PFSE Premier Functional Safety Engineering Safety Instrumented Systems Training Course-TÜV FSEng Certification

Transcription

1 TÜV Eligibility Form ER04 (This form is computer writable) Training Eligibility Requirements For TÜV Functional Safety Engineer TÜV FSEng Please type or write clearly in block letters. Send completed form ER04 with all attached documents to: (scanned and attached to an is preferred method) Invensys- Attn: Mr. Robin McCrea-Steele Phone: Fax: Applicant Name: Company: Date: Note: This form is only required after the participant passes the exam. We normally attach this form to the sent to each student with the result of the exam. The form then should be completed (form is writable), signed and sent to Irvine, California, together with copies of the university diploma, certificate or company letter, as approriate. This package is best sent by scanning and attaching to an to Premier headquarters in California. Fax or mail is also acceptable. Alternatively, the student may fill out ahead of time and give to the instructor during the course. 1

2 Training Course (According to TÜV Functional Safety Program) A minimum of 3 to 5 yrs experience in the field of functional safety AND University degree or equivalent engineer level responsibilities status as certified by employer letter. Name: 1- Functional Safety relevant experience 2

3 Functional Safety relevant experience (continued) Applicant Name: Signature: Total Number of years of relevant Functional Safety experience: (minimum 3 years). Note: I certify that the above information is correct and accurate to the best of my knowledge. I understand that inaccurate information could void my TÜV certification any time in the future. 3

4 2- University degree (minimum Bachelor s) in relevant field or equivalent engineer level responsibilities status as certified by employer letter. Name: University or College Technical field (major) Degree earned Date Certificate or Diploma Name: City: Copy attached (check box) Country: or Company Technical field Title / Responsibility Date Name: City: Country: Company Certification Signed letter attached * (check box) * Letter shall be on Company letterhead and signed by a manager level official. Applicant Name: Compliance to TÜV eligibility requirements. Signature: Note: I certify that the above information is correct and accurate to the best of my knowledge. I understand that inaccurate information could void my TÜV certification any time in the future. 4

5 Information for TÜV Certificate (How you would like your name to be shown on your TÜV Certificate) Please type or write in block letters Full name: (as you would like it to appear on the TÜV Certificate) Mailing Address: (Indicate if Company address) address: Phone: Fax: Comments:... 5