ROM against the editions noted on this sheet.



653_2012 (Revised) 16

CHECKLIST

1. All pages of the application completed

2. Valid e-mail address included so we can contact you

3. All copies of diplomas attached

4. ERF has a notary or company stamp

5. Employment letter attached if necessary

6. BOTH Inspector Agreement forms signed

7. Certification Fee (payment page filled in completely)

8. Copy of transaction documentation if paying by wire

9. Copy of completed application made for your records

MAIL ORIGINAL APPLICATION TO:APIIndividual Certification Programs1220 L Street, NWWashington DC 20005

(Phone: 202-682-8064)Please include candidate’s name(s) on all payments.

IF PAYING BY CHECK OR MONEY ORDER, MAIL APPLICATION TO:API

Individual Certification ProgramsP.O. Box 1425Merrifield, VA 22116

TO SEND CHECKS BY COURIER, PLEASE ADDRESS PACKAGE TO:APIAttn: John Robertson1220 L Street, NWWashington, DC 20005Phone 202-682-8064

653 Newapp 2012 Inspector API

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