Crossover Form Have you read and understood the ADAS Conditions of Certification?* Yes View the ADAS Conditions of Certification.Application TypeSelect your crossover application type:*International Diver Crossover ApplicationRAN / RNZN / Australian Army Crossover ApplicationOnshore Diving Supervisor Crossover ApplicationOffshore Diving Supervisor Crossover ApplicationDiver Medical Technichian Crossover ApplicationLife Support Technichian Crossover ApplicationAssistant Life Support Technichian Crossover ApplicationPlease select which type of diver certification you are applying for:Part 1 Restricted / Scientific diver (Restricted SCUBA to 30m) $300 + GSTPart 1 diver (SCUBA to 30m) $300 + GSTPart 2 Restricted diver (Restricted SSBA to 30m) $300 + GSTPart 2 diver (SSBA to 30m) $450 + GSTPart 3 Restricted diver (Restricted SSBA to 50m) $450 + GSTPart 3 diver (SSBA to 50m) $450 + GSTSurface Supplied Mixed Gas (SSMG) + Part 3 diver (SSBA to 50m) $450 + GSTPart 4 diver (Closed Bell) $450 + GSTPlease select which type of onshore supervisor certification you are applying for:Part 1 only supervisor (SCUBA to 30m) $450 + GSTPart 2 only supervisor (SSBA to 30m) $450 + GSTPart 3 only supervisor (SSBA to 50m) $450 + GSTPart 1 & 2 supervisor (SCUBA & SSBA to 30m) $450 + GSTPart 1 & 3 supervisor (SCUBA to 30m & SSBA to 50m) $450 + GSTPlease select which type of diver certification you are applying for:Part 1 Restricted / Scientific diver (Restricted SCUBA to 30m) $300 + GSTPart 1 diver (SCUBA to 30m) $300 + GSTPart 2 Restricted diver (Restricted SSBA to 30m) $300 + GSTPart 2 diver (SSBA to 30m) $450 + GSTPart 3 Restricted diver (Restricted SSBA to 50m) $450 + GSTPart 3 diver (SSBA to 50m) $450 + GSTSurface Supplied Mixed Gas (SSMG) + Part 3 diver (SSBA to 50m) $450 + GSTPart 4 diver (Closed Bell) $450 + GSTPlease select which type of DMT certification you are applying for:Onshore DMT $150 + GSTOffshore DMT - for holders of Part 3, Part 4, ALST, LST or LSS certifications $150 + GSTPlease select which type of offshore supervisor certification you are applying for:Offshore Air supervisor $450 + GSTOffshore Air & Bell supervisor $450 + GSTDo you want to apply for onshore supervisor certification in conjunction with your offshore supervisor application?YesNoIf you wish to apply for onshore supervisor certification, you will be required to successfully complete an onshore supervisor exam online - further details will be provided once your application has been submitted.Please select which type of certification you are applying for:Assistant Life Support Technician $150 + GSTPlease select which type of certification you are applying for:Life Support Technician $300 + GSTApplicant DetailsADAS Number (if applicable):Name* First Last Postal Address* Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Shipping Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweResidential Address* Same as previous Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Mobile/Cell*Email* Is your billing address different?* Yes Billing addressIf your employer will be paying for your application, please enter the company details here.Company Details* Company Name Contact Name Email Address Company / Billing Address* Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Supporting DocumentationWhat certifications do you currently hold?*Certificate HeldName of OrganisationDate of IssueCertificate Number Please use the '+' button to list additional certifications.Please now send through the documents below to firstname.lastname@example.org. Please include ‘ADAS Crossover – (Insert Full Name)’ in the subject line: A high-quality passport-style photo (Photo to be taken within the last twelve (12) months). A high-quality copy of your passport or alternative identification (e.g. drivers licence, ID Card). Did your card expire over two years ago?*YesNoIn addition to a photo and your identification, please also send the following documents via email: A copy of your logbook showing you have completed at least 80 hours in a supervisory role since you gained your ADAS Onshore Supervisor certification. Logs must be signed by a contractor and show the company stamp. A copy of your First Aid Certificate. Divers/Supervisors - must also provide a copy of their current First Aid, CPR and Oxygen Management certifications. First Aid to be issued in the previous 3 years, CPR and Oxygen Management to be issued or demonstrated in the previous 12 months. A copy of your Oxygen Management & CPR Qualification. Issued or demonstrated within (12) months of the application date. NB: Oxygen Management and CPR certifications are to be issued within the previous twelve (12) months of application date. If Oxygen Management and CPR qualifications are not held, attach a Letter of Confirmation stating you have undertaken a Current Proficiency Assessment. This assessment can be performed by any competent person including a Doctor; a Rig Medic; or a First Aid instructor. The Letter of Confirmation is to be signed by the assessor and written on letterhead paper. Please contact ADAS for assessment guidelines if required. A copy of your Occupational Diver Medical Certificate. Any additional files that may assist your application (e.g. Nitrox certification if you're applying for a Nitrox endorsement). I also understand that I may be required to demonstrate to ADAS though the provision of log books or other appropriate equivalent evidence how those relevant skills and knowledge have been maintained.* Yes DeclarationApplicant Declaration* I agree to the following I understand and warrant that, by my submission of all information herein electronically, I acknowledge that all information is submitted on the basis that it is truthful in its entirety and has the same effect as if I had personally executed this application. I understand that my electronic submission of the information herein, entitles ADAS, its Officers, Servants and/or Agents, to rely upon same as being truthful and accurate and I indemnify, and keep indemnified, all Parties that rely upon the information electronically submitted therein in the event that any such information is found to be false and/or misleading.I have read and understood the material provided by ADAS outlining the regulations and legislation, including occupational health and safety provisions, relating to occupational diving in Australia. I understand that the information is for guidance only and may not be correct. I acknowledge that it is my personal responsibility to ensure that I am aware of, and abide by, all applicable legislation.Additionally, I understand, and agree to abide by, the conditions set out in the "Conditions of ADAS Certification" and that in making this application I am certifying that I: am current in the practical and theoretical skills and knowledge relevant to my level of ADAS certification as identified in the ADAS Diving Competency Standards; hold current First Aid, Oxygen Management, and CPR qualifications in accordance with Australian national requirements; have current medical certificates that meet requirements for occupational diving (if relevant). I also understand that I may be required to demonstrate to ADAS though the provision of log books or other appropriate equivalent evidence how those relevant skills and knowledge have been maintained. Application PaymentNote: GST is applicable to Australian destinations only.Australian shipping and handling Price: $ 4.50 International shipping and handling Price: $ 15.50 GST Price: $ 0.00 Total Payment Due: $ 0.00 How would you like to pay?*Credit CardPaypalBill to CompanyBank Cheque or Money OrderIMPORTANT: Do not close your browser once payment is submitted. If you're paying by credit card or PayPal, you will be transferred to a secure payment page when you click submit. Once the payment process is completed you will be returned to our website. Please wait till you are returned to the website before closing your browser. If you close the browser before this time we may not receive your order.If your company is paying for your application/order please ensure you enter all the relevant details in the 'Billing Address' section.Please make cheque or money order for payable to: "ADAS" and mail to 526 Duncan Road, Dunoon, NSW, 2480. Please allow approximately 7-10 working days for payment to be received. This iframe contains the logic required to handle Ajax powered Gravity Forms.