Welder Continuity Inquiry

UA WELDER QUALIFICATION CONTINUITY REPORT

It is the sole responsibility of the member to have this form completed by the employing contractor and returned to:

UA Local 501 Education Department

Fax (630) 978-9240

or dropped off on or before the certification expiration date.

WELDER CONTINUITY INFORMATION

Indicate the last date the process was used.

Welder's Name: ___________________________________________________

UA Card Number: _______________________________

UA Testing Local: _____________

SMAW ___ ___ / ___ ___ / ___ ___ *Manual Welding

GTAW ___ ___ / ___ ___ / ___ ___ *Manual Welding

GMAW ___ ___ / ___ ___ / ___ ___ *Includes Flux-Cored Arc Welding (FCAW)

Automatic or Machine Welding (GTAW) ___ ___ / ___ ___ / ___ ___ *Includes Orbital Welding

Torch Brazing ___ ___ / ___ ___ / ___ ___ *Non Med Gas

We certify that the statements made on this record are correct:

________________________________________________________

Contractor Name

_______________________________________________________________________

Signature of Company Representative                                                       Date Signed

________________________________________________________________________

Printed Name & Title of Company Representative                                        UA Local Union Number

For Office Use Only

_______________________________________________________________________

Signature of UA ATR                                                                        Date Signed

_______________________________________________________

Printed Name of UA ATR

(2225374858) Revision 09.2007