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Please print, complete (in legible black ink printing), & sign this PCI training application,
along
with
the P.C.I. Code of Ethics,
and send both this application and the signed Code of Ethics
to P.C.I. by
email attachment to: envirodangers@yahoo.com.
Full
name:________________________________________________________________
Mailing
address:____________________________________________________________
_________________________________________________________________________
City:_____________________________ State: ________________ Zip Code:
__________
Country:____________ Daytime phone: (________ )_________________________
Evening
phone: (______)_______________ Email:_______________________________
Designation(s) I desire (upon successful
completion of each certification designation training program, which can
be done simultaneously with one another):
____ Certified Mold
Inspector---tuition $299.00 including first year membership
certification dues in PCI.
____
Certified Mold
Remediator--tuition $299.00 including first year membership
certification dues in PCI.
____
Certified
Environmental Hygienist--tuition
$499.00 including first year membership certification dues in PCI.
If I am
accepted by the Professional Certification Institute, I, and the
organization that I may represent, will always follow and abide by the
Code
of Ethics of P.C.I. I understand and agree that my professional
designations will be terminated if I violate the
Code of Ethics, or if I
do not pay my annual renewal PCI membership dues (currently $49.00 per
certification designation). To accompany this training application,
I will make payment to PCI by
using one of the Credit Card Payment Options listed at the bottom this page,
or by my
personal or business check, or money order payable to Professional
Certification Institute.
If
you have completed ANY post-high school college, trade, or
technical education programs of any kind, please provide the details
including school name, school location, year of graduation or completion
of course, subjects studied, and any other helpful info. Attach extra
sheets of paper if needed.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please describe in detail all
or your business/work/career experiences that you believe would be helpful
to your successful career as a certified environmental professional.
[please include details such as skills learned, employer names and
addresses, and dates]. Attach extra sheets of paper if needed.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please provide the names,
nature of relationship [how you know each person], company [if relevant],
complete mailing address, and current phone number of at least three
persons who personally know your work abilities and/or general character.
Your most ideal references would be your business/professional clients or
co-workers. Please do NOT submit references who are your relatives or
employees. Attach extra sheets if needed.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I
certify that the above information is totally true and complete. I
authorize my references to provide complete information about myself to
the Professional Certification Institute.
___________________________________
____________________
My
Signature
Date
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