Application for Additional Certification v5.1

Name*

First NameMiddle NameLast NameSuffix

Preferred Email*

example@example.com

Certificate Number*

Please use 4 digits for this number. If your certificate number has fewer than 4, please use leading 0s.

Certificate Expiration Date*

Date

Do you hold an FKE certification only?

YesNo

Select the certifications that you are applying form. Please note that each examination requires a separate application fee. If you are applying to take a Field Test, please select "Other" and note the certification that you are seeking.*

Present Employer*

Date of Employment*

Date

Phone Number*

Please enter a valid phone number.

Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Job Title*

Date started current job.*

Date

Date discipline training began*

Date

Date discipline training ended*

Date

Date approved for casework in discipline*

Date

Briefly describe your job duties:*

Upload a copy of your Authorization to Perform Work or equivalent record to demonstrate that you have been approved to perform work in your selected discipline(s).*

Provide a copy of your diploma(s), official transcript(s), or other information verifying your degree and major. Redact your birthday and/or Social Security Number if those items are present on your document.*

Name of your technical leader or direct supervisor*

First NameLast Name

E-mail of technical leader or direct supervisor*

example@example.com

Phone Number of technical leader or direct supervisor*

Please enter a valid phone number.

Employer*

Title*

Name of second professional reference*

First NameLast Name

Email of second professional reference*

example@example.com

Phone Number of second professional reference*

Please enter a valid phone number.

Employer*

Title*

Please indicate below if you are able to provide the name and e-mail of your laboratory director (preferred) or immediate supervisor.*

YesNo

Name of laboratory director or immediate supervisor*

First NameLast Name

E-mail address of laboratory director or immediate supervisor*

example@example.com

I am unable to have this application reviewed and confirmed by the laboratory director or my immediate supervisor due to the following reasons:*

Name of Witness*

First NameLast Name

Position*

Relationship to Applicant*

Email of Witness*

example@example.com

Please note that the ABC allows for Testing Accommodations for qualifying candidates. Applications for testing accommodations must be received 60 days prior to sitting for an examination. Visit our website for more information. Will you be applying for testing accommodations?*

YesNo

I am requesting an additional certification and agree to the following conditions:

I will not discuss the contents of the Certification Examination with anyone except the American Board of Criminalistics Board of Directors or its representative;
I will not participate in fraudulent test-taking practices;
I will provide the American Board of Criminalistics Board of Directors additional information pertinent to the proper processing of this application;
I will notify the Registrar’s Office if my employment changes between the time I complete this application and the time I am certified;
I waive any right to confidentiality of the information supplied on this application and any additional information requested by the American Board of Criminalistics Board of Directors relating to the processing of the application;
I acknowledge that in the event of any misstatement or misrepresentation of a material fact in the Application process, or in the event that any of the aforementioned conditions are violated by me, the American Board of Criminalistics may disqualify me from receiving a Certificate; suspend such a Certificate; revoke such a Certificate; or require the surrender of such a Certificate to the American Board of Criminalistics.
I will hold the American Board of Criminalistics, its officers, examiners, and agents free from any claim, damage, or liability by reason of action, they or any of them may take with respect to this application, including but not limited to the failure of the American Board of Criminalistics to issue to me such Certificate, or the suspension, revocation, or making of any demand for the surrender of an issued Certificate, or the removal of my name from the list of persons certified.
In the event that I am not approved to sit for an examination or I do not pass an examination, I agree to unconditionally release the American Board of Criminalistics, its board of directors, committee members, affiliates, and agents (“Released Parties”) from any and all claims, causes of action, suits, demands, injury, or loss, including but not limited to loss of current employment or inability to obtain employment. I fully understand the terms of this Agreement and acknowledge my entire settlement of any and all claims against the Released Parties. I further agree that if I am not approved to sit for an examination or I do not pass an examination, that any and all recourse shall be strictly governed by the appeals process set forth in the American Board of Criminalistics Challenges and Appeals Procedure (09-09).

Signature*

Date*

Date

Application for Additional Certification

Personal Information

Professional Qualifications

Professional References

Technical Leader or Direct Supervisor

Second Professional Reference

Statement of Application Confirmation

Declaration