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Application Form

This 3-page document outlines the eligibility requirements and application process for candidates seeking certification from EC-Council in various cybersecurity programs. To be eligible, applicants must either have completed official EC-Council training or have 2 years of relevant information security experience along with a completed application and $100 fee. The application collects applicant contact information, experience details, and requires the applicant to agree to a statement of compliance pledging to use skills ethically and abide by all applicable laws.

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Dami Yusuph
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© © All Rights Reserved
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163 views

Application Form

This 3-page document outlines the eligibility requirements and application process for candidates seeking certification from EC-Council in various cybersecurity programs. To be eligible, applicants must either have completed official EC-Council training or have 2 years of relevant information security experience along with a completed application and $100 fee. The application collects applicant contact information, experience details, and requires the applicant to agree to a statement of compliance pledging to use skills ethically and abide by all applicable laws.

Uploaded by

Dami Yusuph
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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EC-Council Exam Eligibility Application Form v2


CEH (Certified Ethical Hacker)
CHFI v8 (Computer Hacking Forensic Investigator v8)
ECSA v9 (EC-Council Certified Security Analyst v9)
EDRP v2 (EC-Council Disaster Recovery Professional v2)
ECDR-VT v1 (EC-Council Certified Disaster Recovery and Virtualization Technology Professional v1)
ENSA v4 (EC-Council Network Security Administrator v4)

Eligibility Requirements
Either one of the following criteria is required by EC-Council so that a determination can be made regarding a candidates eligibility.
a) A candidate has attended "Official" training through an EC-Council Authorized Training Center (ATC).
Accepted "Official" training solutions: Instructor-Led (ILT), Computer -Based (CBT), Web-Based (WBT), or Academic Learning.
b) A Candidate may be granted permission to attempt the exam without "Official" training if:
1. The Candidate has and can prove two years of Information Security related experience.*
2. The candidate remits a non-refundable Eligibility Application Fee of $100 (USD).
3. The candidate submits a completed Exam Eligibility Application.
Application Submission Steps
Step 1: Complete the application form.
Step 2: Attach a copy of your resume, and a scanned copy of an identification document, such as Employee i-Card of your current or previous
employment, which does not carry any Personally Identifiable Information. EC-Council strongly discourage you from submitting your
passport, driver's license, government ID or any other identification document that carries Personally Identifiable Information.
Step 3: Scan the documents and e-mail them to us.
For USA/Canada/LATAM applicants [email protected]
For International applicants [email protected]
Step 4: Remit $100 payment for Non-refundable Eligibility Application Fee
Step 5: A representative from EC-Council's Certification Department will contact your Boss / Supervisor / Department head to verify the
information submitted on your application.
Step 6: If your application is approved, you will be required to purchase the exam voucher directly from EC-Council. You will then receive
your exam eligibility code along with the exam voucher.
Note: We treat personal information securely and confidentially. EC-Council adheres to strict US privacy laws and will not disclose the submitted
information to any third party with the exception of your Boss / Supervisor / Department head. (As stated above, verification is required.)
EC-Council reserves the right to deny certification to any candidate who attempts to sit for this exam without a valid eligibility code. Respectively, if it is
discovered that a certification was granted to a candidate who sat for the exam without a valid eligibility code, EC-Council also reserves the right to
revoke the offending candidate's certification.

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EC-Council Exam Eligibility Application Form v2


Applicant Information
First Name:

Last Name:

Proof of Identity:

Residence:
Address:
City/State/Province:

Country:

Zip/Postal Code:

Daytime phone number/Cellular/other:


e-mail:

(Please write clearly)

Experience Qualifications
Company Name:
Company URL: http://
Job Title / Position:
Number of Years with This Employer:

Number of Months of Security related work experience with this employer:

Type of security related work:


Experience qualifications certified by supervisor / agency representative:

Supervisor Name & e-mail:

Position:

Page 3 of 3

EC-Council Exam Eligibility Application Form v2


Statement of Compliance
The objective of EC-Council's certifications is to introduce, educate and demonstrate hacking techniques and tools for legal
security testing purposes only. Those who are certified by EC-Council any of our various "Hacking" disciplines, acknowledge
that such certification is a mark of distinction that must be both earned and respected.
In lieu of this, all certification candidates pledge to fully support the Code of Ethics. Certified professionals who deliberately or
intentionally violate any provision of the Code will be subject to action by a review panel, which can result in the revocation of
the certification.
To this end, you will not exploit the thus acquired skills for illegal or malicious attacks and you will not use such tools in an
attempt to illegally compromise any computer system. Additionally you agree to indemnify EC-Council and its partners with
respect to the use or misuse of these tools, regardless of intent. You agree to comply with all applicable local, state, national
and international laws and regulations in this regard.
I certify that I meet the experience and training requirements to apply to become certified in EC-Council's various
"Hacking" certification diciplines . The information contained in this application is true and correct to the best of my
knowledge. I understand that if I engage in any inappropriate, unethical, or illegal behavior or activity, my certification
status can be terminated immediately.

By submitting this form to EC-Council, you agree to indemnify and hold EC-Council, its corporate affiliates, and their respective officers, directors and shareholders
harmless from and against any and all liabilities arising from your submission of Personally Identifiable Information (such as passport, government ID, social security
number etc) to EC-Council. Should EC-Council receive any Personally Identifiable Information attached to this application, this application will be rejected.

Agree

Disagree

Signature:

Date:

Print Form

If you submit electronically please don't forget to attached the requested documents. Also, by clicking agree and typing y our
name, in the signature slot, you agree to comply with the statement of compliance. If you choose to print and fax in your
application, please sign with your original signature to secure your compliance.
*Cumulative experience is acceptable. (Security Experience does not need to be in current job, or in one job. )
**If self employed, please submit letter from at least one client describing your IT Security contribution to their business.

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