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Application form

EFNARC examiner for nozzle operator

Please complete the registration form accordingly. In the next step, you will be redirected to a Stripe page to process your deposit. You will receive a confirmation email in your inbox. Please note that your registration will only become valid once the deposit has been received via Stripe. If you have any questions, please feel free to contact info@cuc.academy .

Examiner Course application form

COURSE DATE

Please contact EFNARC to obtain the course date

PARTICULARS - Please write your personal details

Name *

Date of birth *

Nationality *

NAME OF YOUR SUPERVISOR - EFNARC's administration wants this information to facilitate payment for the course.

Name *

Supervisor's email *

Billing address

Address Line 1 *

Address Line 2

Postcode *

City / Town *

Country *

Tel *

Email *

EMPLOYMENT - State the Nozzleman's jobs going back 5 years

Employment 1

1.1 Company
1.2 Position
1.3 Time of employment (MMYY-MMYY) *

Employment 2

2.1 Company
2.2. Position
2.3 Time of employment (MMYY-MMYY)

Employment 3

3.1 Company
3.2 Position
3.3 Time of employment (MMYY-MMYY)

EXPERIENCES OF SPRAYED CONCRETE APPLICATIONS - Write your experiences involving sprayed concrete applications

Experience 1

1.1 Mine or civil project
1.2 Name of mine or civil project
1.3 Task
1.4 Length of experience (months) *

Experience 2

2.1 Mine or civil project
2.2 Name of mine of civil project
2.3 Task
2.4 Length of experience (months)

Experience 3

3.1 Mine or civil project?
3.2 Name of mine of civil project
3.3 Task
3.4 Length of experience (months)

Total length of experience dealing with sprayed concrete? (years) *

EXPERIENCE AND KNOWLEDGE

I have experience ...

as a sprayed concrete Nozzleman or supervisor

of concrete chemicals

of health, safety and environmental requirements

of operator training?

FURTHER INFORMATION

Spoken languages

Please list the languages you speak on a technical level i.e. to handle assessments on *

Assessing colleagues

The practical assessment needs to be conducted by an unbiased EFNARC Examiner, which means that Examiners can train their colleagues (Module 1, 2 and 3: theory, online exam, simulator) but are not allowed to conduct the practical assessment (Module 5) of their colleagues i.e., working in the same company or group.

I accept these terms?

When assessing externally, please explain how you commercially will handle it.

Please state your preferred country for running assessments? *

REFEREE - State the contact details to at least two (2) persons excluding the Examiner who can grant the stated experience.

Referee 1 - details

1.1. Name
1.2 Address
1.3 Tel
1.4 Email *

Referee 1 - relationship

Write and explain your relationship to the Referee? In what way have you worked together? *

Referee 1 - reference

Has the Referee been asked to be reference? *

Referee 1 - recommendation

Does the Referee believe that you have a suitable background to run EFNARC TBM Examiner Assessments? *

Referee 2 - details

2.1. Name
2.2 Address
2.3 Tel
2.4 Email *

Referee 2 - relationship

Write and explain your relationship to the Referee? In what way have you worked together? *

Referee 2 - reference

Has the Referee been asked to be reference? *

Referee 2 - recommendation

Does the Referee believe that you have a suitable background to run EFNARC TBM Examiner Assessments? *

Data Protection Terms

Please note that all your private personal information will be subject to local, national and international laws on data protection
- however once you have been accredited as an EFNARC Nozzleman your name and contact details may be made available by
EFNARC to those with a legitimate reason to request it to prevent fraudulent use of the accreditation

Yes, I agree to the Data Protection Terms *

Confidentiality Agreement

I agree that the Nozzleman Course Notes and other materials provided by EFNARC shall be treated as confidential and shall only be used for the purpose of obtaining and maintaining Nozzleman Certification. I shall not disclose the said documents to any other parties without the expressed permission of EFNARC.

Yes, I agree to the Confidentiality Agreement *

Spam protection *

STRIPE Preypayment

In the next step, you will be redirected to a Stripe page to process your deposit.

*required fields