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EC-Council Exam Eligibility Application Form v3

CEH (Certified Ethical Hacker)
CEH (Practical) (Certified Ethical Hacker (Practical))
CHFI (Computer Hacking Forensic Investigator)
ECSA v10 (EC-Council Certified Security Analyst v10)
ECSA (Practical) (EC-Council Certified Security Analyst (Practical))
ECSP-JAVA v8 (EC-Council Certified Secure Programmer - Java v8)
ECSP.NET v8 (EC-Council Certified Secure Programmer .Net v8)
EDRP v3 (EC-Council Disaster Recovery Professional v3)
ECDR-VT v1 (EC-Council Certified Disaster Recovery and Virtualization Technology Professional v1)
CND v1 (Certified Network Defender v1)

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 [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.

Confidentiality Of Information: 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.)

Disclaimer: EC-Council reserves the right to deny certification to any candidate who attempts to sit for this exam without qualifying as per the
mentioned eligibility criteria. Should the audit team discover that a certification was granted to a candidate who sat for the exam and did not
qualify as per the eligibility criteria, EC-Council also reserves the right to revoke the candidate's certification.

Retention Of Documentation: EC-Council will not retain any supporting documents related to the application beyond a period of 2 years from
date of receipt.

Special Accommodation: Should you have a special accommodation request, you can write to us at [email protected], for more
information on our special accommodation policy please refer to https://cert.eccouncil.org/special-accommodation-policy.html
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EC-Council Exam Eligibility Application Form v3

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:

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EC-Council Exam Eligibility Application Form v3

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.