CWI/SCWI RENEWALAPPLICATIONFor International Agents

8669 NW 36 St, # 130 Miami, FL 33166-6672(800) 443-9353 or (305) 443-9353, ext. 273

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Check sections for compliance.
Personal Information – Last, First, and Middle initial MUST be completed.
Sec. 1: Personal Information – Name must match your current government issued ID or Passport.
Sec. 2: Member Information – Please complete if you are a member.
Sec. 3: Renewal - Please select your renewal.
Sec. 4: Exam Location – Site Code (if Applicable), Exam Date, City/State, and Submission Deadline
Sec. 5: Associations – Type of Business, Job Classification and Technical Interests.
Sec. 6: Qualifying Work Experience– must be completed for each employer to meet minimum work experience
Requirement. All fields are mandatory.
Sec. 7: American Disabilities Act (ADA): if applicable, candidate must print a copy of our ADA package and follow theinstructions.www.aws.org/ada-disability-accommodations
Sec. 8: Visual Acuity Form – Eye Examinations shall be performed not more than one (1) year prior to the date of examination.
Applicants shall submit results to the AWS certification department along with their application.
Sec. 9: Photo Requirement – To learn more, review the information on how to provide a suitable photo for your wallet
card on our web www.aws.org/certification/page/photo-id-requirements
Sec. 10: Terms and Conditions - This section of the application must be read, checked, dated, and signed by theRenewal Application for CWI/SCWI 3rd and 6th Year_2221

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NameAWS Member #RENEWAL APPLICATIONCWI/SCWI 3rd and 6th Yearサンプル

Application must be completed and signed by the person taking the exam
Name must match your current government issued ID or Passport

1. Personal Information

SurnameFirst Name

Street Address
City/Providence/Country

Postal CodeEmailMobile Phone

Date of Birth

2. Check and complete the following:
Are you an AWS Member?
CWISCWI✔ YesNo

If yes, please provide your Member #: ________________________ Company Membership not

Certification number: __________________________ Exp. Date: _______________________

3. Renewal (choose one)

試験なしで更新する場合はこちらを選択する

CWI and SCWI renewal by work experience complete sections 1,2,3, 5, 6, 8,9, 10.

The WI requesting renewal of certification shall attest to having no period of continuous inactivity greater than two years during the previous
three years of certification.

CWI and SCWI renewal by examination Complete sections 1-5, 7,8, 9, 10, 11.
WI not meeting the work experience requirements for renewal may renew by taking the CWI part B Practical exam and meet the scoring
requirements of 6.2.2 of QC1.

4. Exam site code Indicate the exam location of your choice: Confirmation will be emailed in 3-4 weeks from receipt.
1st Site Code:_________________ Exam Date:_________________ City/State: ___________________________ *Submission Deadline:__________________
2nd Site Code: ________________ Exam Date: _________________ City/State: ___________________________ *Submission Deadline: __________________
3rd Site Code: ________________ Exam Date: _________________ City/State: ___________________________ *Submission Deadline: __________________

NOTE: If the first choice is not available, registration will indicate the next available choice site. DO NOT make any hotel or flight arrangements until you havereceived your exam confirmation letter from the Certification Department via email. * Refer to AWS Policies and Fees. Exam Schedule

試験なしを選択した場合は上記は記入不要

Renewal Application for CWI/SCWI 3rd and 6th Year_2221

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AWS Member #5. Associations
Type of Business (check only ONE)Job Classification (check only ONE)

AContract construction

01

President, owner, partner, officer

B

Chemicals & allied productsC

Petroleum & coal industries

02
03

Manager, director, superintendent (or assistant)
Sales

D

Primary metal industries

04

Purchasing

E

Fabricated metal products

05

Engineer — welding

F

Machinery except elect. (incl. gas welding)

06

Engineer — otherG

Electrical equip., supplies, electrodes07

Inspector, tester

H

Transportation equip. - air, aerospace

08

Supervisor, foreman

I

Transportation equip. - automotive

09

Welder, welding or cutting operator

J

Transportation equip. - boats, ships

10

Architect, designer

K

Transportation equip. - railroad

11

Consultant

L

Utilities

12

Metallurgist

M

Welding distributors & retail trade13

Research & development

N

Misc. repair services (incl. welding shops)

14

TechnicianO

Educational Services(univ., libraries, schools)

15

Educator

16

Student

P

Engineering & architectural services(incl. assns.)

17

LibrarianQ

Misc. business services(incl. commercial labs)

18

Customer service

19

Other

R

Government (federal, state, local)

20

Engineer - design

S

Other

21

Engineer - manufacturing

22

Quality Control

Renewal Application for CWI/SCWI 3rd and 6th Year_2221

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Technical Interests(check ALL that apply)
Ferrous metals
AluminumNon-ferrous except aluminum
Advanced materials/intermetallics
Ceramics
High energy Processes
Arc Welding
Brazing & Soldering
Resistance Welding
Thermal SprayCutting
NDT
Safety & Health
Pipe & Tubing
Pressure Vessels & Tanks
Structures
Roll Forming
Sheet metal
Stamping & punching
Bending & shearing
Aerospace
Automotive
Machinery
MarineOtherAutomation
Robotics
Computerization of Welding

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AWS Member #6. Qualifying Work Experience: - Resumes not accepted Refer to AWS QC1, Standard for AWS Certification of Welding Inspectors for further details---

ALL FIELDS ARE MANDATORY

The period of validity for AWS SCWI and CWI certification is three (3) years. The SCWI/CWI shall be responsible for maintaining a current address with
the AWS Certification Department. To be eligible for renewal, the CWI must:oAWS will accept your applications up to 11 months prior to expiration. We highly recommend sending your renewal application 60
days prior to your expiration date to allow sufficient processing time.
oAWS may send a renewal notice, but if not received, it remains the responsibility of the SCWI/CWI to renew on time.
The SCWI/CWI requesting renewal of certification shall attest to having no period of continuous inactivity greater than two years in activities described
in AWS B5.1 and QC1 during the previous three years of certification.
o SCWI/CWI not meeting the requirements of 15.4 from AWS QC1 may renew by taking the CWI part B Practical exam and meet the scoring
requirements of 6.2.2 of QC1.
SCWI/CWI certification renewals are limited to two consecutive three-year periods.

Company NameType of BusinessCompany Phone Number

Company Street Address

City, State, Postal CodeSupervisor’s Name

Title of Immediate Supervisor

Supervisor’s Email Address

Department

Applicant’s Job Title
Job Responsibilities- Detailed Description Required

Employed From:

To:

(Mo.)

(Mo.)

(Yr.)

(Yr.)

どんな事業/製品のどういう業務に携わっているのかできるだけ詳しく書いてください。この記述が簡単すぎて再提出求められるケースがあります。
(Reproduce this section for each additional employer)
7. American with Disabilities Act Accommodations
By checking this box, I am requesting special accommodations due to a disability. AWS is committed to complying fully with theADA. Click here for a copy of the accommodations request package.
Will you be using a glucose meter during your exam? YesNo
8. Visual Acuity Form
A current Visual Acuity Form must be completed and submitted along with this application. To download a copy of the form, visit ourwebsite.
9. Photo Requirement
Applicants MUST submit one (1) passport-style color photograph. Your photo is a vital part of your application. To learn more, review
the information on how to provide a suitable photo to avoid processing delays by visiting our website. The acceptance of your photois always at the discretion of the AWS.

Photos copied or digitally scanned fromdriver’s licenses or other official documents
are not acceptable.
Print your name and AWS membershipnumber on the reverse of the photograph.
Only use scotch tape on the back of the photo.

背景が必ず白色のカラー写真を51mmx51mmのサイズ
Renewal Application for CWI/SCWI 3rd and 6th Year_2221
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Nov 24, 2021にして上記位置に貼り付けるか別ファイルで送ってください。

Name

AWS Member #10. Candidate Attestation Agreement- Please check, date, and sign below.

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Certified Welding Inspector
QC1 Standard for the AWS Certification of Welding Inspectors
B5.1 Specification for the Qualification of Welding Inspectors

I agree to comply with the existing requirements and any subsequent requirements that may be instituted by AWS. I have read andagree to the terms and conditions set forth in the AWS Policies and Fees form. I certify that the information I have included on thisapplication is true. I understand that any false statements will nullify this application. I give AWS permission to verify this information.
I agree to comply with the provisions set forth in the Standard concerning the administration of my examination and certification.
Upon obtaining my certification, I give AWS the right to reveal my certification status as it relates to my validity and expiration date. I
further understand that any required information that is incomplete or missing will cancel this registration.

EXAMINATION POLICIES AND RULES
Furthermore, I certify that I have not obtained any exam materials, have no prior knowledge of the AWS exam questions or answers,
and have not and will not accept any solicitation for the AWS exam questions or answers from anyone at any time before, during, orafter the exam as stated on the Candidate Attestation Agreement (Please click and read this link prior to accepting the Terms andConditions. You will be required to sign this form on exam day). I understand that a violation of this oath may be grounds forinvalidation of my certification and may be grounds for expulsion from any future testing.

COVID-19/COMMUNICABLE DISEASE LIABILITY POLICIES AND WAIVER

Furthermore, I certify that I have read and understand the COVID-19/Communicable Disease Liability Waiver requirements. I certifythat I understand that I will be asked to sign this waiver at the start of any AWS seminar, class, exam, or other AWS event. I furtherunderstand that failing to agree to the pronouncements in the waiver will disqualify me from participating in the event, and I will bebarred from entering the event room or participating the event. I further understand that being barred for failing to agree to thepronouncements will result in forfeiture of all registration fees. I understand that I will also be barred from the event if I do not attest
to both COVID-19 statements related to recent symptoms and exposure risks.

Applicant’s Signature ______________________________________________________ Date _________________________

上記は直筆サイン、日付を記入願います
電子署名でも構いませんがきちんと表示されていることを確認してください。

Renewal Application for CWI/SCWI 3rd and 6th Year_2221

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Name

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AWS Member #VISUAL ACUITY FORM

Member #: _______________ Email address: ___________________________ Date: ______________
Last Name: ___________________________First Name: _______________________ MI: ___________

ApplicantThis form must be submitted for all SCWI/CWI/CAWI/CRI/CWEng applications ONLY.
AWS will not release exam results, recertification results, or renewals without a completed Visual Acuity Record on file.
IMPORTANT: This completed Visual Acuity Form must be sent to the AWS Certification Department along with the application. Applicants who
have not fulfilled all requirements and/or have not submitted the form, shall have test scores/application voided and may be in jeopardy offorfeiting application fees. This form may be sent via email or mail.

Eye Examination

Eye examinations shall be administered by an Ophthalmologist, Optometrist, Medical Doctor, Registered Nurse or Certified Physician’s Assistant orby other ophthalmic medical personnel and must include the state or province license number. Examinations shall be performed not more than one(1) year prior to the date of the certification examination or the expiration date for renewals and recertifications. New visual acuity records do notneed to be supplied for retests occurring within one (1) year from the original examination date.
All applicants must pass an eye examination, with or without corrective lenses, to prove near vision acuity on Jaeger J2 at 12 in. or greater (≥30.5cm). All applicants shall take a color perception test. Eye examination results must be documented on this Visual Acuity Record form supplied by theAWS Certification Department. No other forms will be accepted.

ここから下は印刷したものを医師の方に記入をお願いします。
A. Verify the customer’s close vision acuity to Jaeger J2 specifications at a distance of 12 inches orgreater(≥30.5 cm)
AWS Use

1. The following must be completed by the eye examiner:(Check ONLY one of the following for each eye)
OD

OS

Only

Requires corrected vision to read Jaegar J2 at 12 in. or greater.
No correction is required to read Jaegar J2 at 12 in. or greater.
Unable to read Jaegar J2 at 12 in. or greater even with attempt at correction.

WO
NQ

B. Through a color perception examination, is the applicant colorblind?

AWS Use
Only(Check ONLY one of the following for each eye)
OD

OS

Customer IS NOT colorblind
Customer IS colorblind.

CB

3. Examiner’s Contact Information (print clearly)
Customer Name:

Date of eye exam:

Examiner Name:

Phone Number:

Examiner Address:
City:

State:

Zip/Postal Code:Country:

4. Examiner professional status (check only one)
Ophthalmologist
Optometrist
Certified Physician’s AssistantExaminer Signature:
Renewal Application for CWI/SCWI 3rd and 6th Year_2221

Medical Doctor

Registered Nurse

State/Prov. License number:
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