ASNT Level III Required Experience Form

This form is required. Print and complete the form. Save it in electronic format to be uploaded during the online application
process. List all positions in order by most recent (including present employer). You must supply documentary evidence
of Level II or equivalent experience to meet the minimum experience requirements in the method(s) for which you are
applying. The Statement Option form at the bottom of this page is acceptable as documentary evidence of work
experience.
If Statement Option below is not completed by employer/customer, you will need to submit other documentation
supporting your work experience.
Acceptable (other) documentation can include: inspection log books, inspection reports, employer or third-party
certificates or certification records, human resources records, a signed statement from the employer or responsible Level
III, a signed statement from an ASNT Level III or ACCP Professional Level III, or, for self-employed personnel, signed
statements from at least two (2) customers. All documentation must be in English or accompanied by an English
translation.
Other supporting documents MUST state: Other supporting documents that are NOT accepted:
1. Level of qualification or Level II job duties 1. Certificate of Training / Non-employer issued qualifications
2. Number of months working Level II or comparable 2. Level I certificates
of that of a Level II

Name
First, Middle, Last ASNT ID
Position # 1 Dates of Employment
Start Date End Date Total Time (Months)

Organization Name

Employer/Customer Contact Name

Organization Address

City State/Prov. ZIP/Postal Code Country

Phone Fax Email

Check experience (months performing work with Level II qualifications) by method as related to above employer.

AE # of months IR # of months LT # of months RT # of months ML # of months

Briefly describe below the NDT tasks the candidate named above performed at this location for each of the methods
checked. List the document(s) that are attached to this application as evidence of this engagement.

Statement Option for supporting verification- As the above named candidate’s employer or a
designated and responsible agent of the above named candidate’s employer or as a customer of the candidate, I
confirm that the information given above is true and correct.

Employer/Agent/Customer Signature Date

Employer/Agent/Customer Name (print) Employer Contact Number or Email Address

Title / Position ASNT ID # (if applicable)

Name
First, Middle, Last ASNT ID
Position # 2 Dates of Employment
Start Date End Date Total Time (Months)

Organization Name

Employer/Customer Contact Name

Organization Address

City State/Prov. ZIP/Postal Code Country

Phone Fax Email

Check experience (months performing work with Level II qualifications) by method as related to above employer.

AE # of months IR # of months LT # of months RT # of months ML # of months

ET # of months NR # of months PT # of months UT # of months MT # of months VT # of months

Briefly describe below the NDT tasks the candidate named above performed at this location for each of the methods
checked. List the document(s) that are attached to this application as evidence of this engagement.

Statement Option - As the above named candidate’s employer or a designated and responsible agent of the
above named candidate’s employer or as a customer of the candidate, I confirm that the information given above
is true and correct.

Employer/Agent/Customer Signature Date

Employer/Agent/Customer Name (print) Employer Contact Number or Email Address

Title / Position ASNT ID # (if applicable)

Name
First, Middle, Last ASNT ID
Position # 3 Dates of Employment
Start Date End Date Total Time (Months)

Organization Name

Employer/Customer Contact Name

Organization Address

City State/Prov. ZIP/Postal Code Country

Phone Fax Email

Check experience (months performing work with Level II qualifications) by method as related to above employer.

AE # of months IR # of months LT # of months RT # of months ML # of months

ET # of months NR # of months PT # of months UT # of months MT # of months VT # of months

Briefly describe below the NDT tasks the candidate named above performed at this location for each of the methods
checked. List the document(s) that are attached to this application as evidence of this engagement.

Statement Option - As the above named candidate’s employer or a designated and responsible agent of the
above named candidate’s employer or as a customer of the candidate, I confirm that the information given above
is true and correct.

Employer/Agent/Customer Signature Date

Employer/Agent/Customer Name (print) Employer Contact Number or Email Address

Title / Position ASNT ID # (if applicable)

Name
First, Middle, Last ASNT ID
Position # 4 Dates of Employment
Start Date End Date Total Time (Months)

Organization Name

Employer/Customer Contact Name

Organization Address

City State/Prov. ZIP/Postal Code Country

Phone Fax Email

Check experience (months performing work with Level II qualifications) by method as related to above employer.

AE # of months IR # of months LT # of months RT # of months ML # of months

ET # of months NR # of months PT # of months UT # of months MT # of months VT # of months

Briefly describe below the NDT tasks the candidate named above performed at this location for each of the methods
checked. List the document(s) that are attached to this application as evidence of this engagement.

Statement Option - As the above named candidate’s employer or a designated and responsible agent of the
above named candidate’s employer or as a customer of the candidate, I confirm that the information given above
is true and correct.

Employer/Agent/Customer Signature Date

Employer/Agent/Customer Name (print) Employer Contact Number or Email Address

Title / Position ASNT ID # (if applicable)

Name
First, Middle, Last ASNT ID
Position # 5 Dates of Employment
Start Date End Date Total Time (Months)

Organization Name

Employer/Customer Contact Name

Organization Address

City State/Prov. ZIP/Postal Code Country

Phone Fax Email

Check experience (months performing work with Level II qualifications) by method as related to above employer.

AE # of months IR # of months LT # of months RT # of months ML # of months

ET # of months NR # of months PT # of months UT # of months MT # of months VT # of months

Briefly describe below the NDT tasks the candidate named above performed at this location for each of the methods
checked. List the document(s) that are attached to this application as evidence of this engagement.

Statement Option - As the above named candidate’s employer or a designated and responsible agent of the
above named candidate’s employer or as a customer of the candidate, I confirm that the information given above
is true and correct.

Employer/Agent/Customer Signature Date

Employer/Agent/Customer Name (print) Employer Contact Number or Email Address

Title / Position ASNT ID # (if applicable)