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Date(s) of Class Training____________________________.
To qualify to take this exam, you must submit proof of compliance with ASSE series 6000 standard section 6030-3.2. This information can be found on the NITC website (www.nationalitc.com). “A minimum of two (2) years documented practical experience in the verification of medical gas pipeline systems. Candidates shall have a current certificate of insurance, in the name of the individual or employing verification company, for general liability, completed operations and, as applicable, products liability insurance.” You must submit documentation that includes dates of employment, duties performed, and W-2 forms. You must also submit a resume.The cost of the class MUST be received within 3(three) days of application. There will be NO changes or cancellations accepted within two weeks of class start date. No Refunds will be given within two weeks of class start date. A minimum of 10(ten) students is required to have a class. If the 10-student minimum is not met, all fees will be returned.
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Signature of Applicant Date
Please fax this application to (623) 434-0230
Or mail to 1831 W Rose Garden Lane Ste. 1. Phoenix, AZ 85027
