Have you read and understood the ADAS Conditions of Certification?* Yes View the ADAS Conditions of Certification.Application TypePlease select which type of onshore supervisor certification you are applying for:Part 1 only supervisor (SCUBA to 30m) $540 + GSTPart 2 only supervisor (SSBA to 30m) $540 + GSTPart 3 only supervisor (SSBA to 50m) $540 + GSTPart 1 & 2 supervisor (SCUBA & SSBA to 30m) $540 + GSTPart 1 & 3 supervisor (SCUBA to 30m & SSBA to 50m) $540 + GSTAs an IMCA Offshore Supervisor, you may apply for any level of ADAS Onshore Supervisor certification. It is recommended that you apply for Part 1 & 3 (SCUBA to 30m & SSBA to 50m). Applicant DetailsADAS Number (if applicable): Name* First Last Postal Address* Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Delivery 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 CaledoniaNew 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.YemenZambiaZimbabwePlease select which country your items are being sent to.Residential 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 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 Competency & QualificationsPlease attach a high quality passport style photo:*Accepted file types: jpg, jpeg, Max. file size: 10 MB.Photo to be taken within the last twelve (12) months.Please attach a high quality copy of your passport or alternative identification (e.g. drivers licence, ID card):*Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 10 MB.What Onshore Supervisor certifications do you currently hold?*Certificate HeldName of OrganisationDate of IssueCertificate Number Please use the '+' button to list additional certifications.Please attach copies of Onshore Supervisor certifications listed above:* Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 50 MB. Please attach your supervisor logbook:*Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 50 MB.Attach a copy of your supervisor logbook showing that you have completed at least 20 occupational onshore supervisions in the last 24 months. Logs must be signed by a company representative and show the company stamp.When was your current First Aid Certificate issued?* MM slash DD slash YYYY Supervisors must provide a copy of their current First Aid (or DMT), 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.Please attach your First Aid Certificate documentation:* Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 50 MB. When was your current Oxygen Management & CPR qualification issued?* MM slash DD slash YYYY Please attached your Oxygen Management & CPR qualification documentation:* Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 50 MB. 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.Please upload any additional files that may assist us with your application: Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 50 MB. 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: International shipping and handling Price: GST Price: $ 0.00 Total Payment Due: $ 0.00 How would you like to pay?* Credit Card Paypal Bill to Company Bank Cheque or Money Order Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name 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.IMPORTANT: 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.