LinkedInThis field is for validation purposes and should be left unchanged. ⚠️ Important: Registering on the Zoom meeting attendance form is not the same as registering for this training through this registration form. This form must be completed for our records and to facilitate the processing of certifications. Class SelectionPlease check the classes you are registering for below.Department of Buildings (DOB) 40-Hour Site Safety 8-Hour Site Safety Refresher (Chapter 33) DOB Site Safety Training (SST) 8-Hour Fall Prevention 4-Hour Fall Prevention 2-Hour Drug & Alcohol Awareness 8-Hour Chapter 33 (Site Safety Refresher) 4-Hour Supported Scaffold User / Refresher 2 Hour Site Safety Plan (SSP) 2-Hour Pre-Task Safety Meetings 2-Hour Toolbox Talks 1-Hour Elective SST BUNDLES 10-Hour Worker SST Bundle 22-Hour Supervisor Bundle 32-Hour Supervisor Bundle 4-Hour General / Specialized Elective Bundle 6-Hour SSP / Tool Box / Pre-Task 8-Hour Worker SST Renewal Bundle 16-Hour Supervisor SST Renewal Bundle DOB Scaffold Safety 32-Hour Supported Scaffold Installer/Remover 8-Hour Supported Scaffold Refresher 4-Hour Supported Scaffold User 32-Hour Suspended Scaffold Supervisor 8-Hour Suspended Scaffold Supervisor Refresher 16-Hour Suspended Scaffold User 8-Hour Suspended Scaffold User Refresher DOB Concrete Safety 30-Hour Concrete Safety Manager 8-Hour Concrete Safety Manager Refresher DOB CRANES & DERRICK 4-Hour Mast Climber User/Operator & Refresher 32-Hour Rigging Supervisor 16-Hour Rigging Supervisor Refresher 16-Hour Rigging Worker 8-Hour Rigging Worker Refresher 30-Hour Climber/Tower Crane Rigger 8-Hour Climber/Tower Crane Rigger Renewal 40-Hour Hoist Machine Operator 8-Hour Hoist Machine Operator Refresher 8-Hour Hoisting Machine Operator Class B Rating 16-Hour Special Rigger 8-Hour Special Rigger Renewal 32-Hour Lift Director OSHA 10-Hour Construction Safety 30-Hour Construction Safety 10-Hour OSHA General Industry 30-Hour OSHA General Industry 2 Hour Silica Awareness 4 Hour Silica & Respiratory Protection 8 Hour Confined Spaces 8 Hour Trenching, Excavation, & Competent Person 7600 Disaster Site Worker (15 Hour) HAZWOPER (8 Hour) HAZWOPER (24 Hour) HAZWOPER (40 Hour) Scissor Lift Safety (4 Hours) Aerial / Boom Lift Safety (4 Hours) FDNY - FIRE SAFETY Construction Site Fire Safety Manager Fire Safety Director First Aid, CPR with AED Department of Transportation (DOT) 4-Hour Flagger OTHERIf you don't see the class above, write it here.InstructorSelect an InstructorE-Learning (Online)Akif HussainArsalan NaeemAyad HussainBrian ChapmanBrian DulantoCedric SavinonChad EspositoCipriano GuzmanDaniel CunniffDavid AlbunioDominick DeRubbioFrank Agnello SR.Gustavo CanalesJohn CascaranoJohn ChristodoulouJohn PaladinoJose VeraMartha Liliana ChavurMaryann PiazzaMike IvancichNasar ButtOmar MurrellPhil MezzatestaRobert AmrheinRudy NestorSultan ChatthaThomas MillerTodd PolakoffOtherPick the instructor that is training the class you picked above. If you completed it through our E-learning (online) select that for the instructor.OtherPlease spell their name as best as possible. This helps process your form quicker.Start Date/Submission Date(Required) MM slash DD slash YYYY Select the date your class begins or when you finished your e-learning course.Student InformationName(Required) First Last Please put your official legal name that is shown on legal documents. Do not put a nickname.Date of Birth(Required) Month Day Year Height(Required)4'0"4'1"4'2"4'3"4'4"4'5"4'6"4'7"4'8"4'9"4'10"4'11"5'0"5'1"5'2"5'3"5'4"5'5"5'6"5'7"5'8"5'9"5'10"5'11"6'0"6'1"6'2"6'3"6'4"6'5"6'6"6'7"6'8"6'9"6'10"6'11"7'0"7'1"7'2"7'3"7'4"7'5"7'6"7'7"7'8"7'9"7'10"7'11"Eye Color(Required)AmberBlueBrownGrayGreenHazelRedVioletPhone(Required)Please put the phone number that is the best to contact you at.Email(Required) Please put the email that is the best to contact you at.Address(Required) Street Address Apt., suite, floor City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Company(Required)Put the name of the company that you work for. If you do not currently work for a company type in "Self".Upload a Headshot PhotoPlease upload a photo of yourself from the chest up with a clear background. If it would not be accepted as a passport photo then do not upload it. Take a better one. Headshot photo(Required)Max. file size: 10 MB. Upload SST Card PhotoIf you have an SST card, please upload a picture of the front and back of it. Card FRONTMax. file size: 10 MB. Upload OSHA 30 Card PhotoPlease upload a photo of your OSHA 30 card front and back if you have one. Card FRONTMax. file size: 10 MB. Card BACKMax. file size: 10 MB. Virtual Course Attendance Policy(Required)I acknowledge that I have read and agree to abide by NextWave's Virtual Course Delivery Policies & Protocol at nextwavesafety.com/policies/#zoom-policy. I understand that virtual courses require my full attention, my camera must remain ON throughout the training, and I must attend from a safe, stationary location. I understand that joining a virtual course while driving or operating a vehicle is strictly prohibited and will result in immediate removal from the class with no refund. I have read and agree to the Virtual Course Attendance PolicyAuthorization for Release of Student Information(Required)In accordance with Family Educational Rights and Privacy Act The purpose of this release is to facilitate the communication of student information to authorized individuals identified by the student. The Family Educational Rights and Privacy Act of 1974 (FERPA); as amended, protects the privacy of education records, establishes the rights of students to inspect and review their education records, and provides guidelines for the correction of inaccurate or misleading data through informal and formal hearings. 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