QFO Operator Certification Application Form

Name: Address:

Email: Home Telephone Work Telephone: Fax:

Order Number (for credit card payment):

The test for QFO certification consists of two parts. To achieve certification, applicants must pass Part 1, General Knowledge and at least one of the Part 2 specific operator Class Designations. An individual who is already QFO certified need not retake Part 1 General Knowledge when applying for additional Class certification(s). Are you currently certified under QFO? No I Yes, my QFO Certificate Number is:

1. Selection of Class Designation

Indicate the Class Designation(s) for which you are applying (no more than two per application): Class A - pulverized fuel fired plants and cyclone furnaces Class B - single burner oil, gas or combination fired plants Class C - multiple burner oil, gas or combination fired plants Class D - stoker fired fossil plants Class E - fluidized bed fossil plants Class F - auxiliary fired heat recovery steam generators (HRSG)

2. Education
Complete this section as applicable. All information is subject to future verification. 2.1 High School Diploma High School: Location: 2.2 High School Equivalency Diploma Issued by: 2.3 Baccalaureate Degree in physical sciences or engineering, or Associate Degree in technical studies: Yes Name Location: Degree earned 2.4 As an alternative to (2.3), describe 60 credits of coursework taken at an accredited institution relative to : (1) advanced mathematics, (2) chemistry, (3) fluid dynamics, (4) thermodynamics, (5) materials science, (6) combustion theory, (7) environmental, mechanical, civil, chemical, or electrical engineering. A summary, including the name of the accredited institution must be provided below or attached to this form. No Year Graduated: Yes No Year Issued: Yes No Year Graduated:

C5-1 (07/13) Expires on 6/30/14

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3. Experience
Describe at least two years of experience in general industry or industrial process, which shall include boiler operations. If you have an Associates Degree, Baccalaureate degree or 60 credits of relevant coursework you need only one year of this experience. All applicants are required to have boiler operations experience in the Class designation for which they are applying. You may photocopy this page to document additional experience if necessary. A separate page should be provided for each Class designation for which you are applying. Place of Employment: Location: Dates of employment: Position/Title: Supervisor: Description of duties/experience: From: To:

While employed at this location, I achieved experience in the following Class (Check only one per page.): Class A - pulverized fuel fired plants and cyclone furnaces Class B - single burner oil, gas or combination fired plants Class C - multiple burner oil, gas or combination fired plants Class D - stoker fired fossil plants Class E - fluidized bed fossil plants Class F - auxiliary fired heat recovery steam generators (HRSG) Provide a brief history of applicable training for the applied Class designation:

Affirmation: The applicant affirms that he/she meets all of the relevant requirements and qualifications in the ASME QFO-1 Standard for the Qualification and Certification of Operators of High Capacity Fossil Fuel Fired Plants. The undersigned declares that all representations contained in this application are true.

Applicants Signature

Date

C5-1 (03/13) Expires on 6/30/14

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Fees for QFO Operator New Applicant: A new applicant fee of $638 must accompany the completed application. If the candidate is applying for two classes, the application fee would be $666. A portion of this fee ($58) is a nonrefundable application fee. If a candidate withdraws prior to executing an exam, the unused funds can be refunded. Methods of payment and submittal: Credit Card: Complete the application and click here to make an online payment: (product catalog link). After your payment is approved, you will be issued an order number. Please enter your order number on page one where indicated. Save you completed application and submit it to ASME via email, fax or mail. Order number: ______________

email: certification@asme.org fax: 1-212-591-8502 Check or money order: Complete the application, print, attach check or money order and mail to: Mail: ASME Personnel Certification Processing Department 22 Law Drive Box 2900 Fairfield, NJ 07007-2900

C 1.6 QFO New (07/13) Expires on 6/30/14