ML20214S800
| ML20214S800 | |
| Person / Time | |
|---|---|
| Site: | Salem, Hope Creek, 05000000 |
| Issue date: | 06/04/1987 |
| From: | Collins S NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | Corbin McNeil Public Service Enterprise Group |
| References | |
| NUDOCS 8706090427 | |
| Download: ML20214S800 (17) | |
Text
_
o 4
0 JUN 4 HE7 Docket Nos.
50-272 50-354 50-311 Public Service Electric and Gas Company ATTN: Mr. Corbin A. McNeill, Jr.
Vice President - Nuclear P. O. Box 236 Hancocks Bridge, New Jersey 08038 Gentlemen:
Enclosed is a copy of the revised NRC Form-398 (Enclosure 1), Personal Qualif-ications Statement - Licensee. This revision was made to reflect the changes to 10 CFR Part 55 effective May 26, 1987.
This revised form requires new applicants to complete each category completely including all education, training and experience received up to the date of the application.
Renewal, upgrade, multi-unit and reapplication applicants are required to complete each category except they need only to indicate the educa-tion, training and experience received since their last application.
If any applicant indicates that he or she is a graduate of an INPO accredited operator training program AND that an approved simulation facility, f.e.,
(certified on NRC Form 474 or NRC approved), is used in the operator training program, then education, training and experience DOES NOT have to be completed.
New applications must include the number of significant control manipulations under Item 12.3.
Other changes are detailed in Enclosure 2. is a set of instruc-tions for the completion of all items on the NRC Form 398.
All applications for licenses are to be submitted on this revised form begin-ning May 26, 1987.
The enclosed applications are for your use. Additional copies can be obtained by writing to Vivian Miller, U.
S.
Nuclear Regulatory Commission, Document Management Branch, Mail Stop W-548, Washington, D.C. 20555.
8706090427 870604
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PDR Y
ADOCK 05000272 PDR
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0FFICIAL RECORD COPY OL MULTI LTR - 0037.0.0 l
05/29/87
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'Public Service Electric and Gas Company 2
If you have any questions regarding this form, please contact Robert M. Keller aL 215-337-5211.
Sincerely, Original signed BY.8 i
Samuel J. Collins, Deputy Director 4
Division of Reactor Projects
Enclosures:
As stated e
cc w/ enclosures:.'.
D. Hanson,-' Train'ing. Manager, Hope Creek 4
.4'
, J. Lloyd, ; Training Supervisor,'iSalem
~'
Public Do' cum.ent, Room-(PDR) s Local Public Document Room (LPDR).
Nuclear Safety Info'nnation Center (NSIC)-
NRC Resi' dent Inspector;
.cc w/o enclosures:
.c Thomas S. Shaw, Jrf, Vice President PProduction, Delmarva Power (Salem)
J. M. Zupko,*Jr.,, General-Manager -iSalem Operations
,. B. A.'Preston, Manager, Licensing and Regulation, Salem General Manager' Nuclear Safety Review, Salem M. J. Wetterhahn, Esquire (Salem)
~
R. Fryling, Jr., Esquire (Salem)
S._ LaBruna, General Manager, Hope Creek Operations W. H. Hirst, Manager, Joint. Generation Projects Department, Atlantic Electric (Hope Creek)
L. A. Reiter, General Manager - Licensing and Reliability, Hope Creek Rebecca A. Green, Bureau of Radiation Protection (Hope Creek)
S. E. Miltenberger, Vice President - Nuclear Operations State of New Jersey (w/ enclosures)
A.- K. Thompson, General Manager - Nuclear Services, Salem
- bec w/ enclosures:
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OL Plant File Salem
,0L Plant File Hope Creek' Examiners RI:
RI F' -
P lan mjd/gcb K
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87 6/t 87 6/3/87 0FFICIAL RECORD COPY OL MULTI LTR - 0003.1.0 5/28/87 J
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INSTRUCTIONS FOR COMPLETING NRC FORM 338. PERSON AL QU ALIFICATIONS STATEMENT-LICENSEE s
NEW APPUCANTS: COMMETE EACH CATEGORY OF THE FORM COMPLETELY. FOLLOWING THE INSTRUCTIONS BELO ALL EDUCATION TRAINING AND EXPERfENCE THAT YOU HAVE RECElVED UP TO THE DATE OF THIS APPUCATION. NOT RENEWAL. UPGRADEO. MULTI. UNIT. AND REAPPUCATION APPUCANTS. COMPLETE EACH CATEGORY OF FORM COMP INDICATE ONLY THE EDUCATION. TRAINING, ANO EXPERIENCE YOU HAVE RECEIVED SINCE YOUR LAST APPUCATION. NOTE: See item 14.
SPECIFIC INSTRUCTIONS FOR ITEMS 1119:
INOiCATE BOTH ACADEMIC ANO VOCATIONAL / TECHNICAL POST HIGH SCHOOL EGUCAT10N FOR MAJOR AREAIS) 11-E DUCATION:
INDICATE THE NUMBER OF YEARS 58 ENT IN EACH COLLEGE CURRICULUM AND THE HIGHEST DEGREE RECEIVED. USIN PROvtOEO. FOR VOCATIONAUTECHNICAL EDUCATION. INCLUDE PROGRAMS SUCH AS NUCLEAR POWER SCHOOL. MI CONDITIONING / REFRIGERATION. DIESEL MECHANIC SCHOOL. ETC. INDICATE THE NUMBER OF MONTHS IN EACH PRO A CERTIFICATE OR DEGREE WAS AWARDED. IF ADDITIONAL SPACE IS NEECEO. CONTINUE UNDER ITEM 17 12-TRAINING. IN THIS ITEM INDICATE THE TRAINING YOU HAVE RECEIVED TO MEET THE REOUIREMENTS OF ANSI N18.1/
8REA A DOWN OF TRAINING IN THtS CATEGORY PAR ALLELS THE ANS STANDAROS: PLEASE REFER TO THE STANDARO CLARMATICN. INCLUDE SOTH 8EGJNNtNG ANO COMPLETION DATES AND THE TOTAL NUMEER OF WEEKS SPENT IN EACH ING. NUMBER OF WEEKS IS PROVIDED. IN ADDITION TO BEGINNING AND COMPLET40N DATES. TO ACCOUNT FOR INTERM (FOR EXAMPLE. FOUR WEEKS OF CLASSROOM TRAINING SPREAD OVER A TWO MONTH PERIOO). THEREFORE. THE DATE CO DiCATE A LARGER TIME SPAN THAN THE ACTUAL NUMBER OF WEEKS SPENT IN FULL TIME TR AINING. TIME IN TRAINING APPUED FOR CANNOT BE DOUBLE COUNTED UNDER EXPERIENCE. ITEM 13.
ALL REOUALIFICATION TRAINING TIME IS TO BE ACCOUNTED FOR IN THE REQUAUFICATION ITEM. PLEASE AVOl0 " DOUBLE US ING ALL THE TIME SPENT IN REOUAUFICATION TR AINING UNDER ITEM 12.6. REOUAUFICATION. EVEN THOUGH IT MAY INCLUDE CLA OR SIMULATOR TIME.
13-EXPERIENCE: FOR EACH POSITION HELO. COMPLETE ITEM 16. DO NOT COUBLE COUNT TIME. IF YOU HAD OVERLAPPING DUTIE MONTHS SHOULD REFLECT THE PROPORTION ATE AMOUNT OF TIME YOU WERE ASSIGNED TO THOSE PARTICULAR OUTIES. IN THE NUMBER OF MONTHS REPORTED FOR A PARTICULAR TIME PERIOD EXCEED THE NUMBER OF MONTHS THAT ARE IN THAT TIM 14 FACIUTY OPERATOR TRAINING PROGRAM. INOLCATE
- a. GRADUATE OF INPO ACCREDITED OPERATOR TRAINING PROGRAM: AND b.CER-tTIFIED ION NRC FORM 4741 OR NRC APPROVED SIMULATION FACluTY 15 USED IN THE OPERATOR TRAINING PROGRAM. IF YES IS CHEC IN BOTH ITEMS 4 ANO b. THEN ITEMS 11. EDUCATION.12. TRAINtNG.13. EXPERIENCE AND 16 FXPi:RIFNCF OcTAILS no NOT H AVE TO BE COMPLETEO; IEIM NfW APMCMICE5 %5T 5TIU, IELUGZ int NUMBER OF SIGN!FICANT CONTROL MAFIPULATIONS UNDER ITEM 12.3.
NOTE: INPO ACCRE0lTED MEANS ACCREDITATION BY THE NATIONAL NUCLEAR ACCREDITING BOARD.
85-FOR RENEWALS ONLY: ENTER THE APPROXIMATE NUMBER OF HOURS SINCE PREVIOUS RENEWAL OR ISSUANCE OF UCENSE IF FIRST RENEWAL.
16-EXPERIENCE DETAILS:INCLUCE P3SITION TITLE. TIME PERIOO FROM/TO,FAClUTY AND A BRIEF DESCRIPTION OF DUTIES PERFORMED WHILE SERVING IN THAT POSITION.1F MORE SPACE IS NEEDEO. USE ITEM 17. OR IF NECESSARY ATTACH AOC(TIONAL INFORMATION.
17-COMMENTS: USE THIS SPACE TO INCLUCE ANY EXTRA INFORMATSON OR CLARIFICATION FOR OTHER ITEMS ON THE APPUCATION FORM.
IF THE SPACE PROVICEO IS NOT SUFFICIENT. YOU MAY ATTACH EXTRA INFORMATION WITH YOUR APPUCATION.
18-NRC FORM 396. CERTIFICATION OF MEDICAL EXAMINATION SY FACluTY UCENSEE. MUST ACCOMPANY THIS APPUCATION.
19-SIGNATURES: SIGN AND OATE ITEM 19a. OGTA(N YOUR TRAINING COORDINATOR'S SIGNATURE AND THAT OF YOUR SENIOR MANAGE-MENT REPRESENTATIVE ON SITE.
OETACH THESE INSTRUCTIONS AND SUBMIT THE COMPLETED NRC FORMS 398. IN TRIPUCATE (ongnialand two cooest AND 396 TO THE APPROPRIATE REGIONAL ADMINISTR ATOR.
PRIVACY ACT STATEMENT Pursuant to U.S.C. SE2steH31. enacted into law by Section 3 of the PnvecY Act of 1974 (Public Law $3-5791. the followmg is furnished to in-dindvals who sucody mf ormation to the U.S. Nudeer Regulatory Commission on NRC Form 398. This information is maintemed in a system of records designated se NRC 16 and desenbod at a6 Federet Register 46717 (September 21, 1981).
- 1. AUTHORITY. Section 107 and 161(l) of the Atomec Energy Act of 1954. as amende1 (42 U.S.C. 2137 and 2:01 till.
- 2. PRINCIP AL PUR POSES. The informacon will be coatected and evaluated for determining licensing eligibility and to generate statistical data and reports on licensmg actions.
- 3. ROUTINE USES. Informetron entered on thee form may be used to: (as determine if ttie individual meets the requiremente of 10 CFR Part 55 to be issued en operator's license: (bl provide reeaarchere with information for statistical evaluations rotated to selection. training. and esamination of f acierty operstors: (cl provide f acility management with sufficient information to enroll the individuate in the licensed operator requalification program: (di provide for esamination and testing matenal and obtain results from contractors.
- 4. WHETHER OISCLOSUR E IS M ANDATORY OR VOLUNTARY AND EFFECT ON IN0lVIOUAL OF NOT PROVIDING INFORM ATION: Disclosure is vosuntary. However, if the information requested is not provided. NRC will not be able to evaluate whether the appiication meets the requirements of 10 CFR part 55.
- 5. SYSTEMS MANAGERS AND ADORESSES.
Ragional Adm nestrator. Region i Regonal Admsnistrator, Region II U.S. Nuclear Regulatory Commess.on U.S. Nucteer Regulatory Commesson 631 Park Avenue 101 Marwitta Street. Suete 2900 Kong of Pruss6s. P A 19406 Atlanta, GA 30323 Regional Admin strator Region lli Regiones Admatestrator. Region IV Reg ones Admestrator Reg on v U.S. Nuciear Regulatory Commiss.on U.S. Nucwar Requtatory Commissaon U.S. Nuclear Regulatory Commess.on 799 Roosevent Road 611 Ryan Ptaza Onve. Su ie 1000 1450 Marm Lane. Suste 210 Glen Ellvn. IL 60137 Art.ngton. TX 76011 Wainut Crees. CA 94596
poRM age U. S. NUCLEAR REQULATORY COMMISSION
- '""'3 0 KIEN**
eMEP PERSONAL QUALIFICATIONS STATEMENT - LICEN8EE
- 1. APPWCANT'S PUL4 Naase twar, espNeunN
- 4. TYPE Of APPUCAftCas av RRisuses nesses i.n0T l
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- 4. PRtVtOUS UCEN64tsi HELD D. UCENS8 NUM6tm d E#"AdON O'[i t FAQUTY DOCK 8T NUMetR
- s. OptRATOR
- a. DOCKET NUMGER yy D $1NIOR OPERATOR 56 l
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7 NAME OF APPUCANT'S EA4PLOYER
- 10. CURRENT POSITION AT FAC1UTV
- a. PLANT SUPERINTENDENT L AUXtuARY UNf7 OPERATOR /
ADORE 55
- b. ASSISTANT PLANT $UPERINTENDENT go"ysp
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EO NTOR) c $HtFT $UPERVISOR
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OTv TATE DP CODE d $TAFF ENGINEER E OTHER (Sescs4J'
- e. $MsFT TECH 8eCAL AOvtSOM/5 HEFT ENGsNEER 8 NAME OF APPUCANT'S FAOUTY lFACluTV DOCKET
- f. INSTRUCTOR l NUMBER
- g. $ENsOR CONTROL ROOM
- t. ADOITIONAL FAOUTY OOCKETS #As me.unir trenness OPERATOR u
h CONTROL ROOM OPERATOR
- 11. EDUCATION a.HiGM SLMOOL
- c. MAJOR AREAdS6 OF STUOy gd "Wi OEG8 TEE CODES fTo es,,ases d VOCATIONAUTECHNtCAL 0,"M"wg ca9END for HtGHEST DEGREE GRADUATE ENG' HEE"*G "as w a*** - oorecea s TvrE OF TRAmmG YES NO GEO EQUIVALENCY 0-NONE NO OTMER 1-CERTIFICATE 2-ASSOOATE b NUMBER OF YEARS OF COLLEGE 3-8ACHELOR I 4-M ASTER 5-OOCTORAL
- 12. TRAlfetNG l
- 13. EXPERIENCE la. MONTM AND VEARl0F WEEKS D NUMBER
- a. MONTH ANO YEAR
- b. NUM9ER I soeu 1 vc 1
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- 6. R E QU AUFICA TION l
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I 14 FACIUTY OPERATOR TRAINING PROGRAM e GRAOUATE OF INPO ACCRE04 RED OPERATOR
- b. CERTIFIEO ON NRC Form 474. l' $th4fLATION F AQUTV CERT 1p+
TRAssesseG PROGRAM ATiON~s OR NRC APPROVED $3MULATION F AOUTV 13 USED W l
THE OPERATOR TRAINWG PROGRAM l 'ES l lNO lvES l lNO is FOR RENEWALS ONLY HOUR $ OPERATED FACluTY:
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- c. DUTIES
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e en emes=== ans enachsunne e vue one eeneet. e ene armerce em NAC m esema me meses et emenreuens to my emgeyare for use m presenng r
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DATE the loses, ascename! reeusemone es se heurese as en Operesort5enser Oserecer ourment to Tee 10. Coes of foa
- Sener Quesear temes to podenn husher esmyes chasse sie ehet the mcery seal be mass sweesene for enameisten. I ese certW,mses m h 5 entsv Inse ene assue nemme siensassa ses -
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-aeses a som th as resures ey amenen 50 Se u a er to CFR 50. ene thet ashe has an.
4 apesgue nessier emaname._
cessesserer one essesy. I age cendy unser genany of periury was she adormoqion m the escustent ans areschmenes e rum ene cenett.
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OATE SENarumE-SENeOR MANAGEMENT REPRESENTATTVE ON SITE l
DATE FOR NRC USE wAivEn <Chece er earneses so e as assacemos MEETS neouinEMENTs GaAss E0 av othiED ev
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GTEGOAV DOES NOT MEET 8EOUIREMENis us a% Am-nu ca
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l DATE wit lTTEss SGNA Tunt. REVIEWER I
OPEmaisesG EUGissuTV oTNEa Nac poses see M47) i 4
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~ ENCLOSURE 2
SUMMARY
OF CHANGES TO NRC FORM 398 Moved "New" to below " Hot" and " Cold". '
Item 4.a Combined " Oral" an'd " Simulator" into " Operating". -
Item 4.f Item 5.d Deleted " Instructor Certification".
Itera 14 Added a new item " Facility Operator Training Program" and incorporated under this item the INPO accreditation block (originally under Training);
added a block for NRC approved or NRC Form 474 certifieo simulation facility.
Item 15 Added a new item "For Renewals Only. Hours Operated Facility". (This was originally under Experience).
Items 16 Renumbered previous items 14 through 17 to 16 through 19 through 19.
Item 18 Changed to read "NRC Fom 396, certification of Medical Examination by Facility Licensee is attached" to indicate that in order for the application to be complete the NRC Fom must be attached.
Statement Added Any false statement or omissions in this document, including attachments, may be subject to civil and criminal sanctions.
Item 19.a Changed the wording to read "... certify under penalty of perjury that the information in this document and attachments is true and correct. I also..."
Item 19.b Changed the wording to read "... has i
successfully completed the facility licensee's l
requirements to be licensed as an Operator / Senior Operator pursuant.
Also added the wording "I also certify under penalt) of perjury that the information in this documcnt and attachments is true and correct." Changed signature block from
" Highest Level Of Corporate Management for Plant Operation" to " Senior Management Representative On Site."
Added the wording "I also certify under penalty Item 19.c of perjury that the infomation in this document and attachments is true and correct. Changed signature block from " Highest Level of Corporate Management for Plant Operation" to " Senior Management Representative On Site."
Under waiver category combined " Oral" and FOR NRC USE
" Simulator" into " Operating".
ENCLOSURE 3 e
PERSONAL QUALIFICATIONS STATEMENT - LICENSEE NRC FORM 398 (REV 4/87)
NEW APPLICANTS ARE TO COMPLETE EACH ITEM OF THE NRC FORM 398 COMPLETELY, FOLLOWING INSTRUCTIONS BELOW.
THIS IS TO INCLUDE ALL EDUCATION, TRAINING, AND EXPERIENCE THAT APPLICANT HAS RECEIVED UP TO THE DATE OF THIS APPLICATION (NOTE EXCEPTION:
SEE ITEM 14).
~
RENEWAL, UPGRADE, MULTI-UNIT AND REAPPLICATION APPLICANTS ARE TO COMPLETE EACH ITEM OF THE NRC FORM 398 EXCEPT INDICATE DNLY THE EDUCATION, TRAINING, AND EXPERIENCE RECEIVED SINCE LAST APPLICATION (NOTE EXCEPTION: SEE ITEM 14).
+
A SEPARATE NRC FORM 398 FORM MUST BE SUBMITTED EACH TIME AN APPLICANT APPLIES FOR A LICENSE OR RENEWAL OF LICENSE.
FULL NAME AND CURRENT ADDRESS.
ITEM 1 CITIZENSHIP.
If other than U.
S. Citizen, ITEM 2 citizenship must be specified.
DATE OF BIRTH.
ITEM 3 TYPE OF APPLICATION.
ITEM 4 "X" appilcable boxes:
Applying for a license at 1-Hot
-a plant that has achieved initial criticality.
This should be completed for each appilcation.
Applying for a license at 2-Cold a plant that has not achieved initial criticality. This should be completed for each appilcation.
Applying for the first time
- e. New at this facility OR if previously applied for a license but withdrew (write in "previously withdrew" next to New).
ALL ITEMS MUST BE COMPLETED ON A NEW APPLICATION AND SHOULD INCLUDE ALL EDUCATION, TRAINING AND EXPERIENCE RECEIVED UP TO THE DATE OF THIS APPLICATION.
THERE IS AN EXCEPTION TO THIS - SEE ITEM 14.
o' 2-Now holds a license and i s
- b. Renewal renewing that same type of license.
ALL ITEMS MUST BE COMPLETED ON A RENEWAL APPLICATION BUT NEED ONLY INCLUDE THE EDUCATION, TRAINING AND EXPERIENCE RECEIVED SINCE THE LAST APPLICATION.
THERE IS AN EXCEPTION TO THIS - SEE ITEM 14.
Now holds an operator's
- c. Upgrade license and i s applying for a senior operator's license.
ALL ITEMS MUST BE COMPLETED ON AN UPGRADE APPLICATION BUT NEED ONLY INCLUDE THE EDUCATION, TRAINING AND EXPERIENCE APPLICANT RECEIVED SINCE LAST APPLICATION.
THERE IS AN EXCEPTION TO THIS -
SEE ITEM 14.
d.
Multi-unit Applying for a license on more than one unit OR is a licensed operator on one unit and is applying to extend license to additional units.
(Notes all facility docket numbers are to be listed under Items 8 and 9).
ALL ITEMS MUST BE COMPLETED ON A MULTI-UNIT APPLICATION BUT NEED ONLY INCLUDE THE EDUCATION, TRAINING AND EXPERIENCE RECEIVED SINCE LAST APPLICATION.
THERE IS AN EXCEPTION TO THIS -
SEE ITEM 14.
Previously took a licensing
- e. Reapp11 cation exam and was denied a license and is now reapplying for that same type of Ilconse at j
the same facility.
The j
reapplication should i dentify those areas i n which the appilcant demonstrated weaknesses during the previous examination and the additional training received to correct these specific deficiencies in Item 12.7 and/or Item 17.
ALL ITEMS MUST BE COMPLETED ON A REAPPLICATION APPLICATION BUT NEED ONLY INCLUDE THE EDUCATION, TRAINING AND EXPERIENCE RECEIVED SINCE LAST APPLICATION.
THERE IS AN EXCEPTION TO THIS - SEE ITEM 14.
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1-First-If denied a license for the first time, the appilcant 5
must wait two months from the date of denial letter before reapplying for a license.
2-Second
- If denied a license for the second time, the applicant must wait six months from the date of denial letter before reapplying for a license.
3-Third If tiented a license for the third time, the applicant mur,t wait two years from the date of denial letter before tempplying for a license.
- f. Walver Request
- NOTE:
Justification for any waiver request is required under Item 17.
1-Written
- To request a waiver on entire written exam or on part of the written exam.
(Category (s) for which waiver requested should be specified in space provided.)
2-Operating
- To request a waiver on an operating exam.
3-Eligibility
- To request a waiver on eligibility requirements.
4-Other
- To request any other Walver, i.e.,
medical.
ITEM 5 TYPE OF LICENSE APPLIED FOR
- a. Operator
- Applying for an operator license.
b.
Senior Operator
- Applying for a senior operator license.
- c. Limited SRO
- Applying for a limited senior operator license (e.g. fuel handler).
ITEM 6 PREVIOUS LICENSE (S) HELD i
l
- To be completed if previously held a license (or instructor certificate).
a.
Docket Number
- Docket number assigned for previous license (s) held (SS-XXXXX).
Indicate if this license was for RO or SRO.
If this was for
-a.
Instructor Cortificotten or Limited Senior Operator, please write-in.
If a denial letter was-Issued, a docket number was assigned,
and should be Indicated in this block.
- b. License Number
- License number (s) previously held.
License number should include the present renewal number, if any, (i.e., XXXXX-3).
- c. Expiration Date Date of Ilcanse expiration.
If several renewals have occurred, IIst only latest expiration date.
- d. Facility Docket No.
- Docket number of facility where applicant held license (50-XXX).
Note:
If previously held license / Instructor certification at a training center, simulator, etc.,
where there is no facility docket number, write in the name.
ITEM 7 NAME OF APPLICANT'S EMPLOYER Name and address of current employer.
ITEM 8 NAME OF APPLICANT'S FACILITY Name and docket number (50-XXX) of facility where applying for a license.
ITEM 9 ADDITIONAL FACILITY DOCKETS If applying for multi-unit license ALL appilcable additional docket numbers must be entered.
ITEM to CURRENT POSITION AT FACILITY
- a. Plant Superintendent Note license type 11 required by position.
b.
Assistant Plant Superintendent Note license type if required by position.
- c. Shift Supervisor Position requires current senior license for a plant with fuel in the reactor.
- d. Staff Engineer Note license type if required by position.
e.
Shift Technical Advisor / Shift Engineer-Note license type if required by position.
1.
Instructor Note license typa if required by position.
- g. Senior Control Room Operator
- Position requires-current senior license for a plant with fuel in the I
reactor.
h.
Control Room Operator - Posit'lon requires current operator license for a plant with fuel in reactor.
- l. Auxillary Unit Operator / Trainee /
Turbine Building /
Eauipment Operator (ncn-licensed operator)- Ensure description is detailed enough to allow evaluation of position.
J. Other (Specify)
- Ensure description is detailed enough to allow evaluation of position.
Note license type if required by position.
ITEM 11 EDUCATION a.
High School Graduate
- Graduated from high school.
GED Equivalency
- Received GED equivalency.
No
- Did not complete high school.
b.
Number of Years of College
- Number of years of college I
successfully completed.
(Freshman = 0 to 1 year Sophomores 1 to 2 years Juniors 2 to 3 years Senior = 3 to 4 years Graduate = 4 years or more)
- c. Major Ares (s) of Study-t Engineering
- Fleid of engineering majored l
Ins number of years, ands highest degree obtained.
4 l
Other
- Other fleid majored ini number of years, andt highest degree obtained.
I
- d. Vocational / Technical l
Type of Training-Vocational / technical training schools, including allitary schools, applicable to the operation of a i
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pcwor plant.
Includo such c1
- programs as nuclear power: school, air conditioning / refrigeration school, diesel mechanic school, Instrumentation and control maintenance, etc.
Number of Months-Calculate the approximate number of full months appilcant received actual training.
(4 weeks, 8 hours9.259259e-5 days <br />0.00222 hours <br />1.322751e-5 weeks <br />3.044e-6 months <br /> / day = 1 month)
Certificate Received Indicate if certificate was received for this training.
ITEM 12 TRAINING
- Training is indicated in weeks based upon 40 hours4.62963e-4 days <br />0.0111 hours <br />6.613757e-5 weeks <br />1.522e-5 months <br /> per week.
Indicate training received to meet the requirements of ANSI N18.1/ANS3.1.
The breakdown below parallels the ANS standards.
Beginning and completion dates and the total number of weeks spent in each type of training must be included.
The number of weeks is provided to account for Intermittent training (for example, four weeks of classroom training spread over a two month period).
Therefore, the date column may Indicate a larger time span than the actual number of weeks spent in full-time training.
Time in training for the license applied for cannot be double counted under Experience, i
Item 13.
REQUALIFICATION training time is be accounted for in Item 12.6.
1-Nuclear Power Fundamentals (Classroom)
- Fundamental course that covers the theory of the nuclear fission process and reactor operations.
I 2-Plant Systems
- Systems Instruction to include both observation and classroom work.
This instruction is plant specific.
Classroom
- Instruction covering nuclear power plant systems and system and component malfunctions.
Observation
- Planned systematic observation training on accessible plant equipment.
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7 3-Operating Practice Training ~ln operating practices in the control room for which the candidate will license and at a plant referenced simulator if one is
- available.
Control Room Operations Observation of the operating practices and the operation of nuclear power plant from the central control room.
Hot Ilconse candidates must manipulate the controls under direct supervision of a licensed operator at the Individual's duty station for a variety of plant operations.
Cold license candidates are to participate in the plant preoperational testing program.
Actual time assigned to the operating shift should be counted in 12.5 below.
Simulator Operations (Includes Classroom)
Practice in manipulating plant controls during normal, abnormal and emergency conditions on a plant referenced simulator.
Simulator Name(s)
Specify the simulator (s) where training was received.
If more i
than two simulators specify the two most recent only.
Startup Certification "X' Yes or No.
(Notes For Completed facilities with plant referenced i
simulators, certification of startup training will be provided by the facility organization.
For those facilities without a plant referenced simulator, startup certification must be obtained from the organization at which the startup demonstration was performed.)
Number of Reactivity Manipulations:
Number of actual reactivity manipuistions in which the appilcant was involved broken down by
)
plant and simulator.
(Detalls should be provided in Comments,
)
Item 17.)
Instruction in the duties of 4-SRO Instruction a senior operator.
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,' l 5-Extra Person on Shift - Must be a alnlaus of three months j
on shift performing the actual duties of the licensed position i
applied for.
These duties are performed under the direct supervision of Ilconsed personnel on normal shift rotation.
This should be J
in a structured, documented 4
program.
Do not double count this time j
in 12.3 or as operating experience.
1 6-Requalification
- ALL requalifications training, including classroom and simulator time.
7-Other (Specify)
- Ensure description is detailed enough to allow evaluation.
Include number of research reactor startups, if performed.
EXPERIENCE
- Experience is indicated in months.
ITEM 13 For each position held, list the month / year to cover the period you were quellfled for that position.
The number of months must reflect the time spent actually exercising the respon-sibilities of that position.
Item 16 should be completed for each position held.
DO NOT DOUBLE COUNT TIME.
If there were overlapping duties, the number of months should reflect the proportionate amount of time assigned to those particular duties.
In no case should the number of months reported for a particular time period exceed the number of months that are in that time period.
Also, do not count time in training, i
Military nuclear power experience should be listed in 1-5.
j NAVY Non-nuclear allitary power experience should be listed under Fossil 6-9.
i 1-RO Quallfled to operate the controls of a Navy Propulsion or training reactor.
Authorized to supervise the operation of 2-E00W/PPWO Navy Propulsion plants.
_. ~. _.. _ _ _ _ _ _ _ _ _ _ _.. _ - _ _ _ _ _. _, _ _. _. _, _ _,
m.
4 a) Graduate of INPO Accredited Operator c
Training Program "X" Yes or No if the sppilcant is.a graduate of an INPD accredited operator training program.
(NOTE:
INPO accredited means accreditation by the National Nuclear Accrediting Board.)
b) Certlfled on NRC Form 474 (Simulation Facility Certification) or NRC Approved Simulation Facility is Used in the Operator Training Program "X" Yes or No if, in the operator training program, a certified on NRC Form 474 or NRC approved simulation facility is used.
ITEM 15 -
FOR RENEWALS ONLY - HOURS OPERATED FACILITY:
- The approximate number of hcurs appilcant has operated the facility under his existing Ilconse.
l ITEM 16
- EXPERIENCE DETAILS
- Include position title, time period (from/to), and description of duties performed while serving in that position.
Item 17 should be used if more space is needed.
l ITEM 17
- COMMENTS
- This space should be used to complete information from previous items or clarification for other Items on the appilcation form.
If l
space provided is not sufficient, extra pages may be attached to I
appilcation.
ITEM 18
- NRC FORM 396, CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE
- Any appilcation for a license or renewal of Ilconse is not complete without NRC Form 396.
A medical is good for six months from the date the physician signs it.
For appilcations following a voluntary withdraual or license denial or an upgrade appilcation, walvers may be granted on a case basis if the original medical evaluation was performed within one year.
If waiver is requested, Item 4.f.4 should be marked.
..g.
3-EWS/PPWS Quellfled to direct and supervise the
't operations of a Navy Propulsion plant.
4-ERS/CRW Quellfled to direct and supervise Navy Propulsion plant operations outside the maneuvering area.
5-DTHER (Specify)
Ensure description is detailed enough to allow evaluation.
FOSSIL 4-Operator Navy or commercial non-nuclear propulslon/ power plant operation.
7-Supervisor Authorized to direct and supervise non-nuclear operators.
8-Plant Staff Non-nuclear power plant staff experlence.
9-Other (Specify)
Ensure description is detailed enough to allow evaluation.
COMMERCIAL NUCLEAR (Including Research/ Test Reactor) 10-Reactor Operator (Licensed)
Must hold or have held valid NRC operator license.
11-Senior Operator (Licensed)
Must hold or have held valid NRC senior operator license.
12-Shift Supervisor (Licensed)
Must hold or have held valid HRC senior operator license.
13-Staff / Shift Engineer (Licensed)
Must be at the facility and involved in the day-to-day plant operational (engineering) staff work.
14-Aux./ Equip. (Nonllcensed)
Operator Personnel used in direct support of plant operations as directed by l
Ilconsed operators.
15-Plant Staff Staff work other than that directly associated with plant operations.
1 16-Other (Specify)
Ensure description is detailed l
enough to allow evaluation.
l ITEM 14 FACILITY OPERATOR TRAINING PROGRAM If "Yes" is checked in BOTH a) and b) then Items 11 (Education),
12 (Training), 13 (Experience), and 16 (Experience Detalls) DO NOT have to be completodi except new applications must still include the number of significant control manipulations under Item 12.3.
r ITEM 19
- SIGNATURES REQUIRED l
Any false statement or ommission in this document, including attachments, cay be subject to civil and criminal sanctions.
- o. Date and signature of appilcant certifying under penalty of perjury that the information provided on NRC Form 398 is true and correct.
Appilcant's signature also authorizes the NRC to submit results of examinations to appilcant's employer,
- b. Date and signature of Training Coordinator AND Senior Management Representative on Site certifying, under penalty of perjury, that appilcant has successfully completed the facility licensee's requirements to be licensed as an Operator / Senior Operator pursuant to 10CFR553 and that the applicant has a need for this license to perform assigned duties.
Also certifies that facility ul11 be available for examinations.
- c. RENEWAL ONLY - Must be signed and dated by Training Coordinator AND Senior Management Representative On Site certifying, under penalty of perjury, that applicant meets the approved requalification program (ulth any exception noted in Comments, Item 17) as required by section i
50.54(1-1) of 10CFR50 and has discharged licensed responsibilities competently and safely.
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