Accredited Training Provider Application "*" indicates required fields CONTACT INFORMATIONCOMPANY NAME*COMPANY ADDRESS* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PHONE*EMAIL WEBSITE PRIMARY CONTACT NAME*PRIMARY CONTACT CCO IDPRIMARY CONTACT TITLE*PRIMARY CONTACT PHONE*PRIMARY CONTACT EMAIL* COMPLIANCE ADMINISTRATIVE CONTACT NAMECOMPLIANCE ADMINISTRATIVE CONTACT TITLECOMPLIANCE ADMINISTRATIVE CONTACT PHONECOMPLIANCE ADMINISTRATIVE CONTACT EMAIL SECONDARY ADMINISTRATIVE CONTACT NAMESECONDARY ADMINISTRATIVE CONTACT TITLESECONDARY ADMINISTRATIVE CONTACT PHONESECONDARY ADMINISTRATIVE CONTACT EMAIL D-U-N-S® NUMBEREIN NUMBER*SUPPORTING DOCUMENTATIONCUSTOMER RESOLUTION ISSUE PROCESS*Provide evidence of a documented customer resolutions issue process. Drop files here or Select files Max. file size: 2 GB. INSTRUCTOR BIOS / RESUMES / CONFIDENTIALITY AGREEMENTS*Provide biographies/resumes and confidentiality agreements for instructors. At least one of the ATP’s personnel shall have at least 3 years of work experience directly related to the training of personnel in the load handling industry. Drop files here or Select files Max. file size: 2 GB. TESTING PERSONNEL BIOS / RESUMES / CONFIDENTIALITY AGREEMENTS*Provide biographies/resumes and confidentiality agreements for testing personnel. Drop files here or Select files Max. file size: 2 GB. SCOPE OF OFFERINGSCheck each program in which your organization provides training OR testing.Articulating Crane Operator Articulating Crane Operator - ABC Articulating Boom Loader Operator - ABL Articulating Boom Crane w/ Winch - ABW Concrete Pump Operator Concrete Pump Operator - CPO Crane Inspector Crane Inspector – Articulating - ACI Crane Inspector – Mobile - MCI Crane Inspector - Overhead - OCI Crane Inspector - Tower - TCI Dedicated Pile Driver Operator Dedicated Pile Driver Operator - DPD Digger Derrick Operator Digger Derrick Operator - DDO Drill Rig Operator Foundation Drill Rig - FDR Anchor/Micropile Drill Rig - AMP Lift Director Lift Director – Mobile Cranes – MLD Lift Director – Tower Cranes - TLD Mobile Crane Operator Lattice Boom Crane Operator – LAT Telescopic Boom Crane – Swing Cab - TLL Telescopic Boom Crane – Fixed Cab - TSS Telescopic Boom Crane – Service Truck - STC Overhead Crane Operator Overhead Crane Operator - OVR Rigger Rigger Level I - RIG1 Rigger Level II - RIG2 Telehandler Operator Fixed Telehandler Operator - THF Rotating Telehandler Operator - THR Signalperson Signalperson - SGP Tower Crane Operator Tower Crane Operator - TWR REVIEW AND CONFIRMATIONDECLARATION* I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT.SIGNATURE*DATE SIGNED* MM slash DD slash YYYY
