QRS 24Page 1 of 4 Issue O Dated 27/05/16

QRS 24Page 1 of 4 Issue O dated 27/05/16

EN4179 EXAMINATION APPLICATION FORM

Please complete this form and email to:

(0044) 01279 870 276

PART A – Candidate Details

Candidate First Names / Click or tap here to enter text. /
Candidate Surname / Click or tap here to enter text. /
Candidate Telephone Number / Click or tap here to enter text. /
Candidate Email / Click or tap here to enter text. /
Company Name
Or Self Sponsored / Click or tap here to enter text. /
Company Address / Click or tap here to enter text. /

PART B – Examination Details

NDT Method / PT
☐ / MT
☐ / ET
☐ / UT
☐ / RT
☐ / FI
☐ / BRS☐ / IRT☐ / BASIC☐ / HT
☐ / CT
☐ / AFD☐ / ETCH
☐
Other ☐Specify:Click or tap here to enter text.
Level / 1 Ltd☐ / 1☐ / 2☐ / 3☐
Type / Initial☐ / Recertification☐ / Re-sit☐ / Supplementary☐
If Re-sit specify which exam parts / General
Theory☐ / Specific
Theory☐ / Full
Practical☐ / Part
Practical☐ / Instruction☐
Date of Examination / Click or tap to enter a date. /
Location: / AIT
Takeley
☐ / *AIT
Malta
☐ / Other ☐Specify:Click or tap here to enter text.
Qualification Specification / EN4179☐ / NAS 410☐ / SNT- TC-1A☐

*AIT Malta available soon

Part C, D & E need not be completed if this form is to be submitted with QRS20

Part C – Written Practice & Responsible Level 3

AN ELECTRONIC COPY OF YOUR COMPANY WRITTEN PRACTICE / PROCEDURE FOR CERTIFICATION OF NDT PERSONNEL MUST BE SUPPLIED TO AIT PRIOR TO CONFIRMATION OF TRAINING
Our Company Written Practice will be provided at the following status: / WP Revision / Issue No:
Click or tap here to enter text. / Our company does not have a Written Practice and we need to discuss its preparation with AIT: / Click or tap here to enter text. /
Written Practice Title / Reference / Click or tap here to enter text. /
Name of Your Company
Responsible Level 3 (RL3) / Click or tap here to enter text. /
RL3 Email Address / Click or tap here to enter text.
RL3 Contact Telephone Number / Click or tap here to enter text.

Part D – Dietary Requests

Special Dietary Requirements: / Click or tap here to enter text. /

Part E – Invoice & Payment

Does your Purchase Order Number need to be quoted on the invoice? / YES ☐ / Purchase Order Number
please provide a copy to support your application: / Click or tap here to enter text. /
NO☐
How will the invoice be paid: / Credit/Debit Card☐
(We do not accept American Express) / Cash ☐
(Ensure that you have the exact money as we do not hold change) / Cheque ☐
(UK Only) / BACS☐
Company VAT Number: / Click or tap here to enter text. /
Invoice address if different from the company address: / Click or tap here to enter text. /
Accounts department email contact: / Click or tap here to enter text. /
How would you like your training/examinations documents delivered to you? Please select as desired: / ☐Free UK Postal Service
No Tracking or Signature.
AIT cannot be held responsible for any loss or damage of documentation. / ☐ AIT Courier Charged to You at Cost
Tracking Available – signature is required upon receipt, PO Box addresses must not be used. / ☐ I will Arrange Collection of all Documents

Part F –Specific Theory Examination - EN4179 3.30, 4.1.2 & 7.13

List the specifications used by your employer which shall be required in the specific theory examination.
Revision number or issue status to be included:
Aerospace Inspection Training will require electronic copies of all specifications listed. / Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text. /
Click or tap here to enter text. /
Do you require Product Technology Training & Examination, if so detail here: / Click or tap here to enter text.

Part G – Practical Examination – EN4179 3.32, 4.1.2 & 7.14

Penetrant Inspection
Select Type of Work / ☐On Aircraft Inspection / ☐Wheel & Brakes / ☐Manufacturing
Techniques Used / ☐Type 1 Method A / Water Washable / ☐Type 1 Method C / Solvent Removable / ☐Type 1 Method D / Post Emulsifiable
Types of Material / ☐Titanium / ☐Casting / ☐Aluminium
Magnetic Particle Inspection
Select Type of Work / ☐On Aircraft Inspection / ☐Wheel & Brakes / ☐Manufacturing
Techniques Used / ☐Current Flow / ☐Threader Bar / ☐Coil / ☐Yoke
Eddy Current Inspection
Select Type of Work / ☐On Aircraft Inspection / ☐Wheel & Brakes / ☐Manufacturing
Techniques Used / ☐High Frequency / ☐Low Frequency / ☐Rotary
Type of Testing / ☐Manual Handheld Scanning / ☐Automated Wheel Scan
Ultrasonic Inspection
Select Type of Work / ☐On Aircraft Inspection / ☐Wheel & Brakes / ☐Manufacturing
Techniques Used / ☐Compressional Wave / ☐Shear Wave
Types of Material / ☐Metallic / ☐Carbon Fibre Composite
Type of Testing / ☐Manual Handheld Scanning / ☐Automated Immersion / ☐Automated Dry
Radiography Inspection
Select Type of Work / ☐Aircraft
Inspection / ☐Welds / ☐Castings in Manufacturing / ☐Composites in Manufacturing
Techniques Used / ☐X-Ray Film / ☐X-Ray Digital Processing
Thermography Inspection
Type of Testing / ☐Heat Gun / ☐Heat Blanket / ☐Fridge / Freezer / ☐Pulse
Hardness Testing / Conductivity Testing / Etch Inspection & Anodic Flaw Detection
Type of Testing / Click or tap here to enter text. /
All NDT Methods
Instruction Writing must be included
EN4179 – 3.34 / Yes☐ / No☐ / Additional information / Click or tap here to enter text. /

Part H – Company Responsible Level 3 Authorisation

Responsible Level 3 Signature: / /
AIT will only accept this application form once it has been signed by your company Responsible Level 3
Date of Signature: / Click or tap to enter a date.
FOR INTERNAL USE ONLY
Acknowledgment of the above examination is now confirmed
AIT Examination
Co-ordinator Signed:
Date:
Comments / Limitations: