CERTIFICATION PROGRAM

APPLICATION FOR CERTIFICATION

 

NAME: ____________________________________________________________________________________________________

 

HOME TELEPHONE (____)-______-____________                            BUSINESS TELEPHONE: (____)-_____-__________________

 

COMPANY: ________________________________________________________________________________________________

 

POSITION: _________________________________________________________________________________________________

 

COMPANY ADDRESS: _______________________________________________________________________________________

 

 

DISCIPLINE OF ROLL DESIGN CERTIFICATION BEING APPLIED FOR:

 

___________________________________________________________________________________________________________

 

IDENTIFICATION OF DOCUMENTS BEING USED FOR PROOF TO BOARD:

 

___________________________________________________________________________________________________________

 

___________________________________________________________________________________________________________

 

___________________________________________________________________________________________________________

 

___________________________________________________________________________________________________________

 

___________________________________________________________________________________________________________

 

APPLICANT'S SIGNATURE OF AUTHENTICITY __________________________________________________________________

 

                INDIVIDUAL VERIFYING ROLL DESIGNER'S WORK

 

NAME: ____________________________________________ TITLE: __________________________________________________

 

ADDRESS: _________________________________________________________________________________________________

 

COMPANY: _____________________________________________________________ PHONE: (       )_______-_______________

 

               

THE ABOVE MENTIONED WORK IS THE WORK OF THE APPLICANT AND PROVEN IN THE MILL, IN MY PRESENCE ON

 

 (DATE) __________________ AT THE LOCATION OF (MILL & WORKS)_______________________________________________

 

___________________________________________________________________________________________________________

 

                                                SIGNED ________________________

1) Enclose a check payable to: “The Institute of Roll Design” in the amount of $25.00 with each application.  Use one application for each discipline being applied for.

2) Please attach a resume for Professional Roll Designer or Master of the Art of Roll Design applications.