Joseph A. Holmes Safety Association

Professional Miner Program

Application

       

To be considered for certification as a Professional Miner by the Joseph A. Holmes Safety Association, please provide the following information:

First Name:  (Capitalize normally - exactly as it should appear on the certificate)
Middle initial:
(Letters only, no period)
Last name: (Capitalize normally - exactly as it should appear on the certificate)
Street address:
Address (second line):
City:
State:
Zipcode:
Email address:

Mine Type: Underground   Surface

Commodity:

Coal
Sand & gravel
Limestone
Stone
Phosphate
Gold or silver
Copper
Iron ore
Cement
Clay
Other (write in):
 

Certification level for which you are applying:

Double Diamond (40 years, No lost workday injuries)
Diamond (30 years, No lost workday injuries)
Granite (20 years, No lost workday injuries)
Marble (10 years, No lost workday injuries)
Platinum (5 years, No reportable injuries)
Gold (3 years, No reportable injuries)
Silver (3 years, No lost-time injuries)

Professional Miner's Pledge
"As a Professional Miner I pledge to serve as a positive role model for other miners, and as a mentor for new miners. By recognizing “Safety and Health are Values,” I will work to ensure a safe, healthy, and alcohol and drug free workplace for myself and coworkers, and promote and participate in health and safety initiatives."

"I release this information for Joseph A. Holmes Safety Association use only."

If you agree with these statements, and the information entered in the form is correct, click  "I Accept"

Copyright © 2004 Joseph A. Holmes Safety Association. All rights reserved.
Revised: 04/11/08