NCCCO Written Exam ScheduledFeb 27, 2021  · Tower Crane Prep Wednesday, thFebruary 24 Overhead...

14
ATTENTION OPERATING ENGINEERS NCCCO Written Exam Scheduled Saturday, February 27, 2021 @ IUOE Local 181 Boston Training Site 1450 Wilson Creek Rd Boston, KY 40107 Application deadline is Friday, February 5, 2021 Prep Sessions will be held at the Boston Training Site: Friday & Saturday, February 19 th & 20 th Tower Crane Prep Wednesday, February 24 th Overhead Crane Prep Thursday, February 25 th Load Chart Review Friday, February 26 th Class size is limited Call 502-833-2358 for an Application Packet or Download from our website www.iuoelocal181.org Testing for IUOE members in good standing only

Transcript of NCCCO Written Exam ScheduledFeb 27, 2021  · Tower Crane Prep Wednesday, thFebruary 24 Overhead...

Page 1: NCCCO Written Exam ScheduledFeb 27, 2021  · Tower Crane Prep Wednesday, thFebruary 24 Overhead Crane Prep Thursday, February 25th Load Chart Review Friday, February 26th • Written

ATTENTION

OPERATING ENGINEERS

NCCCO Written Exam Scheduled

Saturday, February 27, 2021

@ IUOE Local 181 Boston Training Site

1450 Wilson Creek Rd – Boston, KY 40107

Application deadline is Friday, February 5, 2021

Prep Sessions will be held at the Boston Training Site:

Friday & Saturday, February 19th & 20th

Tower Crane Prep Wednesday, February 24th

Overhead Crane Prep Thursday, February 25th

Load Chart Review Friday, February 26th

Class size is limited

Call 502-833-2358 for an Application Packet or

Download from our website www.iuoelocal181.org

Testing for IUOE members in good standing only

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From the Office of:

From the Office of:

□ Lynnville Training Site

722 E. S.R. 68

Lynnville, IN 47619

Phone: 812-922-5541

Fax: 812-922-5018

■ Boston Training Site

P.O. Box 78

1450 Wilson Creek Rd.

Boston, KY 40107

Phone: 502-833-2358

Fax: 502-833-3224

□ Master Records and Bookkeeping Office

P.O. Box 34 ● Henderson, KY 42419-0034

Phone: 270-826-2704 ● Fax: 270-827-2014

All forms were revised September 2020. Previous revisions will not be accepted by NCCCO. If you need the new forms

please call us at 502-833-2358 or access the new forms on the Internet at Local 181’s website www.iuoelocal181.org click on

Apprenticeship & Training, see NCCCO Testing Information.

Mail Completed Applications & Requested Documents to: IUOE Local 181 JATP

PO Box 78

Boston KY 40107

• Lodging – If mileage from your home to the training site (one way) is over One Hundred (100) miles, you qualify for

a motel room. Wingfield Inn & Suites in Elizabethtown – Please submit the enclosed NCCCO Prep Session & Motel

Reservation Questionnaire with your completed Application. (To make changes to your reservation call the Boston

Training Site 502-833-2358 during Business hours 7:00 a.m. to 3:30 p.m. EST) PLEASE NOTE THAT THE TRAINING PROGRAM “REIMBURSEMENT POLICY” HAS BEEN AMENDED AS FOLLOWS:

If the member has asked for a room reservation that he/she cannot fulfill, he/she must call the motel to cancel the reservation. If the

reservation is not cancelled and the Program is billed for the “no show”, the hotel charges will be deducted from future reimbursements

due to the member.

The test is scheduled as follows:

• Application Deadline: Friday, February 5, 2021.

• Prep Classes: 7:00 a.m. – 3:30 p.m. Eastern Standard Time at the Boston Training Site

Friday and Saturday, February 19th & 20th

*Please note that the following 4 load charts only will be covered during the Prep Session: Manitowoc (for Lattice

Boom Crawler and Truck), Grove (Large Telescopic-Swing Cab), and Shuttlelift (Small Telescopic-Fixed Cab)

Tower Crane Prep Wednesday, February 24th

Overhead Crane Prep Thursday, February 25th

Load Chart Review Friday, February 26th

• Written Test: Saturday, February 27, 2021 at 8:00 a.m. EST – Site will be open at 7:00 a.m. EST

• Test Site # - KY53744

• Recertification applications must include a color photo without hat/sunglasses and a copy of your current

NCCCO certification card. The training site may have a useable photo on file, please call ahead to verify.

• Anyone interested in the Lift Director Exam needs to call the training site for more information.

• All applications must include payment by credit card only.

Per NCCCO: Candidates will be charged an additional $30 fee if: your application form is incomplete; you do not send in

full payment, you do not select a load chart option on specialty exam; or if you change load chart options after packet is sent

in; or if you decide to add a specialty after packet is sent in; or if your check or credit card charges are declined. There is a

$50 late fee for applications sent in after the application deadline and the late fee must be included with the application.

International Union of Operating Engineers, Local 181

JOINT APPRENTICESHIP AND TRAINING PROGRAM

IUOE Local 181, Indiana Construction Association, Building Division - ICA, Inc.

And Highway Contractors, Inc.

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Please return completed applications with requested documents by February 5, 2021 to:

IUOE Local 181 JATP

PO Box 78

Boston KY 40107

Applications received after the application deadline are subject to a $50 late fee which

must be included with the application

APPLICATION CHECKLIST

First Time / Retest / Adding Specialties: □ Completed and Signed Candidate Application Revised 09/20*

□ Load Charts Selected

□ Payment by Credit Card only **No Cash, Checks, or Money Orders Accepted**

□ Prep Session & Motel Reservation Questionnaire

□ Signed Hold Harmless Agreement

□ Completed Experience Form

□ Copy of current NCCCO Certification Card if adding specialties

Recertification Applicants: □ Completed and Signed Recertification Application Revised 09/20*

□ Load Charts Selected

□ Payment by Credit Card only **No Cash, Checks, or Money Orders Accepted**

□ Prep Session & Motel Reservation Questionnaire

□ Signed Hold Harmless Agreement

□ Color Photo – full face, no sunglasses, no hat The Training Site may have a useable photo on file, if not, an updated photo will be taken

when you are on site for the prep session or test and forwarded to NCCCO for you.

□ Copy of current NCCCO Certification Card

*All application forms were revised September 2020.

Previous revisions will not be accepted by NCCCO.

**Incomplete Applications will not be submitted**

□ If you are a member of another local you will need to provide a letter from your home

office stating that you are a member in good standing with your local.

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NCCCO Prep Session & Motel Reservation Questionnaire NCCCO Test: February 27, 2021

Print Name:

Please check all that apply

□ I will attend the NCCCO Prep Sessions / Written Exam

□ Friday, February 19th (Standards / Core Exam Questions)

□ Saturday, February 20th (Load Chart Instruction)

□ Tower Crane Prep Wednesday, February 24th

□ Overhead Crane Prep Thursday, February 25th

□ Load Chart Review Friday, February 26th

□ Written Exam Saturday, February 27th

□ I do not live 100 miles (one way) from the training site and do not qualify for a motel room

□ I am a member of another Local and do not qualify for a motel room

□ I live 100 miles (one way) from the training site and will need a motel room

For the 2-Day Prep Session (week before the test): Check In: _______________________ Check Out: __________________________ For Additional Instruction & Test: Check In: _______________________ Check Out: __________________________ Check In: _______________________ Check Out: __________________________

□ Special Instructions (i.e. you qualify for a motel room but plan to drive):____________________________ ___________________________________________________________

Notes: Only Local 181 members are eligible for motel rooms paid for by the training fund Reservations must be made by Training Site Personnel

All Reservations will be made at the Wingfield Inn & Suites in Elizabethtown for eligible members

All Rooms at the Wingfield Inn & Suites are non-smoking

PLEASE NOTIFY THE TRAINING SITE OF ANY CHANGES TO YOUR RESERVATIONS PLEASE NOTE THAT THE TRAINING PROGRAM “REIMBURSEMENT POLICY” HAS BEEN AMENDED AS FOLLOWS: If the member has asked for a room reservation that he/she cannot fulfill, he/she must call the motel to cancel the reservation. If the reservation is not cancelled and the Program is billed for the “no show”, the hotel charges will be deducted from future reimbursements due to the member.

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NCCCO CRANE CERTIFICATION

WAIVER AND HOLD HARMLESS AND INDEMNIFICATION AGREEMENT

The undersigned enters into this Waiver and Hold Harmless and Indemnification

Agreement based upon the following Agreement:

The undersigned person, hereby waives any right he/she may have to take any action

against the I.U.O.E. Local 181 and the Joint Apprenticeship and Training Programs of the

I.U.O.E., Local 181 as a result of the information release described below, and the undersigned

person hereby agrees to indemnify and hold harmless the I.U.O.E., Local 181 and the Joint

Apprenticeship and Training Programs of the I.U.O.E., Local 181, in Indiana and Kentucky, their

Agents, Representatives and Trustees against any and all claims or demands or causes of action

made by anyone, including the undersigned, growing out of or in any manner attributable to any

injuries or damages that may be sustained or incurred by said person or anyone on his behalf

arising from injuries incurred from any employment or activity resulting from said release of

information which may arise in the future and any expenses incurred by I.U.O.E., Local 181 and

the Joint Apprenticeship and Training Programs of the I.U.O.E., Local 181 in defending any such

action brought by any person whatsoever, whether such claim or action arises direct, by

subrogation, assignment or otherwise.

I hereby acknowledge that no promise, inducement or agreement not herein

expressed has been made to me and that this Hold Harmless Agreement contains the entire

Agreement between the parties hereto and that this Agreement is contractual and not a mere

recital.

The undersigned has read the foregoing Agreement of Indemnification and fully

understands it.

I, herein grant permission to the I.U.O.E. Joint

Apprenticeship and Training Program to release my CCO Crane Certification Test Scores and

information pertaining to my CCO Crane Certification.

Dated this day of , 2021 .

(Signature)

Operating Engineers Local 181 Apprenticeship and Training Program

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27Copyright 1996–2020 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 09/20 TEST CODE 50014 FORM 101

Candidate ApplicationWRITTEN EXAMINATION—MOBILE, TOWER, & OVERHEAD CRANE OPERATOR (PAPER/PENCIL TESTS ONLY)

WRITTEN EXAMINATION(S) FOR WHICH YOU ARE APPLYINGFILL IN the circle next to the crane type(s) for which you are applying; for Mobile Cranes, CHECK ☑ the load chart you want to use for that crane type. Also FILL IN the appropriate circle(s) below for correct fees. NOTE: If you are registering for Mobile Crane exams, you must register for the Mobile Core Exam and at least one Specialty Exam (unless you are a Retest Candidate).

If you are recertifying, please use separate Recertification Written Examination Application Form.

LOAD CHARTS

P Mobile Core Exam 652603 (Check one for each Specialty Exam)

P Lattice Boom Crawler 652620 Terex/American (LBC) 652607 Manitowoc

P Lattice Boom Truck 652609 Link-Belt (LBT) 652610 Manitowoc

P Telescopic Boom— 652612 Grove (Truck Mount) Swing Cab (TLL) 652613 Link-Belt (Rough Terrain)

652618 National (Boom Truck)

P Telescopic Boom— 652616 Manitex (Boom Truck) Fixed Cab (TSS) 652660 Shuttlelift (Carry Deck)

P Boom Truck—Fixed 652671 Manitex (Boom Truck) Cab (BTF)

P Tower Crane 654601

P Overhead Crane 653601

WRITTEN EXAMS* WRITTEN EXAM/RETEST FEES

MOBILE CRANE OPERATOR EXAMS P Core Exam ................................................................... $160 P Core Exam plus one Specialty Exam .............................. $180 P Core Exam plus two Specialty Exams ............................. $200 P Core Exam plus three Specialty Exams ........................... $220 P Core Exam plus four Specialty Exams............................. $240 P One Specialty Exam ........................................................ $75 P Two Specialty Exams ....................................................... $95 P Three Specialty Exams ................................................... $115 P Four Specialty Exams..................................................... $135

TOWER CRANE OPERATOR EXAM P Tower Crane Operator Written Exam ............................. $180

OVERHEAD CRANE OPERATOR EXAM P Overhead Crane Operator Written Exam ........................ $180

OTHER FEES P Candidate Late Fee (if applicable).................................... $50 P Incomplete Application Fee (if applicable) ........................ $30

TOTAL AMOUNT DUE . . . . . . . . . . . $

I AM REQUESTING TESTING ACCOMMODATIONS IN COMPLIANCE WITH THE AMERICAN WITH DISABILITIES ACT (ADA).(For details on NCCCO’s Testing Accommodations policy, please see www.nccco.org/accommodations.)

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

COMPANY/ORGANIZATION PHONE

FULL LEGAL NAME FIRST* Middle LAST* Suffix (Jr., Sr., III) (as shown on driver’s license)

CCO CERTIFICATION NUMBER (if previously certified) CANDIDATE ID: (if previously tested)

DATE OF BIRTH*

HOME PHONE CANDIDATE EMAIL* (PERSONAL EMAIL UNIQUE TO CANDIDATE)CELL PHONE*

COMPANY MAILING ADDRESS CITY COUNTRYSTATE ZIP

PERSONAL MAILING ADDRESS* CITY* COUNTRYSTATE* ZIP*

USA

USA

IUOE Local 181

PO Box 34 Henderson KY 42419

270-826-2704

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TEST CODE 50014 FORM 101 Copyright 1996–2020 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 09/2028

CANDIDATE APPLICATION (CONT’D)WRITTEN EXAMINATION—MOBILE, TOWER, & OVERHEAD CRANE OPERATOR

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 or 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 requirements, I must report it to NCCCO immediately.CANDIDATE SIGNATURE* DATE*

METHOD OF PAYMENT FOR CANDIDATE EXAMINATION FEES

CREDIT CARD NUMBER EXPIRATION DATE

NAME (Print as it appears on card) SIGNATURE (on card)

SECURITY CODE

(Three- or four-digit code located on the card.)

If using company credit card, provide company name: __________________________________________

Email credit card receipt to: __________________________________________________________________

Checks and money orders should be payable to: NCCCO

Please send application and payment to:

IUOE Local 181 JATPPO Box 78Boston KY 40107Email: [email protected]

Please do not staple your check or money order.

Personal check Employer check enclosed

Money Order enclosed

TEST SITE AT WHICH YOU INTEND TO TAKE THE WRITTEN EXAMINATIONTEST SITE NAME TEST SITE COORDINATOR NAME*

TEST SITE ADDRESS

TEST ADMINISTRATION NUMBER* TEST DATE*

CITY ZIPSTATE COUNTRY

rev 0820

IUOE Local 181 JATP Michael T. Embry

PO Box 78, 1450 Wilson Creek Rd

Boston KY 40107 USA

KY53744 February 27, 2021

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LOCAL 181 OPERATING ENGINEERS EXPERIENCE FORM FOR CCO TESTING 

Operators Name ___________________________________________________________________________________________________ 

Address:  _________________________________________________________________________________________________________ 

SS #: ________________________________ Date of Birth:  ____________________________________ 

A candidate must have had at least 1000 hours of documented experience in the past four years before applying for the Practical (hands on) Examination.1  For practical examination purposes, experience is defined as any crane or hoisting operating experience.  On this basis, please list below the employment dates, employing company or organization and specific job responsibilities applicable to the experience gained in crane operation. 

NOTE:  Photocopy this page to document additional positions held.  Please make sure you enclose the Experience form with your completed application.  DO NOT STAPLE form to your application. 

I. Company/Organization:  ____________________________________________________________________________________________ 

  Address:  _________________________________________________________________________________________________ 

  Job Title:  ________________________________________Dates:  From_______________________ To _____________________ 

  Supervisor:  __________________________________ Title: _______________________ Phone: (      ) ______________________ 

  Describe your specific job responsibilities and experience: 

  ________________________________________________________________________________________________________ 

  ________________________________________________________________________________________________________ 

  ________________________________________________________________________________________________________ 

  Approximate number of hours of crane operation:  __________________ 

II.Company/Organization: ____________________________________________________________________________________________ 

  Address:  _________________________________________________________________________________________________ 

  Job Title:  ________________________________________Dates:  From_______________________ To _____________________ 

  Supervisor:  __________________________________ Title: _______________________ Phone: (      ) ______________________ 

  Describe your specific job responsibilities and experience: 

  ________________________________________________________________________________________________________ 

  ________________________________________________________________________________________________________ 

  ________________________________________________________________________________________________________ 

  Approximate number of hours of crane operation:  __________________ 

The attestation statement below must be signed by the candidate.  

I hereby attest that the information provided above is accurate, complete and truthful, and that I have accomplished the required experience in crane operation.  I understand that it is the policy of IUOE to conduct random audits of applications and that falsification of any information in the application may result in denial to take the certification examination and and/or revocation of certification. 

Signature:  __________________________________________________  Date:  ______________________________________ 

 

                                                            1 Individuals whose crane operating experience did not occur within the past four years, and who have more than 1000 hours of experience may petition the Local 181 Certification Committee to sit for the examination.  Call 812‐922‐5541 or 502‐833‐2358.   

Page 9: NCCCO Written Exam ScheduledFeb 27, 2021  · Tower Crane Prep Wednesday, thFebruary 24 Overhead Crane Prep Thursday, February 25th Load Chart Review Friday, February 26th • Written

33Copyright 1996–2020 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 09/20 TEST CODE 50014 FORM 101

Recertification ApplicationWRITTEN EXAMINATION—MOBILE, TOWER, & OVERHEAD CRANE OPERATOR (PAPER/PENCIL TESTS ONLY)

WRITTEN EXAMINATIONS FOR WHICH YOU ARE APPLYINGThis application is for recertification only. You may ONLY recertify for the designation(s) in which you are currently certified. FILL IN the circle next to the crane type(s) for which you are applying for recertification. If you would like to take Additional Examinations for cranes that you are not currently certified on, then FILL IN the examinations of your choice and CHECK the load chart you want to use for that crane type.

EXAMINATIONS*

RECERTIFICATION EXAMS LOAD CHARTS P Core Exam 652605 (Check one for each Specialty Exam)

P Lattice Boom Crawler 652625 Terex/American (LBC) 652608 Manitowoc

P Lattice Boom Truck 652611 Link-Belt (LBT) 652635 Manitowoc

P Telescopic Boom— 652614 Grove (Truck Mount) Swing Cab (TLL) 652645 Link-Belt (Rough Terrain)

652646 National (Boom Truck)

P Telescopic Boom— 652656 Manitex (Boom Truck) Fixed Cab (TSS) 652665 Shuttlelift (Carry Deck)

P Tower Crane 654602

P Overhead Crane 653602

RECERTIFICATION EXAM FEES/RETEST FEES

ADDITIONAL EXAMINATIONS LOAD CHARTS(Check one for each Specialty Exam)

P Lattice Boom Crawler 652620 Terex/American (LBC) 652607 Manitowoc

P Lattice Boom Truck 652609 Link-Belt (LBT) 652610 Manitowoc

P Telescopic Boom— 652612 Grove (Truck Mount) Swing Cab (TLL) 652613 Link-Belt (Rough Terrain)

652618 National (Boom Truck)

P Telescopic Boom— 652616 Manitex (Boom Truck) Fixed Cab (TSS) 652660 Shuttlelift (Carry Deck)

P Boom Truck—Fixed 652671 Manitex (Boom Truck) Cab (BTF)

P Tower Crane 654601

P Overhead Crane 653601

I AM REQUESTING TESTING ACCOMMODATIONS IN COMPLIANCE WITH THE AMERICAN WITH DISABILITIES ACT (ADA).(For details on NCCCO’s Testing Accommodations policy, please see www.nccco.org/accommodations.)

COMPANY/ORGANIZATION PHONE

FULL LEGAL NAME FIRST* Middle LAST* Suffix (Jr., Sr., III) (as shown on driver’s license)

CCO CERTIFICATION NUMBER* CANDIDATE ID: (if previously tested)

DATE OF BIRTH*

HOME PHONE CANDIDATE EMAIL* (PERSONAL EMAIL UNIQUE TO CANDIDATE)CELL PHONE*

COMPANY MAILING ADDRESS CITY COUNTRYSTATE ZIP

PERSONAL MAILING ADDRESS* CITY* COUNTRYSTATE* ZIP*

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

MOBILE CRANE OPERATOR EXAMS P Core Exam ................................................................... $160 P Core Exam plus one Specialty Exam .............................. $180 P Core Exam plus two Specialty Exams ............................. $200 P Core Exam plus three Specialty Exams ........................... $220 P Core Exam plus four Specialty Exams............................. $240 P One Specialty Exam ........................................................ $75 P Two Specialty Exams ....................................................... $95 P Three Specialty Exams ................................................... $115 P Four Specialty Exams..................................................... $135

TOWER CRANE OPERATOR EXAM P Tower Crane Operator Written Exam ............................. $180

OVERHEAD CRANE OPERATOR EXAM P Overhead Crane Operator Written Exam ........................ $180

OTHER FEES P Candidate Late Fee (if applicable).................................... $50 P Incomplete Application Fee (if applicable) ........................ $30

TOTAL AMOUNT DUE . . . . . . . . . . . $

USA

IUOE Local 181 270-826-2704

PO Box 34 Henderson KY 42419 USA

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TEST CODE 50014 FORM 101 Copyright 1996–2020 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 09/2034

CANDIDATE RECERTIFICATION APPLICATION (CONT’D)WRITTEN EXAMINATION—MOBILE, TOWER, & OVERHEAD CRANE OPERATOR

rev 0820

TEST SITE NAME TEST SITE COORDINATOR NAME*

TEST SITE ADDRESS

TEST ADMINISTRATION NUMBER* TEST DATE*

CREDIT CARD NUMBER EXPIRATION DATE

NAME (Print as it appears on card) SIGNATURE (on card)

Personal check

SECURITY CODE(Three- or four-digit

code located on the card.)

CITY ZIPSTATE COUNTRY

If using company credit card, provide company name: __________________________________________

Email credit card receipt to: __________________________________________________________________

Please send application and payment to:

IUOE Local 181 JATPPO Box 78Boston KY 40107Email: [email protected]

TEST SITE AT WHICH YOU INTEND TO TAKE THE WRITTEN EXAMINATION

METHOD OF PAYMENT FOR CANDIDATE EXAMINATION FEES

CANDIDATE SIGNATURE* DATE*

Do you have 1,000 hours of documented crane-related experience during your current certification period?*

Yes, and I understand that NCCCO may, at any time, request documentation to be provided in order to verify my experience,and if such documentation is not provided my certification may be impacted.

No, and I understand I must take and pass the practical exam(s) prior to my expiration date.

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 or 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 requirements, I must report it to NCCCO immediately.

IUOE Local 181 JATP Michael T. Embry

PO Box 78, 1450 Wilson Creek Rd

Boston KY 40107 USA

KY53744 February 27, 2021

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53Copyright 1996–2020 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 09/20 TEST CODE 50014 FORM 101

Change of Address Form

Please use this form to advise of any changes of address. Please mail, fax, or email this completed form to:

NCCCO—Customer Service Department 2750 Prosperity Ave., Suite 505 Fairfax, VA 22031-4312

Phone: 703-560-2391 ext. 801Email: [email protected]

Please type or print neatly. All fields marked with an asterisk (*) must be completed.

OLD ADDRESS

COMPANY / ORGANIZATION

COMPANY MAILING ADDRESS

EFFECTIVE DATE OF CHANGE

COMPANY PHONE

NEW ADDRESS

COMPANY / ORGANIZATION

COMPANY MAILING ADDRESS

COMPANY PHONE

CCO CERTIFICATION NUMBER CANDIDATE ID DATE OF BIRTH*

FULL LEGAL NAME FIRST* Middle LAST* Suffix (Jr., Sr., III) (as shown on driver’s license)

CITY ZIPSTATE COUNTRY

CITY ZIPSTATE COUNTRY

PERSONAL MAILING ADDRESS*

CITY* ZIP*STATE* COUNTRY

HOME PHONE CANDIDATE EMAIL* (PERSONAL EMAIL UNIQUE TO CANDIDATE)CELL PHONE*

PERSONAL MAILING ADDRESS*

CITY* ZIP*STATE* COUNTRY

HOME PHONE CANDIDATE EMAIL* (PERSONAL EMAIL UNIQUE TO CANDIDATE)CELL PHONE*

USA

USA

USA

USA

IUOE Local 181 270-826-2704

PO Box 34

Henderson KY 42419

IUOE Local 181 270-826-2704

PO Box 34

Henderson KY 42419

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From the Office of:

From the Office of:

□ Lynnville Training Site

722 E. S.R. 68

Lynnville, IN 47619

Phone: 812-922-5541

Fax: 812-922-5018

■ Boston Training Site

P.O. Box 78

1450 Wilson Creek Rd.

Boston, KY 40107

Phone: 502-833-2358

Fax: 502-833-3224

□ Master Records and Bookkeeping Office

P.O. Box 34 ● Henderson, KY 42419-0034

Phone: 270-826-2704 ● Fax: 270-827-2014

Notice to NCCCO Candidate Reimbursement Procedure

Dear Local 181 Member:

Please be advised that the JATC Board revised the NCCCO Reimbursement Policy May 23, 2011 as follows:

Reimbursement will be processed when the training site has received notification that a passing grade has been

awarded for both the written and practical exams and the member has provided a copy of their NCCCO

certification card to the training site.

Please mail a copy of the front side of your NCCCO Certification Card when received to:

IUOE Local 181 JATP

PO Box 78

Boston KY 40107

Or take a photo/scan and e-mail a copy to:

[email protected]

(Note: send photos full size – reduced/thumbnail sized photos cannot be processed.)

Please include a copy of your test scores. Fax copies will not be accepted. All dates and numbers must be legible

for reimbursement to be processed. You must be a member in good standing to receive reimbursement.

Please note, the additional fee charged by the third-party test administrator, PSI, for computer-based testing is not

reimbursable. All NCCCO Reimbursements are processed by the Boston Training Site.

Please call the Boston training site at 502-833-2358 if you have any questions.

Thank you in advance,

IUOE Local 181 JATP

Boston Training Site

Rev. 08/20

International Union of Operating Engineers, Local 181

JOINT APPRENTICESHIP AND TRAINING PROGRAM IUOE Local 181, Indiana Construction Association, Building Division - ICA, Inc.

And Highway Contractors, Inc.

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Directions to IUOE Local 181 Boston Training Site for Members not eligible for motel accommodations:

Physical Address: 1450 Wilson Creek Rd, Boston KY 40107 Phone: 502-833-2358

Office Hours: Monday through Friday, 7:00 a.m. to 3:30 p.m. EST

From Southern Indiana / Louisville Area: Take I-65 South toward NASHVILLE. Take the KY-61 exit –

EXIT 105- toward BOSTON / LEBANON JCT. Take the ramp toward BOSTON. Turn LEFT onto KY-61.

Turn LEFT onto US-62 (at caution light, stop sign, road T’s). Follow US-62 ½ mile, turn LEFT onto KY-733

(If you pass the Dollar General, you went too far). Go 1 ½ miles, Training Site will be on your right.

From Western KY / Paducah Area: Take Western KY Parkway to I-65 North. Take the KY-61 exit – EXIT

105- toward BOSTON / LEBANON JCT. Take the ramp toward BOSTON. Turn LEFT onto KY-61. Turn

LEFT onto US-62 (at caution light, stop sign, road T’s). Follow US-62 ½ mile, turn LEFT onto KY-733 (If

you pass the Dollar General, you went too far). Go 1 ½ miles, Training Site will be on your right.

From Eastern KY /Ashland Area – through Lexington: Merge onto I-64 W. Take the US-27 / US-68 exit,

EXIT 113, toward Paris / Lexington. Turn right onto N Broadway / US-27 S / US-68 W. Turn right onto W

New Circle Rd / US-25-BYP N / US-60-BYP W / US-421-BYP N / KY-4 W. Merge onto US-60 W via EXIT

5B toward Martha Layne Collins Bluegrass Parkway. Take the Martha Layne Collins Bluegrass Parkway W

ramp toward LAWRENCEBURG / ELIZABETHTOWN. Take the KY-52 exit – EXIT 10- toward NEW

HAVEN / BOSTON. Turn RIGHT onto KY-52. Go approx. 2 miles and Turn RIGHT onto US-62. (Go

through Boston; pass the Boston Food Mart and 61/62 intersection at the caution light). Turn LEFT onto KY-

733 (first road on the left after the caution light). (If you pass the Dollar General, you went too far). Go 1 ½

miles, Training Site will be on your right.

From South Eastern KY Area – through Danville/Bardstown: US-150-BYP W & US-150 Byp W become

US-150 W. Stay straight to go onto US-150-BYP N / S Danville Byp. Turn left onto US-150 / KY-52 /

Perryville Rd go ~ 24 miles. Turn left onto KY-555 go ~ 1.5 miles. Turn right onto Bardstown Rd / US-150

go ~ 16.5 miles. Enter roundabout and take the 2nd exit onto W Stephen Foster Ave / US-62. Go approx. 12

miles; turn RIGHT onto KY-733 (first road on the right past the Dollar General). Go approximately 1½ miles

and training site will be on your right.

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Wingfield Inn and Suites

1043 Executive Drive, Elizabethtown KY 42701

(270) 769-3030

From Indiana through Louisville From Paducah Area / Western KY Area

Take I-65 South to the Elizabethtown exit #94; turn Take Western KY Parkway to I-65 North.

right at end of ramp. Turn left onto Executive Dr Take the Elizabethtown exit #94, turn left at

and motel will be on the left in between the end of ramp. Turn left onto Executive Dr

Cracker Barrel and Ruby Tuesday. and motel will be on the left in between

Cracker Barrel and Ruby Tuesday.

From Ashland / Eastern KY Area From Wingfield Inn to Boston Training Site

In Lexington take the Martha Layne Collins Turn right out of Executive Dr onto US-62.

Bluegrass Parkway W to I-65 North. Take the Travel 11 miles, turn left onto Wilson Creek Rd

Elizabethtown exit #94, turn left at the end of (KY-733). (If you pass the Dollar General, you

ramp. Turn left onto Executive Dr and motel went too far), go 1½ miles and training site will be

will be on the left in between Cracker Barrel on your right.

and Ruby Tuesday.