Cal/OSHA Excavation Competent Person Examination

 
Applicants for this Examination must complete an eight (8) hour course.

Personal

First Name:
M.I:
Last Name:
SSN #:
Street Address:
City:
State:
Zip:
Email Address:
Home Phone:
Work Phone:
Cell/Other Phone:
Local Union # (If Applicable):
I would like to receive notifications via text:
I would like to receive notifications via email:
Have you taken this exam on a previous date:
If yes, date::
Have you completed a recognized Apprenticeship training program:
Work Experience in Specialty (Years and Months):

Experience

List your present or most recent employer first:
Employer Name #1:
City:
Phone:
From Month/Year:
To Month/Year:
Employer Name #2:
City:
Phone:
From Month/Year:
To Month/Year:

I do solemnly swear or affirm that the above statements are true. I further realize that falsification of these statements shall be cause for disqualification.

As a holder of a NITC Certification I shall agree to the following:


I will make no false claims about the scope of m y certification(s)
I will not engage in false or misleading advertising of my NITC Certification, nor shall I utilize an NITC certification in a ny manner that portrays NITC unfavorably.
I will not utilize any written documents, reports, procedures, e tc., with the NITC certification mark in any manner whatsoever that may be inaccurate or false.
I will notify NITC without delay of any changes in my capability to fulfill the requirements of this certification.

I understand that NITC reserves the right to su spend or revoke my certification should I violate these obligations. Should my certification be revoked, I agree to cease and desist any and all references to being the “holder” of an NITC Certification and shall return a ny certificates, including wal let s ized photo identification cards to NITC.

I understand and agree that my examination results may be shared with the course instructor, training coordinator or training entity.

By affixing my signature to this application , I agree to abide by the rule s and regulations of certification holders as set forth by the NITC Certification Committee.