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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: envirodangers@yahoo.com,
or FAX to 63-35-226-3219.
Full
name:_______________________________________________________________________________
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 Mold Inspector and Certified Mold
Remediator combination -- tuition
US$998 for both PCI professional designation certifications
Certified Mold Inspector and Certified Mold Remediator, plus US$198
first year PCI certification membership dues total for both designations,
for a total of US$1,196.
____
Certified
Environmental Hygienist--tuition
$499.00 including first year membership certification dues in PCI.
____
All three Certifications in one
Money-Saving Combination. Be trained and Certified as Certified Mold
Inspector, Certified Mold Remediator, and Certified
Environmental Hygienist for only US$1,999.00 including first year PCI
Certification membership dues a saving of US$295.
____ Certified Environmental Science Technician---tuition
$299, including first year membership certification dues in PCI of
All
payments are in US$.
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 at the top of the
home page,
or by my personal or business check, or money order payable to
the 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 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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