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

CWI 9th Year
Application
Checklist Form

For your convenience, please use our Certification Application Portal.
Effective November 15th,2019, applications will be charged an additional non-refundable fee of $125.00 if sent to
AWS by email or paper.

Applicants Information:
Last Name: _____________________________ First Name: _________________________ Middle: ______________
Certification #: __________________________
Check sections for compliance.

*Incomplete applications will not be processed.

Personal Information – Last, First, and Middle initial MUST be completed, including Certification number.
Sec. 1: Payment Information - Payment MUST accompany this application.
Sec. 2: Personal Information – Last, First, and Middle initial MUST be completed.
Sec. 3: Member Information and Certification number
Sec. 4: Recertification by Exam Option – if recertifying by exam and/or taking a Seminar, please check this option.
Sec. 5: Recertification by Non- Exam Option - if recertifying by non-exam, please check one option.
Sec. 6: Exam Location – Site Code (if Applicable), Exam Date, City/State, and Submission Deadline
Sec. 7: Proof of Identity – current color copy of government passport or national ID
Sec. 8: Associations – Type of Business, Job Classification and Technical Interests.
Sec. 9: American Disabilities Act (ADA): if applicable, candidate must print a copy of our ADA package and follow the
instructions. www.aws.org/ada-disability-accommodations
Sec. 10: Qualifying Work Experience - MUST be completed for each employer to meet minimum work experience
requirement. All fields are mandatory.
Sec. 11: Visual Acuity Form – Eye Examinations shall be performed not more than one (1) year prior to the date ofcertification. Applicants shall submit results to the AWS certification department along with their application.
Sec. 12: Photo Requirement – To learn more, review the information on how to provide a suitable photo to avoid
processing delays by visiting our website www.aws.org/certification/page/photo-id-requirements
Sec. 13: Terms and Conditions - This section of the application must be read, checked, dated, and signed by theapplicant taking the exam.
Sec. 14: Continuing Education and/or Teaching Credit - Complete this section only if submitting 80 Personal Development
Terms
Hours.

上記チェックボックスで完了したものにチェックを入れてくだ
さいFor Exam Fees Certification Price List

Method of Payment -AWS USE ONLY

Payment must accompany this application

Check if billing address is different from mailing____________________________________________________________________________________________________________________________________

Acct #: ___________________________________All checks and money orders made payable to AWS
Check or money order #_______________________
VISA

CC#:

MC

AMEX

/

Date: ____________________________________

Discover

/

/

Exp:

/
Amt$:_______________________________CWI

SIGNATURE :____________________________________________________________

Recertification Application for CWI 9th Year_1108

CVV: ___________________

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Feb 22, 2022

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LAST NAME ______________________________FIRST NAME __________________________________________

2. Personal Information

Name must match your current government issued ID or Passport

Last NameFirst Name

Certification #Exp. Date

Street Address

Middle Initial

AWS Member #City, State, Zip CodeHome Telephone

Work Telephone

Email

Mobile Telephone

Date of Birth MM/DD/YY

Last Four Digits ofSS#

3. Member Information: Check and complete
Are you an AWS Member?

Yes

No

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

What is your AWS CWI Certification number and Expiration:

CWI #: ___________________________ Exp. Date: _______________________

4. Recertification Exam Options (choose, unless recertifying by a non-exam option):CWI Part B- Practical Exam Only - Complete Sections 6 through 9 and 11 through 13.
Exam Only
Seminar & ExamPart B Seminar & Exam

Body of Knowledge

5. Recertification Non-Exam Options (choose one, unless recertifying by an exam option): Sample ✔
5a.
5b.
5c.
5d.

80 Professional Development Hours (PDHs) - Complete sections 7-14 and skip 9
CRI Certification achieved prior to 9th year of CWI Certification (submit copy of certificate) - Complete sections 7 and 10 through 13

Endorsement- Achieved prior 9th year of Certification (submit a copy of certificate) - Complete sections 7 and 10 through 13
9-year Recertification Course - Complete sections 6 through 7 and 10 through 13

6. Indicate exam location of your choice: Confirmation is emailed in 3-4 weeks from receipt of application.
1st

Exam Schedule

Site Code_________________ Date__________________ City/State __________________________ *Submission Deadline__________________________

2nd Site Code_________________ Date__________________ City/State___________________________ *Submission Deadline__________________________
3rd Site Code_________________ 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 have

SiteCodeは受験するたびに毎回変わります。受験場所、日に合ったコードをAWSホームページで確認して入力願
received your exam confirmation letter from the Certification Department via email. Refer to AWS Policies and Fees.
います。不明な場合は当センターにご連絡ください。
7. Proof of Identity
Please check that you’ve attached a color copy of your current Government issued ID to this application, such as a driver’s license or
passport. This is required if testing for an endorsement exam through Prometric.

Recertification Application for CWI 9th Year_1108

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5. Associations
TYPE OF BUSINESS (CHECK ONLY ONE)Job Classification (check only ONE)A

Contract Construction

01 ✔ President, owner, partner, officer

B

Chemicals & Allied productsC

Petroleum & Coal Industries

02
03

Manager,Director,Superint.(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 — other

GElectrical Equip., Supplies, Electrodes07

Inspector, tester

08

Supervisor, foreman09

Welder, welding or cutting operator

10

Architect, designer

11

Consultant

12

Metallurgist

13

Research & development

14

Technician

15

Educator

16

Student

17

Librarian18

Customer service

19

Other

20

Engineer - design

21

Engineer - manufacturing

22

Quality Control

H ✔ Transportation Equip. - Air, Aerospace
I

Transportation Equip. - Automotive

J

Transportation Equip. - Boats, Ships

K

Transportation Equip. - Railroad

L

Utilities

M

Welding Distributors & Retail Trade

N

Misc. Repair Services (incl. welding Shops)

O

Educational Services (Univ,Libraries,Schools)

P

Engineering & Architectural Serv.(Incl.Ass.)Q

Misc. Business Services (Incl.Comm.Labs)R

Government (Federal,State,Llocal)

S

Other

Initial CAWI/CWI Exam Application 1101

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Technical Interests (check ALL that apply)✔

Robotics
Computerization of Welding
Ferrous Metals
AluminumNonferrous Metals Except Aluminum
Advance Materials/Intermetallics
Ceramics
High Energy Beam Process
Arc Welding
Brazing & Soldering
Resistance Welding
Thermal Spray
Cutting
NDT
Safety & Health
Bending & Shearing
Roll Forming
Stamping & Punching
Aerospace
Machinery
MarinePiping & Tubing
Pressure Vessels & Tanks
Sheet Metal
Structures
Other
Automation
Computerization of Welding

Feb 22, 2022

Name:AWS Member #9. 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
the ADA. Click here for a copy of the accommodations request package.
Will you be using a glucose meter during your exam?

Yes

No

10. Qualifying Work Experience – Resumes not accepted.
_______ I attest to having no period of continuous inactivity greater than two years during the previous three years of certification. I understand that work
(Initial)

experience documented on this application will be verified with both past and present employers.

Company Name

Type of BusinessCompany Street AddressCompany Phone Number
City, State, Zip CodeSupervisor’s Name

Title of Immediate Supervisor

Supervisor’s Email Address

Department

Applicant’s Job Title

Employed From:

To:

(Mo.)

(Mo.)

(Yr.)

(Yr.)

Job Responsibilities- Detailed Description Required

ご自分の関係する事業・製品などで溶接部のどのような業務（溶接そのもの、検査、監督、設計など）に携わっているのかできる限り詳しく書いてください。過去に説明が単純すぎて再提出を求められたケースがなんどもあります。
DUPLICATE THIS SECTION FOR EACH ADDITIONAL EMPLOYER

11. Visual Acuity Form
A current Visual Acuity Form must be completed and submitted along with this application. To download a copy of the form,
please visit our website.
12. 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 ofyour photo is always at the discretion of the AWS.

Print your name and AWS membership number on the reverse of the photograph.
DO NOT STAPLE OR PAPER CLIP PHOTO

Photos copied or digitally scanned fromdriver’s licenses or other official
documents are not acceptable.

必ず背景が「白色」のカラー写真を51ｍｍｘ51ｍｍのサイズにして左記の位置に貼り付けるか別ファイルで送ってください。

Only use scotch tape on
the back of the photoRecertification Application for CWI 9th Year_1108

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CANDIDATE ATTESTATION AGREEMENTPROGRAM AND REGISTRATION TERMS, POLICIES, AND FEES
I hereby attest that I have read the program requirements contained in the following program document:•QC1 Specification 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 and agree to the terms and conditions set forth in the AWS Policies and Fees form. I -attest thatthe information I have included on this application is true. I understand that any false statements will nullify thisapplication. I give AWS permission to verify this information. I agree to comply with the provisions set forth in theSpecification 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.
CODE OF ETHICS, RULES OF CONDUCT AND PRACTICE
I attest that I have thoroughly read QC1: 2016-AMD 1 Specification for the AWS Certification of Welding Inspectors,
Clause 11 - Code of Ethics, Rules of Conduct and Practice and agree to comply with it.
Administrative Procedures for Alleged Violations of AWS Certification Programs
EXAMINATION POLICIES AND RULES
Furthermore, I attest that I have not obtained any exam materials, have no prior knowledge of the AWS examquestions 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, or after the exam as stated on the Candidate Attestation Agreement(Please click and read this link prior to accepting the Terms and Conditions. You will be required to sign this formon exam day). I understand that a violation of this oath may be grounds for invalidation of my certification andmay be grounds for expulsion from any future testing. AWS may send text alerts regarding your seminar and/or
exam site information or status.
COVID-19/COMMUNICABLE DISEASE LIABILITY POLICIES AND WAIVER
Furthermore, I attest that I have read and understand the COVID-19/Communicable Disease Liability Waiver
requirements. I attest that 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 further understand that failing to agree to the pronouncements in the waiverwill disqualify me from participating in the event, and I will be barred from entering the event room or participating
the event. I further understand that being barred for failing to agree to the pronouncements 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 of
the COVID-19 statements related to recent symptoms and exposure risks.

下記は直筆サイン、日付の記入をお願いします。
きちんと表示されていることを確認してください。

Applicant’s Signature __________________________ Date: ___________________________Name:AWS Member #14. Continuing Education and/or Teaching Credit
Complete this section only if submitting 80 Personal Development Hours, include certificate of completion and course
description and/or syllabus. Duplicate this page as necessary. For details regarding documentation of PDHs please refer to QC1
section 16.5. www.aws.org/library/doclib/QC1-2007.pdf#page=19#

Example:PDH

Institution or provider name and contact information:

Title of course or seminar:

Sample Institution
1234 Street
Anywhere, US 54321
Phone: 999-555-1212

Welding Technology 101

40

DATE OF COMPLETION:
Institution or provider name and contact information:

January 2, 2099
Title of course or seminar:

PDH
DATE OF COMPLETION:
Institution or provider name and contact information:

Title of course or seminar:

PDH
DATE OF COMPLETION:
Institution or provider name and contact information:

Title of course or seminar:

PDH
DATE OF COMPLETION:
Institution or provider name and contact information:

Title of course or seminar:

PDH
DATE OF COMPLETION:

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Recertification Application for CWI 9th Year_1108

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Name:AWS Member #VISUAL ACUITY FORM
Member #: _______________ Email address: __________________________________
Last Name: ________________________________

Date:____________________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 injeopardy of forfeiting 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 or by 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 not need 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(≥30.5 cm). All applicants shall take a color perception test. Eye examination results must be documented on this Visual Acuity Record form
supplied by the AWS Certification Department. No other forms will be accepted.

ここから下は、印刷した用紙に医師の方に記入をお願いしま
1. The following must be completed by the eye examiner: す。
A. Verify the customer’s close vision acuity to Jaeger J2 specifications at a distance of 12 inches or greater(≥30.5 cm)(Check ONLY one of the following for each eye)OD

AWS UseOnly

OS

Requires corrected vision to read Jaegar J2 at 12 in. or greater.

W

No correction is required to read Jaegar J2 at 12 in. or greater.

O

Unable to read Jaegar J2 at 12 in. or greater even with attempt at correction.

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 colorblindC

Customer IS colorblind.

B

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

Medical Doctor

Examiner Signature:

Registered Nurse

Certified Physician’s AssistantState/Prov. License number:

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Recertification Application for CWI 9th Year_1108

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