CANDIDATE APPLICATION (NEW & RECERT)

WRITTEN & PRACTICAL EXAMS OR QUALIFIED RIGGER & SIGNALPERSON APPLICATION, MOBILE CRANE,
SERVICE TRUCK & ARTICULATING CRANE OPERATOR

 

    Please type or print neatly. All fields marked with an asterisk (*) must be completed or the application will be considered incomplete.

    Which training are you applying for:

    Enter the class start date you are applying for:


    (as shown on driver’s license)





















    EXAMINATION(S) FOR WHICH YOU ARE APPLYING

    WRITTEN & PRACTICAL EXAMS*

    WRITTEN & PRACTICAL EXAM/RETEST FEES

    MOBILE CRANE OPERATOR EXAMS

    120
    180
    240
    300
    360
    60
    120
    180
    240

    PRACTICAL EXAM

    60


    SERVICE TRUCK CRANE OPERATOR EXAM

    180

    ARTICULATING CRANE OPERATOR EXAM

    180

    OTHER FEES

    50
    30

    QUALIFIED RIGGER & SIGNALPERSON FEES

    ARE YOU TAKING THE QRS CLASS?

    250
    250
    MEETS OSHA REQUIREMENTS FOR QUALIFIED RIGGER OR SIGNALPERSON

    ARE YOU A RECERT CANDIDATE?*

    Do you have 1,000 hours of documented crane-related experience during your current certification period?* PLEASE CHECK BOX
    I declare that the foregoing statements and those in any required accompanying documentation are true. I understand and agree that my failure to provide accurate and complete information or abide by NCCCO’s policies and procedures, including the Code of Ethics, shall constitute grounds for the rejection of my application, or denial or revocation of my certification, or other sanctions. I understand that NCCCO reserves the right to verify any information in this application or in connection with my certification. I expressly consent to NCCCO's release of any information consistent with NCCCO's Information Release policy, and I expressly consent to NCCCO’s Privacy Policy as set forth on the NCCCO website. I have read the NCCCO Candidate Handbook and agree to be bound by all NCCCO policies and procedures—including NCCCO’s substance abuse policy—as they may be amended from time to time, including without limitation those posted at nccco.org. I agree to cooperate with any NCCCO investigations and further agree that any legal proceeding arising out of ot in any way relating to my NCCCO certification(s) shall be commenced in the state of Virginia and irrevocably submit to, and waive any objections to, such exclusive jurisdiction and venue. I understand that if at any point during my certification period I fail to meet any of the requirements outlined above, or if matters arise that can affect my capability to continue to fulfill certification requiments, I must report it to NCCCO immediately. rev 0122