API 936

Certification Program
Refractory Personnel

Examen en Junio/ Diciembre de 2012, en ARGENTINA

Toda la documentación y pagos para la inscripción al examen deben enviarse a:

TEDUC
Av. Roque Sáenz Peña 615, Of. 611
(C1035AAB) Buenos Aires, Argentina
Tel/Fax.: (005411) 4326-1404/ 4328-4459

Consultas: sabino@teduc.com.ar
www.teduc.com.ar

FECHAS LÍMITE PARA EL EXAMEN – ARGENTINA

Fecha límite para solicitar

Fecha de Examen Fecha límite de aplicación y pago
re-examen

Pago: 14 de Febrero
6 de Junio de 2012 22 de Febrero
Entrega de Doc: 22 de Febrero

Pago: 10 de Agosto
5 de Diciembre de 2012 17 de Agosto
Entrega de Doc: 17 de Agosto

- Deberá completar y enviar a TEDUC, en sobre cerrado, la aplicación para el examen

(original), junto con la documentación pertinente, antes de la fecha límite de aplicación. No
se aceptarán aplicaciones por fax o mail.
- Enviar el pago a TEDUC. Completar y enviar por correo, mail (sabino@teduc.com.ar ) o fax
(0054-11-43261404), la solicitud de pago antes de la fecha límite. Si Usted ha realizado el
pago por transferencia bancaria, por favor, enviar comprobante del mismo por mail o por fax.
- Para re-inscripciones completar y enviar la solicitud de pago (página 1.2), con el
comprobante de pago correspondiente y completar y re-enviar página del aplicativo
(REQUEST FOR FOREIGN LANGUAGE EXAMINATION).

1.1
Nombre del Candidato:
API 936 - Solicitud de Pago

La tasa para miembro API aplica para el personal en relación de dependencia de empresas miembro API, no para personal
contratado/subcontratado.
Miembro API No Miembro
U$S 350.00 U$S 500.00

INSTRUCCIONES DE PAGO – Examen en ARGENTINA

• Todos los pagos deben realizarse en TEDUC. Incluir u$s110 por gastos administrativos y de gestión. Valor neto
a transferir: Miembro API u$s460/ No Miembro u$s610. Para re-inscripción incluir u$s30 (Neto u$s180)
• Los pagos deben ser realizados antes de la fecha límite de inscripción.
• Cheques deben estar emitidos a la orden de TEDUC S.R.L. Usted será responsable por el pago de impuestos.
• Transferencia Bancaria: Debe ser realizada a la cuenta indicada y Usted será responsable por los gatos de
transferencia.
• Complete y entregue la solicitud de pago. Envíe comprobante de pago en caso de transferencia bancaria.

INDIQUE FORMA DE PAGO

Pago por Inscripción Pago por Re-inscripción
(U$S460/ U$S610 + IVA) (U$S 180 +IVA)
CHEQUE/EFECTIVO Nro. Cheque: Bco.:

TRANSFERENCIA Datos para transferencia:

Razón social: TEDUC S.R.L
Cuit: 30-70851313-6
Banco de la Nación Argentina - Sucursal Villa del Parque (N° 94)
Cuenta Corriente: 2400105-72
CBU 01100242-20002400105721

Recuerde agregar en su pago los gastos de transferencia. Envíe comprobante de pago

por mail a administracion@teduc.com.ar o por teléfono/fax llamando al (0054-11)
4328-4459/ 4326-1404.
TARJETA DE CRÉDITO (Consulte recargos por pago con tarjeta)
Tipo de Tarjeta: VISA MASTERCARD
N° Cuotas

Datos de la Tarjeta
Nombre(s) Apellido(s)
Código de
Número de Tarjeta
Seguridad
Vencimiento DNI

Domicilio Teléfono

Datos de Facturación
Nombre/Apellido o
Cuit
Razón Social
Dirección Teléfono

1.2
API 936
Refractory Personnel Certification Program

Instrucciones para el Aplicativo.

1. Este aplicativo es un archivo PDF se puede escribir. Por favor, asegúrese de descargar el
documento y guardarlo en su computadora. A continuación, puede abrir la aplicación,
escriba su información en el mismo PDF, e imprima el aplicativo. (Cualquier Aplicativo que
se complete en línea no se guardará, deberá descargarlo a su PC para completarlo).
Deberá enviarlo impreso y con todas las firmas en original a TEDUC.

2. Complete todas las páginas de esta solicitud.

3. Por favor escriba su nombre tal como aparece en su pasaporte / documento oficial de
identidad / licencia de conducir.

4. Si ya ha aplicado a API y tiene asignado un número de identificación (ID) de API, se

deberá incluir en todos los lugares donde aparece su nombre.

5. Asegúrese de incluir una única y actual dirección de correo electrónico. Toda la

correspondencia de API, incluyendo su carta de admisión y el informe de calificación del
examen, será enviada a la dirección de correo electrónico que usted proporcione.

6. Tome nota de los documentos de estudio que se enumeran en la hoja de Publications

Effectivity Sheet. Los códigos para los exámenes de certificación de ICP pueden obtenerse
a través de IHS (www.global.ihs.com) o TechStreet (www.techstreet.com).

7. La página 5 debe completarse con los últimos tres trabajos que haya realizado. Desde el
más reciente, hasta el más antiguo, respectivamente.

8. En la página 6, haga una marca en la fecha que desea realizar el examen. Para indicar el
lugar donde desea presentar el examen, escriba la ciudad y país donde figura API-
approved special site (si no encuentra en el listado de países el lugar).

9. Leer y firmar los dos Acuerdos del Inspector y la página de FOREIGN LANGUAGE
WAIVER. Recuerde colocar, en esta última, en la opción idioma la leyenda “en español e
Inglés” para recibir el examen en ambos idiomas.

10. En la página 16 deberá indicar lo siguiente: en la primera pregunta si usted ha

realizado un curso preparatorio para rendir el examen y el nombre del proveedor del
curso. En la segunda pregunta debe indicar si los códigos que lleva al examen fueron
provistos por el proveedor del curso. De no ser así deberá colocar como obtuvo los
códigos. En la última parte de la pagina (Include proof of legal purchase) deberán indicar la
proveniencia de los códigos originales que llevará al examen; a. Colocar el ID de la
empresa en la cual trabaja, que les facilita los códigos, (no podrá colocar el ID de una
empresa de la cual no es empleado), b. Indicar el numero de factura en el caso de que
haya comprado el código, c. indicar otras formas de obtención de los códigos.
API 936
Refractory Personnel Certification Program

11. Realizar el Pago. Vea la página 1.2 de Solicitud de Pago. No se tramitará ninguna
solicitud hasta que se reciba el pago. La página 1.2 remplaza a la página 11 del aplicativo,
por tal motivo sólo deberá completar la página 1.2.

12. Asegúrese de guardar una copia de la Aplicación completa que usted envíe, incluyendo
copias de su ERF, diplomas, carta del empleador, etc.

13. Cuando haya completado su solicitud, revise la lista en la parte posterior del aplicativo,
para asegurarse que ha incluido toda la información y los documentos
necesarios. Recuerde que el aplicativo original debe ser enviado a TEDUC, por tal motivo
deberá omitir la información posterior con dirección de API.

TEDUC SRL

Av. Roque Sáenz Peña 615, Piso 6, Of. 611 (C1035AAB)

Ciudad Autónoma de Buenos Aires - Argentina
Tel: (54-11) 4328-4459 - Tel/Fax: 4326-1404

INFORMACIÓN PARA EL DÍA DEL EXAMEN:

• Se le permite tener sólo lo siguiente en la sala de examinación: Los códigos API originales
y permitidos, lápiz No. 2, una goma de borrar y una calculadora (simple, no
programable). Cualquier otro elemento podría ser confiscado por el personal que tome el
examen.

• Cualquier material adicional a los de referencia no están permitidos. Esto incluye los
materiales de capacitación, las páginas insertadas en los libros de códigos, etiquetas pre-
impresas incorporadas a los códigos, páginas en blanco de escritura (a mano o en el medio
de los libros de códigos).

• Las pequeñas notas en los márgenes están permitidas.

Ante cualquier consulta no dude en contactarse con TEDUC.

API 936 Refractory Personnel
Certification Program
Application Instructions

1. This application is a writable PDF. BE SURE to download the document and save it on your
computer, before filling it out. Open the saved application, type in your information, and print
the application forms to be mailed to API. (Any application filled in while viewing it online will not
be saved, nor will it be sent to API electronically.) All original 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 / govt-issued ID / driver’s license.

4. If you have previously applied to API and been assigned an API ID number, include it every place
that your name appears in the application form.

5. Be sure to include a unique and current e-mail address. All API correspondence will be sent to
the e-mail address you provide.

6. Make note of the applicable documents to study as listed on the Publications Effectivity Sheet.
The publications for ICP certification exams may be ordered through IHS (www.global.ihs.com) or
TechStreet (www.techstreet.com)

7. Read and sign BOTH Inspector Agreements

8. Include the certification fee. See Page 2 for ICP Financial Policies. We will not process any
application until full payment is received.

9. Be sure to keep a copy of the completed application that you mail to API.

10. When you have completed your application see checklist at the back of this packet to ensure you
have included all the information and documents necessary.

INFORMATION FOR THE DAY OF THE EXAM:

You are allowed to have only the following in the test room: Sharpened No. 2 pencils, an eraser and a
calculator (simple function only, non-programmable). Anything else could be confiscated by the test staff.

936_newcertapp_2012-2013_final_7-23-12.docx
 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 ICP
EXAMINATION if payment has not been received AND processed by API. Proof of payment
must be included with your application.

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

 All payments must be made in United States currency.

 Paying by credit card provides the best opportunity to ensure that payment is received and
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 allow plenty
of time for the company to make payment.

 If paying by wire transfer please submit a copy of the electronic transaction document with
your application. The applicant’s name MUST be included on the wire transaction document.
If the copy is not included with the application please e-mail a copy to inspector@api.org 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.  

936_newcertapp_2012-2013_final_7-23-12.docx
Application Form – Basic Information
API 936, Refractory Personnel Certification Program

New – API Exam EXAM ID #

(if previously assigned)

___________________________________________________________________________________________
FIRST MIDDLE LAST
NAME (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 Data
Work Telephone Number

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

Employer’s Address (P.O. Box or Number and Cell Phone Number

Street)

If you want your exam admission letter / score report

City, State and Zip or Postal Code to be sent to your employer, trainer, or exam
organizer, please include this person’s e-mail here:

Country Group Contact E-mail

936_newcertapp_2012-2013_final_7-23-12.docx
Additional Information
API 936, Refractory Personnel Certification Program
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
Yes No
Directory, when you obtain your certification?
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.

Program / Certification Number Expiration Date

Program / Certification Number Expiration Date

Program / Certification Number Expiration Date

3. Are you currently a full-time, non-contract employee of Yes No

an API member company?
If yes, please enter the company name.

4. Please check the boxes that correctly describe your organization. Please be sure to check
one box on each side.
Industry Organization type

PETROLEUM OWNER-USER
CHEMICAL INDIVIDUAL CONTRACTOR
PAPER/PULP INSPECTION COMPANY
SERVING ALL INDUSTRIES CONSULTING/CONSTRUCTION
OTHER OTHER

5. Please check the boxes that correctly describe your employment status. Please be sure to
check one box only.
Full-time employee of an owner/user
Full-time employee of an inspection agency/other company
Independent contractor

936_newcertapp_2012-2013_final_7-23-12.docx
Employment History
API 936, Refractory Personnel Certification Program
(Last three employers or at least the last five years)

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

From:
Employer ____________________

To:
Mailing Address (Number and Street) ____________________

City, State and Zip Code

Job Title / Detailed Description of Responsibilities

2. Name and Address of Employer Date of Employment

From:
Employer ____________________

To:
Mailing Address (Number and Street) ____________________

City, State and Zip Code

Job Title / Detailed Description of Responsibilities

3. Name and Address of Employer Date of Employment

From:
Employer ____________________

To:
Mailing Address (Number and Street) ____________________

City, State and Zip Code

Job Title / Detailed Description of Responsibilities

936_newcertapp_2012-2013_final_7-23-12.docx
API 936 Test Registration
Applicant’s Name: _________________________________________
Exam ID # (If previously assigned):
Examination Locations and Dates

Please indicate your preferred exam date and location listed below.

December 5, 2012 (Application Deadline – API must receive no later than September 17, 2012)

June 5, 2013 (Application Deadline – API must receive no later than March 20, 2013)

Application deadlines are firm — no exceptions will be made.

*NOTE: An additional sitting fee will be required at the Edmonton location in December. You will
receive information, prior to the exam date, from ABSA / API, with payment instructions.
North America:
Anchorage, AK * Edmonton, AB (Canada) Oakland, CA

Atlanta, GA Houston, TX Oklahoma City, OK

Baton Rouge, LA Indianapolis, IN Philadelphia, PA

Corpus Christi, TX Los Angeles, CA

Other Locations:

Abu Dhabi, UAE Chennai, India Kuala Lumpur, Safat (Kuwait City), Kuwait
Malaysia
Al-Khobar, Saudi Arabia Chia, Colombia Mumbai, India Singapore, Singapore

Cairo, Egypt Doha, Qatar Port of Spain, United Kingdom

Trinidad (contact API for city info)

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.

936_newcertapp_2012-2013_final_7-23-12.docx
 FOREIGN LANGUAGE WAIVER for ICP CERTIFICATION EXAMS
OUTSIDE OF UNITED STATES
(Complete this form only if testing in a language other than English.)

Please complete and sign the form below to take the API exam in a Foreign Language. This form is
sufficient for all your attempts within a given program until you obtain your certification. If you do
not submit this form, or the form is incomplete, you will take the exam in English. Please note:
Translations are not available for all languages or all programs, and API does not guarantee that
your requested translation will be available. Make sure to visit the API website and confirm
language availability prior to applying.

I, ________________________________________________________ ID # ____________________
(Please print your full name above. If you hold another certification with API please include that number),
request to take the following examination in a foreign language:
API program: _______________________________________
Location: ___________________________________________
Language requested: __________________________________

Assumption of the Risk and Waiver of All Claims

Read this carefully before signing.
Translation of technical terminology and complex subjects is difficult and subjective. API cannot warrant
that the foreign language translations of API materials are accurate. By signing this form, you agree to
assume any risk of inaccurate translations and also to waive any claim against API related to the accuracy
of the translated exam.
I, the undersigned, agree to the following:
1. I agree to take the API __________ examination in a foreign language. I understand that the technical
translation of the terminology in the course of the examination may or may not be familiar and
acceptable to me.
2. In the event of my failing the examination I agree to hold API harmless against any claims related to
the language of the examination.
3. In the event of my failing or not taking the examination I understand and agree that API will not make
any refunds of my application fees or be liable for any damages whatsoever.
4. API shall be the sole judge or whether I have the appropriate qualifications to become certified under
API Individual Certification programs.

Signature: ____________________________________________
Full name: _____________________________________________
Company Name: ________________________________________
Date: ______________________________________________

936_newcertapp_2012-2013_final_7-23-12.docx
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”), residing at 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 that API
shall be the sole judge of whether the Inspector has the appropriate qualifications to become certified, remain certified, 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 any
misrepresentation 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 not warrant or
guarantee the competency of any inspector certified under this program. The inspector agrees not to mislead 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 ensure that 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 deadline specified 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 e-mail address, or (2) by posting the changes on the API website. It is the responsibility of
the Inspector to notify API of address and e-mail 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 certification requirements. It is the responsibility of the Inspector to obtain this information by
contacting API or by checking the API 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 this
Agreement or with respect to the subject matter of this Agreement, API shall be entitled to recover reasonable attorney'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 the
inspector has: (1) made material errors, omissions, or misrepresentations on the application or in any other documents
submitted to API, or (2) violated any terms or conditions of this Agreement or any ICP policies or requirements. API also
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 the Inspector’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.
10. The Inspector agrees to comply strictly with all U.S. export laws relating to this program. The Inspector warrants that he is
not located in, or under the control of, or a national or resident of any embargoed countries.
11. This agreement shall not and is not intended to benefit or to grant any right or remedy to any person or entity that is not a
party to this Agreement.
936_newcertapp_2012-2013_final_7-23-12.docx
12. This instrument contains the entire and only agreement between the parties. No oral statements or representations not
herein contained shall have any force and effect.
13. Paragraphs 2, 3, 4, 5, 6, 7, and 8 survive termination of this agreement.
14. It is expressly understood between the parties hereto that no association, agency, apparent agency, employer/employee
relationship, partnership, or joint venture of any kind has been created. Inspector agrees not to refer to himself as API’s
agent nor refer to the relationship between the parties as a joint venture or partnership or in any manner inconsistent with
this Agreement. Inspector shall have no authority to act or contract on behalf of API.
15. No waiver by API of any default, misrepresentation, or breach of warranty or covenant hereunder, regardless of whether
intentional, shall be deemed to extend to any prior or subsequent default, misrepresentation, or breach of warranty or
covenant hereunder or affect in any way any rights arising by virtue of any prior or subsequent such occurrence.
16. API makes no express or implied warranties regarding the ICP program or potential benefits of the certification to the
Inspector.
17. The Inspector agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by any government
body or authority in any way measured by this Agreement, or any portion of it, or any services related thereto.
18. Inspector understands and agrees that Inspector is not granted any rights under the program or this Agreement until API has
determined that the Inspector has satisfied all of the program requirements and has issued a Certificate to the Inspector. The
Inspector’s certification shall be effective on the date that is noted on the Certificate and shall be effective for a period of
three years unless terminated pursuant to the terms of this Agreement.
19. This Agreement shall be governed by and construed in accordance with the laws of the District of Columbia, USA, without
regard to the rules regarding conflicts of law. The parties agree that any action, suit, or proceeding based upon any matter,
claim, or controversy arising hereunder or relating hereto shall be brought exclusively in the federal or state courts located
in District of Columbia, USA. The parties consent to the jurisdiction and venue of such courts, and waive any objections to
the jurisdiction and venue thereof.

I, the undersigned, certify that I have read and fully comprehend this form in its entirety and agree to comply
with the conditions specified above.
Applicant’s name (please print) _____________________________ E-mail: _________________________

___________________________________ _________________
Signature of Applicant Date

Applicant’s address: ______________________________________________

______________________________________________

API Reviewer’s Initials: ____________

936_newcertapp_2012-2013_final_7-23-12.docx
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 API
determines 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 the
appropriate 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 any
supplemental information or documents deemed necessary by API to verify an applicant’s qualifications. Applicant
understands and agrees that API does not represent or warrant that the submission of the fees and materials by the
Applicant 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 each
applicant three consecutive attempts during the 12-month period to sit and pass the test, starting with the first exam
administration 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 the
date 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. Reschedule fees are not refundable.
7. An applicant is entitled to a 50% refund of the application fee if the refund request is received by API within 6 months
from 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
lose their certification.
12. Circumstances such as heavy work schedule or work in other countries do not relieve the inspector 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 renew
the 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 deadline
specified 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 e-mail address, or (2) 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 not relieve the Applicant of the responsibility to file a
timely renewal application or to comply with new certification requirements. It is the responsibility of the Applicant to
obtain this information by contacting API or by checking the API website.
14. The Applicant agrees to comply strictly with all U.S. export laws relating to this program. The Applicant warrants that
he is not located in, or under the control of, or a national or resident of any embargoed countries.
15. The Applicant agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by any
government body or authority based on in any way measured by this Agreement, or any portion or it, or any services
related thereto.

936_newcertapp_2012-2013_final_7-23-12.docx
 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’s
qualifications. Applicant agrees to indemnify API for any claims, losses, or damages resulting from the Applicant
submitting inaccurate or misleading information.

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

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

___________________________________ _________________
Signature of Applicant Date

API Reviewer’s Initials ________________

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API 936 - PAYMENT INFORMATION
Applicant’s Name: _________________________________________
Exam ID # (If previously assigned):

API member rate applies to full-time, non-contract employees of API-member companies.

API Member Non Member
$350.00 $500.00

PAYMENT INSTRUCTIONS
 All payments must be made in United States currency.
 Checks must be drawn on a U.S. bank. You are responsible for all taxes, banking or other service fees,
including all applicable withholding taxes. Applicant’s name(s) must be included on the check.
 For payments by electronic transfer: (1) you are responsible for all electronic transfer, A.C.H. and banking
fees (be sure to add the fees to your payment); (2) for electronic payments not drawn on a U.S. bank a fifty-
dollar ($50) handling fee must be added at the time payment is made.
Please include a copy of the wire / electronic transaction. Applicant’s name(s) must be included
on the transaction document.

PAYING BY CREDIT CARD CAN EXPEDITE THE PROCESSING OF YOUR APPLICATION

AND PAYMENT TO ENSURE YOUR PLACE IN THE EXAMINATION.
Credit Card Type: Visa American Express MasterCard

Card Number: Expiration Date:

Name as it appears on card _____________________________________________

Signature _______________________________________ Initial Certification Fee

Reschedule / Retest Fee

E-mail address to send receipt: ($150.00)

Check Late Penalties

Bank Fee (if wired)

Wire Transfer to: TOTAL SUBMITTED

TD Bank
1030 15th St NW
Washington, DC 20005 USA
ABA Routing # 054001725
Credit to: American Petroleum Institute
Account # 4251303172
SWIFT: NRTHUS33
(Reference: Applicant’s Name and SS-2100-D9200-7110)

Your application will not be processed if this page is not completed.

936_newcertapp_2012-2013_final_7-23-12.docx
API 936 Exam Publications Effectivity Sheet
FOR: December 5, 2012 and June 5, 2013
Listed below are the effective editions of the publications required for this exam for the date(s) shown above.

API Publications

API Standard 936; 3rd Edition, Nov 2008 – Refractory Installation Quality Control Guidelines –
Inspection and Testing Monolithic Refractory Linings and Materials.

Please ensure you obtain this document from one of API’s authorized redistributors:
Techstreet: www.techstreet.com; Phone: 1-800-699-9277
IHS Documents: www.global.ihs.com; Phone: 1-800-854-7179

ACI (American Concrete Institute) Publications:

These two documents are currently available as a .pdf file through the ACI bookstore. To access these two
titles go to http://www.concrete.org/bookstorenet/.

(Type 547.R-87 in “Search” field; then select “ by” Order Code; then “in” Inactive -- both documents should appear)

547.R-87 – State of the art report: Refractory Concrete

547.1R-89 – State of the art report: Refractory plastic and Ramming Mixes

ASTM (American Society for Testing and Materials) Publications:

C113-02 – Standard Test Method for Reheat Change of Refractory Brick

(Available at http://www.astm.org/Standards/C113.htm)
C133-97 – Standard Test Methods for Cold Crushing Strength and Modulus of Rupture of Refractories
(Available at http://www.astm.org/Standards/C133.htm)
C181-09 – Standard Test Method for Workability Index of Fireclay and High-Alumina Plastic Refractories
(Available at http://www.astm.org/Standards/C181.htm) C704-01 - Standard Test Method for
Abrasion Resistance of Refractory Materials at Room Temperatures (Available at
http://www.astm.org/Standards/C704.htm)

936_newcertapp_2012-2013_final_7-23-12.docx
 CHECKLIST

1. All pages of the application completed

2. Valid e-mail address included so we can contact you
3. Foreign Language Waiver signed, if necessary
4. BOTH Inspector Agreement forms signed
5. Certification Fee (payment page filled in completely)
6. Copy of transaction documentation if paying by wire
7. Copy of completed application made for your records

IF PAYING BY CREDIT CARD, MAIL ORIGINAL APPLICATION TO:

API
Individual Certification Programs
1220 L Street, NW
Washington DC 20005

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

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

API
Individual Certification Programs
P.O. Box 1425
Merrifield, VA 22116
Note: Couriers do NOT deliver to a P.O. Box.

TO SEND ORIGINAL APPLICATIONS AND CHECKS BY COURIER:

PLEASE ADDRESS PACKAGE TO:
API
Attn: John Robertson
1220 L Street, NW
Washington, DC 20005
Phone 202-682-8064

ALL CUSTOMER SERVICE INQUIRIES MUST BE DIRECTED TO:

inspector@api.org

936_newcertapp_2012-2013_final_7-23-12.docx