Full Name
*
First Name
Last Name
Business Phone
*
(including Country e.g. US/Canada is 1)
Country
(###)
###
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Alternate Phone Number (optional):
(including Country e.g. US/Canada is 1)
Country
(###)
###
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Business Email
*
Alternate Email (optional):
Mailing Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Credential(s) you wish to renew/maintain:
*
If Other above, please specify:
Certification Number(s), (if known)
For Base-Level and Pro-Level credential holders: I hereby confirm that I completed at least 12 hours of relevant training/education over the prior 12 months
*
For Pro-Level credential holders only: I hereby certify that I have at least 3,600 hours (total) of relevant work experience over the prior three years.
Name of First Professional Verifier:
First Name
Last Name
Phone of First Professional Verifier:
(including Country e.g. US/Canada is 1)
Country
(###)
###
####
Email of First Professional Verifier:
Your relationship to the verifier above:
Select one of the below
I directly report to the above person
I used to report to the above person
The person above is my colleague
The person above is my client
Other (please specify):
If Other (above), please specify:
Name of Second Professional Verifier:
First Name
Last Name
Phone of Second Professional Verifier:
(including Country e.g. US/Canada is 1)
Country
(###)
###
####
Email of Second Professional Verifier:
Your relationship to the verifier above:
Select one of the below
I directly report to the above person
I used to report to the above person
The person above is my colleague
The person above is my client
Other (please specify):
If Other (above), please specify:
Name of Third Professional Verifier:
First Name
Last Name
Phone of Third Professional Verifier:
(including Country e.g. US/Canada is 1)
Country
(###)
###
####
Email of Third Professional Verifier:
Your relationship to the verifier above:
Select one of the below
I directly report to the above person
I used to report to the above person
The person above is my colleague
The person above is my client
Other (please specify):
If Other (above), please specify:
By submitting the application for certification, the candidate acknowledges that they have read, understood, and agree to abide by the Code of Ethics outlined below. Failure to comply with these ethical standards may result in the revocation of certification or disqualification from receiving the certification.
*
Code of Ethics
I commit to uphold the highest standards of integrity, professionalism, and accountability. I pledge to:
1. Integrity and Honesty: Conduct all activities with honesty and integrity; avoid any conduct that would discredit my profession, organization, or certification; accurately represent my qualifications, experience, and affiliations.
2. Professional Competence: Maintain the knowledge and skills necessary to perform my duties effectively; commit to ongoing professional development and continuous learning; only undertake tasks for which I am qualified through education, training, or experience.
3. Confidentiality and Privacy: Protect the confidentiality of information acquired during professional activities unless authorized or legally obligated to disclose it; respect the privacy rights of individuals and organizations.
4. Objectivity and Independence:
Maintain objectivity and avoid conflicts of interest; disclose any potential or actual conflicts of interest promptly; base all judgments and decisions on accurate and relevant data, free from undue influence.
5. Compliance with Laws and Standards: Adhere to all applicable laws, regulations, and professional standards; promote ethical behavior and compliance within my organization; support effective internal controls and risk management practices.
6. Accountability and Responsibility: Accept responsibility for my actions and decisions; promptly report unethical or illegal conduct; foster a culture of accountability, integrity, and ethical behavior.
7. Respect and Fairness: Treat all individuals with fairness, dignity, and respect; promote diversity and inclusion in the workplace and profession; avoid discrimination, harassment, and abusive conduct.
Acknowledgement
*
By submitting this application, I confirm that the information I’ve provided is accurate and complete to the best of my knowledge. I understand that applying does not guarantee approval. My eligibility will be determined solely based on the information I provide, and any false or misleading details may result in cancellation of any credential awarded. I understand that all fees paid are non-refundable.
I authorize Sarbanes Oxley Group LLC to verify the contents of my application and assess my professional standing through any inquiries it deems necessary. I understand that this application and related materials will be kept confidential unless I authorize disclosure or disclosure is legally required. I also consent to Sarbanes Oxley Group LLC using anonymized application data for statistical or program-related analysis.
I release Sarbanes Oxley Group LLC, along with its staff, board members, examiners, and agents, from liability for any actions or decisions related to this application, including denial or withdrawal of certification.
I understand that Sarbanes Oxley Group LLC has the sole and final authority to determine my eligibility. I understand that Sarbanes Oxley Group LLC reserves the right to modify the requirements, nomenclature, process, prices, or criteria for certifications at any time. I have read this statement in full and agree to be legally bound by its terms.
