OFFICIAL APPLICATION FOR SOURCE EVALUATION TESTING FIRMS SOURCE EMISSIONS TESTER QUALIFICATION EXAMINATION ( Download PDF file )

Please send application to
The Secretariat, AQMS
EMB-DENR Compound
Visayas, Avenue,Diliman, Quezon City

 

The information in this application will be treated as confidential by the Source Tester Examination Committee. Please type or print information except where signature is required. Complete each section as completely as possible to ensure that the Board has adequate information to consider your certification. Include additional pages where necessary. Be sure to have the application notarized before submission.

Last Name: ____________________ First Name_______________ Middle Initial _____
Photo Identification Number: _______________________________________________
Type of ID: __________________________
Title:________________________________
Firm/Company Name:_____________________________________________________
Business Address:



 

City
Phone: _____________________ E-mail Address:_______________________________
Fax Number: _____________________________
Home Address

 



City                                                                                                                                                                        Zip Code
Phone: _________________ E-Mail Address: __________________________________

This is my initial application for the required test:________ QA/QC Manager
                                                                                 ________ Team Leader

Educational Background :
High School _____________________________________________________________
City: _________________________________________ Year of Graduation: _________
College/University :______________________________ Year of Graduation: ________
Postgraduate: ___________________________________ Year of Graduation: ________
If you have more than one institution and/or degree, please list the institution, degree, field of degree, year of graduation on a separate sheet.

List any relevant Professional Development Courses taken ( course name, provider, location, date, contact info ):

 

 

 

List any relevant Safety Training ( course name, provider, location, date, contact info):

 

 

 

List any Professional Designations ( Professional Engineer, Qualified Environmental Professional , etc.):

 

 

 

Experience in Source Emission Testing ( required ):
Employer:________________________________________ Number of Years: ________
Type of Experience: _______________________________________________________
Employer: _______________________________________ Number of Years: ________
Type of Experience: _______________________________________________________
Employer: _______________________________________ Number of Years : ________
Employer: _______________________________________ Number of Years: ________
Type of Experience: _______________________________________________________

 

 

One year experience and/or ten sources sampled is required for Source Tester Qualification.
Experiences; ( check all that apply ):

       ( ) Test Methods                                            ( ) Trouble shooting
       ( ) Calibration/preparation/packing             ( ) Equipment
       ( ) Set-up at test site                                     ( ) Operation/Data Recording
       ( ) Sample analysis                                       ( ) Sample recovery/handling custody
       ( ) Procedure compliance                            ( ) Quality Assurance/Quality Control
       ( ) Data Reduction ( Calculations, data     ( ) Reporting
       validation, and interpretation )                   ( ) Safety training

Approved by Examination Committee: Yes ( ) No ( )


 

Approved for Test by: _____________________________________________________
: ____________________________________________________
Payment received: _____________________________________________________

 

Date: ________________

 


Demonstrated Skills

Use two separate project sheets to provide a clear and concise explanation of your involvement in representative projects from each year of experience. Provide one sheet ( maximum three pages) for each of the last year of experience claimed. Please demonstrate experience in the areas checked above;
The Source Examination Committee expects all Source Emission Testers Qualification Examination applicants to possess the following skills: critical thinking; verbal and written communication skills; technical/science skills; selection and knowledge of test methods and their application and limitations; selection, calibration, setup, use and operation of testing equipment for different applications and conditions; source types and characteristic sampling conditions and challenges; sample analysis and special considerations for different applications; test method modifications and deviations needed for different applications; data quality metrics and implications.
In completing the paperwork for the application, please make every effort to show your command of as many of these skills as possible.

 

 

 

 

I hereby certify that the information contained in this application and on supporting documents attached to this application is correct to the best of my knowledge. I agree to indemnify and hold harmless the Source Emission Tester Committee and all others affiliated with the Source Tester Examination Programs.
Applicant’s Signature in Full: _________________________________ Date: _________
Notary Public: _____________________________________________ Date: _________
Notary Seal/Stamp: