If you encounter any issues when filling out this application please contact: Jennifer Darden, Training Director
Phone: 678-487-0558
Fax: 770-459-1812
Email: training@emgsi.com
Mailing Address:
103 Hunter Industrial Dr.
Villa Rica, Ga 30180

ASSE 6040 Medical Gas Maintenance Application

Paragraph 40-3.2.1 of the 2012 edition of the ASSE 6040 standard states, “The candidates for ASSE 6040 certification shall be employed or contracted by a health care facility, or actively engaged in working with medical gas systems, and shall have one (1) year minimum experience in the maintenance of the medical gas and vacuum systems.”

Employer 1 Name, City & Phone:

Employer 2 Name, City & Phone:

Employer 3 Name, City, Phone

The following box should be checked by the applicant