List your present or most recent employer first. Attach any documentation you have that would prove that you have a minimum of two (2) years of documented practical experience in the verification of medical gas piping systems. Records substantiating the required experience or testimonial letters on company letterhead from employers are required. Testimonial letters must fully describe duties performed and dates employed and must be accompanied by W-2 forms. Candidates are also required to have a current certificate of insurance, in the name of the individual or employing verification company, for general liability, completed operations and, as applicable, products liability insurance. Acceptable documentation: letters from employers, employment history, certification records, state license(s) and any other employment
records. (Phone numbers are required for verification.)

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 an NITC Certification I shall agree to the following:

• I will make no false claims about the scope of my certifications(s)
• I will not engage in false or misleading advertising of my NITC Certification, nor shall I utilize an NITC certification in any manner that portrays NITC unfavorably.
• I will not utilize any written documents, reports, procedures, etc., with the NITC certification mark in any manner whatsoever that may be inaccurate or false
• I understand that NITC reserves the right to suspend 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 any certifications, including wallet sized 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 rules and regulations of certification holders as set forth by the NITC.

If you would like to include any additional documentation, you can upload a pdf file along with this application below by choosing to upload a file.

Information Sheet for Medical Gas Verifier Certification Examination

TO QUALIFY FOR THIS EXAMINATION all candidates must meet the requirements of the ASSE Series 6000, Professional Qualifications Standard for Medical Gas Systems Personnel, Standard 6030. Applicants should include the following:

1.  Successful completion of a minimum 32-hour training course conducted by an Instructor certified to ASSE 6050, and

2.  Successful completion of a written and a practical examination covering all facets of ASSE Standard 6000, NFPA 99, NFPA 55, and CGA M-1, and

3.  A minimum of two years of documented practical experience in the verification of piping systems, and

4.  A current certificate of insurance, in the name of the individual or employing verification company, for general liability, and professional liability insurance.

THE EXAMINATION FEE is One Hundred Seventy-Seven Dollars ($177.00) for the written examination and One Hundred Seventy-Seven Dollars ($177.00) for the practical examination. There will be an additional fifty-seven dollar ($57.00) processing fee for each examination for testing at a PSI Center.  Contact NITC at (877) 457-6482 to provide credit card payment information. For NITC No-Show, Reschedule, Cancellation and Refund Policy refer to the NITC Rules and Procedures.

For testing at PSI: The written examination is available computer-based at PSI centers. Exams given at PSI centers require that an email address be provided. You will receive an e-mail confirmation with your login information to schedule the exam date and time. For any examination scheduled at a PSI center, cancellation and rescheduling must be made at least 48 hours prior to the assigned date and time or a rescheduling fee will be assessed.  To locate a PSI center near you visit https://nationalitc.com/psi-locator.cfm.

All electronic devices are prohibited. No cell phones or any other types of devices that record or send data are allowed to be used during the examination.

SPECIAL REQUESTS FOR TAKING THE EXAMINATION

Information on special accommodations can be found in Section XVII of the NITC Rules and Procedures, available for download from our web site at www.nationalitc.com.

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