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Level 2/3 Certified Installer Application Form

    Level 2/3 Certified Installer Application Form

    Certification in Air Barriers for:
    Certification:


    Types of Air Barriers / Hours of Experience

    Self-Adhered Membrane Sprayed Polyurethane Foam Fluid Membrane Boardstock

    University/College, Trade Licenses/Certificates, or Other Training Courses

    Course Institution / Organization Year Completed
    Yes No

    Employment History - Please List Two




    From: To:






    Employment From: To:

    List Jobs Over the Past 3 Years - Air Barrier Experience on Walls

    Project Name Company General Contractor Architect (If Available) Date of Project Type Installed Number of Hours of AVB Application Duties Performed

    List Jobs Over the Past 3 Years - Applicable Related Trade Experience

    Project Name Company General Contractor Architect (If Available) Date of Project Type Installed Number of Hours of Application Duties Performed

    References

    Contact Name Relationship Phone Number

    Applicant Declaration
    I certify that the information given above is true and correct, and complete in every respect, and I understand it may be subject to verification by the accreditation committee or its representative. I undertake to report to the accreditation committee as soon as possible any changes in the above information and I am aware that making false statements or failing to inform the selection committee of omissions or changes to the information on this form may affect my acceptance in the program. I agree that the information on this form may be shared with authorities providing my certification and/or training.

    I Accept

    Professional Guidelines
    Certified Professionals make all reasonable efforts to participate in required training and skills development programs as recommended by BPQI, including any refresher courses that may be required. Certified Professionals adopt, and follow in good faith, the systems, programs, methods as recommended and prescribed by industry and regulatory bodies in respect to application, inspection, and documentation required. Certified Professionals conduct any and all dealings in respect to application, inspection, and documentation within the guidelines for ethical conduct as set forth by BPQI. Certified Professionals agree that their status can be suspended when the individual is found in breach of the guidelines for professional and ethical conduct or any of the requirements of the BPQI.