UA WELDER QUALIFICATION CONTINUITY REPORT
Full Name
*
First Name
Middle Name
Last Name
UA Card Number
*
UA Testing Local
*
UA Local Union Number
*
Email
*
WELDER CONTINUITY INFORMATION
Indicate the last date the process was used
SMAW
/
Month
/
Day
Year
*Manual Welding
GTAW
/
Month
/
Day
Year
*Manual Welding
GMAW
/
Month
/
Day
Year
*This includes Flux-Cored Arc Welding (FCAW)
Automatic or Machine Welding (GTAW)
/
Month
/
Day
Year
*This includes orbital welding
Torch Brazing
/
Month
/
Day
Year
*Non Med-Gas
We certify that the statements made on this record are correct:
Manufacturer/Contractor Company Name
*
Company Representatives Name
*
First Name
Last Name
Company Representatives Title
*
Signature of Company Representative
*
Date Signed
*
/
Month
/
Day
Year
Date
Name of UA ATR
First Name
Last Name
Signature of UA ATR
Date Signed
/
Month
/
Day
Year
Date
Preview PDF
Submit
Should be Empty: