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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,
scan both documents, and then email both this application and the signed
Code of Ethics to P.C.I. by
email attachment to: moldtraining@moldinspector.com
Full
name:______________________________________________________________________________________
Age: ________
Mailing
address:_____________________________________________________________________________________________
City:_______________________________ State: __________________
Postal Code: __________ Country:_________________
Daytime phone: (________ )_____________________ Evening phone:
(________ )____________________
Email address:____________________________________________________________________________________
Designation(s) I desire (upon successful
completion of each certification designation training program, which can
be done simultaneously with one another):
____
Certified Environmental Hygienist -
Tuition is only US$499 for your online
distance training and certification as a Certified Environmental
Hygienist, including first year $99 PCI environmental hygienist
certification membership dues.
____
Certified Mold Inspector
-
Tuition is only US$299 for your online
distance training and certification as a Certified
Mold Inspector, including first year PCI certification membership dues
for the first year.
____ Certified Mold Remediator -
Tuition is only US$299 for your online
distance training and certification as a Certified Mold
Remediator, including first year PCI certification membership dues for
the first year.
____
Certified Mold Inspector and
Certified Mold Remediator COMBINATION -
SAVE $99 for the CMI/CMR
combination. Tuition is only US$499 for both PCI professional designation certifications Certified
Mold Inspector and Certified Mold Remediator, including
first year PCI certification membership dues total for both designations.
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 $99.00 per
certification designation). To accompany this training application,
I will make payment
to PCI by using one of the PayPal payment links on the
home page,
or by bank wire (contact us for bank wire instructions) or direct bank
deposit to to any nationwide USA branch of Chase Bank (contact us for bank
account deposit details) or by mailing your check or money order payable
to Enviro Mold Mart USA, P.O. Box 32002, Mesa, AZ 85275, USA.
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 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 |
