2447 Cap Exam Application Form (Page 3 of 3) in pdf

2447 Cap Exam Application Form Page 3

Contact ISA at (919) 549-8411 if you have questions regarding employment verification.

C. EDUCATION

If your eligibility for CAP was based on attaining a four year technical degree, submit an official transcript of the academic work submitted

on your certification application. Copies are not acceptable.

I certify that the information I have provided in this application is complete and accurate to the best of my knowledge and belief. I autho-

rize ISA to contact my current and any former employers and educational institutions to verify the provided information, and I waive any

and all rights of confidentiality or privacy with regard to the release of all employment or educational information relevant to my applica-

tion to ISA for recognition as a Certified Automation Professional.

I hereby waive and release ISA, my current and former employers, and any educational institutions I have attended, and their respective

officers, directors, and representatives, from any claims arising from the disclosure of such information to ISA for the purposes of ISA evalu-

ation of this application. I understand that ISA will reject any application that contains false or fraudulent information, and that, in that

event, I will not receive reimbursement of any fees paid, nor credit for any examinations taken. If the fraud is discovered after certification

is awarded, certification will be revoked.

I understand that I must complete all audit forms and return them to ISA within sixty (60) days of audit notification. Failure to do so will

result in revocation of your application and certification.

_____________________________________________________________________

_________________________________

signature of applicant

date

Return Audit Information to :

ISA

CAP Program Audit

PO Box 12277

Research Triangle Park, NC 27709 USA

92-2447-088

2447 Cap Exam Application Form Page 3