APPLICATION FOR CERTIFICATION | ISO22301 Scheme

*****

DATE (YYYY/MM/DD): _____________________________

1. Certification type
Please ensure that all information submitted is clear, as any information that may be un-
readable will delay the processing of your application.

ISO 22301 Foundation Certification ($200)

ISO 22301 Auditor Certification

ISO 22301 Provisional Auditor ($500)

ISO 22301 Auditor ($500)
ISO 22301 Lead Auditor ($500)

ISO 22301 Implementer Certification

ISO 22301 Provisional Implementer ($500)

ISO 22301 Implementer ($500)
ISO 22301 Lead Implementer ($500)

ISO 22301 Master ($500)

Page 1 of 11 PECB-840 Application for certification Scheme ISO22301

Please ensure you have read the conditions for each certification and you met all the criteria
prior to applying
Grade Exam Professional BCMS BCMS Other
experience Audit project requirements
experience experience
ISO 22301 ISO 22301 None None None Signing the
Provisional Lead Auditor PECB code of
Auditor Exam ethics

ISO 22301 ISO 22301 Two years Audit None Signing the
Auditor Lead Auditor One year of activities PECB code of
Exam BCMS work totalling ethics
experience 200 hours

ISO 22301 ISO 22301 Five years Audit None Signing the
Lead Auditor Lead Auditor Two years of activities PECB code of
Exam BCMS work totalling ethics
experience 300 hours

ISO 22301 ISO 22301 None None None Signing the

Provisional Lead PECB code of
Implementer Implementer ethics
Exam

ISO 22301 ISO 22301 Two years None Project Signing the
Implementer Lead One year of activities PECB code of
Implementer BCMS work totalling 200 ethics
Exam experience hours

ISO 22301 ISO 22301 Five years None Project Signing the
Lead Lead Two years of activities PECB code of
Implementer Implementer BCMS work totalling 300 ethics
Exam experience hours

ISO 22301 ISO 22301 Ten years Audit Project Signing the
Master Lead Auditor Six years of activities activities PECB code of
Exam BCMS work totalling totalling 500 ethics
ISO 22301 experience 500 hours hours
Lead
Implementer
exam

Page 2 of 11 PECB-840 Application for certification Scheme ISO22301

2. Applicant Information

*Title (Mr., Ms.)

*First name

Middle name/initial

*Last name

Maiden name / former name

Name you wish to appear on

certificate
Birth date (optional)
yyyy/mm/dd
*Home address

Street address line 2

*City

*Country

*Province/State/Region

*ZIP/Postal code

*Applicant email address #1

Applicant email address #2

*Applicant daytime telephone

Applicant evening telephone

Fields marked with an asterisk (*) are required

Page 3 of 11 PECB-840 Application for certification Scheme ISO22301

3. ISO 22301 Exam(s)

*Exam passed (please choose): ISO 22301 Lead Auditor

ISO 22301 Lead Implementer

Other (please specify): _________________________

*Exam or certificate number

*Date of achievement

*Exam supplier

*if exam provider is other than PECB, please send us a copy of certificate
Other details

Fields marked with an asterisk (*) are required

Page 4 of 11 PECB-840 Application for certification Scheme ISO22301

4. Work Experience (*please send us your most updated CV or Resume with your
application)
Present employer information
*Job title

*Business name

*Business Address 1

Business Address 2

*City

*Country

*State/Province/Region

* Zip/Postal code

Business webpage

*Immediate supervisor name

*Supervisor title

*Date started
yyyy/mm

* Job experience related to Business Continuity. Yes | No (if Yes, please fill below)

BCMS Audit Experience

*Number of hours of BCMS audit experience: ___________
Details (can be included in your resume): _________________________________________________

BCMS Project Management

*Number of hours of BCMS Project Management: __________
Details (can be included in your resume): _________________________________________________

Fields marked with an asterisk (*) are required

Page 5 of 11 PECB-840 Application for certification Scheme ISO22301

Other work experience 1 (if applicable)

*Employer

* Job title
*Business name

*Business Address 1

Business Address 2

*City

*Country

*State/Province/Region

* Zip/Postal code

Business webpage

*Dates of employment
from _ _ _ _ /_ _ _ to _ _ _ _ / _ _ yyyy/mm

* Job experience related to Business Continuity. Yes | No (if Yes, please fill below)

BCMS Audit Experience

*Number of hours of BCMS audit experience: ___________
Details (can be included in your resume): _________________________________________________

BCMS Project Management

*Number of hours of BCMS Project Management: __________
Details (can be included in your resume): _________________________________________________

Fields marked with an asterisk (*) are required

Page 6 of 11 PECB-840 Application for certification Scheme ISO22301

Other work experience 2 (if applicable)

*Employer

* Job title
*Business name

*Business Address 1

Business Address 2

*City

*Country

*State/Province/Region

* Zip/Postal code

Business webpage

*Dates of employment
from _ _ _ _ /_ _ _ to _ _ _ _ / _ _ yyyy/mm

* Job experience related to Business Continuity. Yes | No (if Yes, please fill below)

BCMS Audit Experience

*Number of hours of BCMS audit experience: ___________
Details (can be included in your resume): _________________________________________________

BCMS Project Management

*Number of hours of BCMS Project Management: __________
Details (can be included in your resume): _________________________________________________

Fields marked with an asterisk (*) are required

Page 7 of 11 PECB-840 Application for certification Scheme ISO22301

Please highlight the sectors (max. 9) of industry where your work experience can apply (NACE Code)

Agriculture & Hunting Concrete, Cement, Lime, Wholesale & Retail of

Forestry Plaster, etc. Food, Beverages &
Fishing Basic Metals & Tobacco
Mining & Quarrying Fabricated Metal Wholesale & Retail of
Extraction of Crude Oil & Products Pharmaceuticals
Natural Gas Hotels & Restaurants
Food & Beverage Machinery & Equipment Transport and Storage
Products (excluding Electrical Equipment (excluding
Tobacco) (excluding medical Communications)
Tobacco equipment) Communication
Textile & Textile Products Manufacture of Medical
Manufacture of Wearing Equipment Financial Intermediation
Apparel Manufacture of Motor Real Estate & Renting
Leather & Leather Vehicles Information Technology
Products Shipbuilding Research & Development
Wood & Wood Products Railway Locomotives and Other Services
Pulp, Paper & Paper Rolling Stock (excluding architectural,
Products Aerospace engineering & legal
Publishing Other Transport services)
Printing Companies Equipment Architectural &
Manufacture of Coke & Manufacture of Furniture Engineering Activities
Petroleum Products Manufacturing not
(excluding Nuclear elsewhere classified Legal Activities
Materials) Manufacture of Sports Public Administration
Nuclear Fuel Goods & Toys Education
Chemicals & Chemical Recycling Health (excluding social
Products (Excluding Electricity Supply work and veterinary
Pharmaceuticals) Gas Supply medicine)
Pharmaceuticals Water Supply Social Work
Rubber & Plastic Construction Veterinary Medicine
Products Wholesale & Retail Trade Sewage and Refuse
Non-metallic Mineral (excluding food & Disposal, Sanitation &
Products (excluding pharmaceuticals similar activities
concrete, cement, lime & Sale, Maintenance & Other Social Services
plaster) Repair of Motor Vehicles

Page 8 of 11 PECB-840 Application for certification Scheme ISO22301

5. Education and Certification

*Indicate the highest degree obtained

Have not completed high school
High School
College
Certificate
Bachelors degree
Advanced graduate degree
Masters degree
Doctorate

Professional certifications (indicate the professional certification already obtained-if applicable)

1. Certification: ____________________________, Issued by: ____________________, Date: ________________

2. Certification: ____________________________, Issued by: ____________________, Date: ________________

3. Certification: ____________________________, Issued by: ____________________ , Date: ________________

4. Certification: ____________________________, Issued by: ____________________ , Date: ________________

5. Certification: ____________________________, Issued by: ____________________ , Date: ________________

Fields marked with an asterisk (*) are required

Page 9 of 11 PECB-840 Application for certification Scheme ISO22301

6. Professional Experience (Please provide minimum of 2 references that can confirm your
professional experience.)

Reference 1
* First Name

Middle name/initial

*Last Name

*Relationship to applicant

*Business name

*Telephone number

* Email

Reference 2
* First Name

Middle name/initial

*Last Name

*Relationship to applicant

*Business name

*Telephone number

* Email

Fields marked with an asterisk (*) are required

Page 10 of 11 PECB-840 Application for certification Scheme ISO22301

 7. Declaration
I apply for certification and confirm that I understand and agree to the following conditions
I confirm that the information contained in this application is correct to the best of
my knowledge and belief.
I have declared any information that may reasonably be considered to affect
adversely my certification evaluation.
I will observe the PECB code of conduct.
I will observe PECB rules and policies applicable to my certifications.
I understand that, if I provide incorrect information or withhold relevant
information, I am likely to be excluded or removed from the PECB register.
* All the conditions above are mandatory

To read PECBs code of ethics please visit: http://pecb.org/en/about-pecb/pecb-code-of-ethics

In case you are necessarily in need of accommodation due to special needs, please contact
certification@pecb.org

Please choose one of the following options to send us your application with other required
documents (copy of certificates and resume or CV):

By fax: 1-888-603-9595
Email: certification@pecb.org

Fields marked with an asterisk (*)

are required

Page 11 of 11 PECB-840 Application for certification Scheme ISO22301