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APPLICANT ENDORSEMENT FORM

Please complete online or legibly print in black or blue ink all information.
Fax to: 727.738.8522
Please attach Candidate's resume (curriculum vitae) fax
or sign and mail form to: (ISC)² 2494 Bayshore Boulevard, Suite 201,
Dunedin, FL 34698 USA
CANDIDATE INFORMATION

Last Name/Surname:

First Name/Given:

Examination Number: (as assigned by (ISC)², Inc.

Select One: CISSP® CAP® SSCP®

ENDORSER INFORMATION

First Name/Given:

Last Name/Surname:

Email Address:

Phone: Fax Number:

ENDORSEMENT

I , hereby affirm that I am (in "Good Standing")

Select One: CISSP® CAPCM SSCP® ISSAP® ISSMP® ISSEP®

Certification Number: Position/Title:

and that I personally know, or have researched and reviewed to the best of my ability, the work history, experience, and
reputation of the above-referenced candidate and find that he/she meets the requirements of certification as prescribed by (ISC)².
In support of my findings, I have attached a copy of the candidate's resume/experience (cirriculum vitae) as presented to me by
the candidate. Based upon my findings, I hereby endorse the above-referenced candidate for certification.

Submitted this the day of ,20

Endorsers' Signature (Print and Sign, or Online Signature):

"Member in Good Standing"

"MEMBER IN GOOD STANDING"

Upon certification, (ISC)² members may use their designations (CISSP, SSCP, etc), subject to (ISC)² Logo Guidelines - as long as their certification remains in
"good standing". To remain in good standing, members must:
1.) Abide by the (ISC)² Code of Ethics (https://www.isc2.org/ethics );
2.) Submit Annual Maintenance Fees (AMFs) upon receipt of annual invoices; and
3.) Obtain and submit the required Continuing Professional Education (CPE) credits.
Members in "good standing" have the right to elect (ISC)² directors, attend (ISC)²'s annual meeting, volunteer for various committees and activities, provide
endorsement of a candidate for an (ISC)² Certification and participate in other important functions of (ISC)².
Please check member directory (https://isc2.org/cgi-bin/directory.cgi?displaycategory=503) to find a credential holder in your area.
© Copyright 2008 (ISC)², Inc. All rights reserved. All contents of this form constitute the property of (ISC)², Inc. and may not be copied, reproduced or distributed without prior written permission.
All marks are the property of the International Information Systems Security Certification Consortium, Inc.
(ISC)² Examination Registration Form (2008-02-01) Page 1 of 2
 ONLY IF you need a Credentialed Endorser:

If you are unable to find a credentialed endorser in your area, please send the "Applicant Endorsement Form" along with the
documentation listed to the office below.
- Copy of College Degree/Diploma, if applicable.

- Up to date Resume'/Curriculum Vitae (including phone numbers, and positions held (title), descriptions of duties,
supervisor names, and addresses of each employer listed.

- Any other employment records, job descriptions or other doucments that would establish the required professional
experience was in fact obtained.

Please send to: (ISC)² Services

2494 Bayshore Boulevard
Suite 201
Dunedin, FL 34698
USA
Fax #: 727.738.8522
Phone: 1.888.333.4458

WAIVER:

I as a candidate for the certification, hereby

request (ISC)² 's assistance in the endorsement process and authorize (ISC)² to provide my certification application, education/
employment history, and other relevant documents to an appropriate (ISC)² representative, to render an opinion as to my
qualifications for certification and, if appropriate, endorse my application. I agree to provide immediate, full and relevent
feedback to any party reviewing my qualifications for endorsement purposes. For such purposes the following email address
should be used:

I understand and agree that this request is contrary to the (ISC)² Privacy Policy and am requesting (ISC)² waive the Privacy
Policy concerning my records for the sole purpose of seeking endorsement assistance for me. Upon completion of the
endorsement process, my records will continue to be subject to the (ISC)² Privacy Policy.

In exchange for (ISC)²'s assistance in providing an appropriate (ISC)² certificate holder to review, and possibly endorse, my
records for certification, I agree to hold (ISC)² and the selected (ISC)² certificate holder reviewing my records harmless for any
action or inaction that might arise from reviewing my records and rendering a professional opinion, whether positive or
negative, regarding my qualifications for certification by (ISC)².

Name: Application #: Date:

APPLICANT AGREEMENT
I have read the (ISC)² Code of Ethics and hereby confirm that I will comply with it in the future.
All information provided by me in this application is true to the best of my knowledge. (ISC)² may, at its sole discretion, make inquiry of
individuals and organizations directly or indirectly referenced in any part of this application to verify the accuracy and completeness of the
information I have provided. I further agree to cooperate in any such investigation by (ISC)² regarding the information I have provided, including
my criminal history. I understand that providing any information that is fraudulent, or failing to completely or accurately disclose facts known to
me, or my failure to cooperate in any inquiry by (ISC)² into the information I have provided, will result in the refusal of (ISC)² to issue the
credential to me, and being forever barred from ever attending the credential.

Any action arising out of the application, the examination, or the certification must be brought in the Circuit Court of Suffolk County,
Massachusetts, USA and shall be governed by the laws of the State of Massachusetts.

I HAVE READ AND UNDERSTAND THESE STATEMENTS AND INTEND TO BE LEGALLY BOUND BY THEM.

Signature
Date:
(Print & Sign or Online Signature):
© Copyright 2008 (ISC)², Inc. All rights reserved. All contents of this form constitute the property of (ISC)², Inc. and may not be copied, reproduced or distributed without prior written permission.
All marks are the property of the International Information Systems Security Certification Consortium, Inc.
(ISC)² Examination Registration Form (2008-02-01) Page 2 of 2