APPLICATION FORM FOR CERTIFICATION

Version 1/2014
PERSONAL DETAILS:
NAME AND SURNAME:
CERTIFICATION NUMBER:
(if already certified)
ACHIEVED LEVEL OF EDUCATION:
(e.g. Diploma in…)
DATE OF BIRTH:

PERSONAL ADDRESS:

CITY‘: COUNTRY:

POSTCODE/ZIP CODE: TEL:

Email: MOBILE:
The applicant confirms that he/she is aware of the requirements in the applicable Certification Scheme and that the outcome of the
certification process is subject to assessment by the person responsible for deliberation and ratification of ERCA. The applicant must agree
to the statement in the Guidelines for Certification, the Code of Ethics and the Guide on how to use the ERCA Mark (Annexes to Guideline
for Certifications). The documents can be found on our website www.erca-academy.com.

I HEREBY APPLY FOR THE ERCA CERTIFICATION:

Please complete which professional figure, type of training course and scheme you wish to apply for (select from the following):

PROFESSIONAL FIGURE:

TRAINING COURSE:

CERTIFICATION SCHEME:

DECLARATION:
I apply for certification and confirm that I understand and agree with the following conditions:
◊ the details which I have given on the application form will be published in the ERCA register
◊ I shall declare any information that may affect adversely my ability to perform effectively my Audit obligations
◊ I shall observe and abide by the ERCA Code of Ethics.
I confirm that the information contained in this application form (including any attachments) is correct to the best of my knowledge
and belief. I understand that, once certified, I am obliged to notify ERCA without any delay changes to my circumstances.

______________________________ ______________________________
Date Signature

DOCUMENTARY EVIDENCE REQUESTED TO ATTACH:

◊ CURRICULUM VITAE structured
◊ EDUCATION DEGREE (attach a copy of diploma, degree)
◊ IDENTITY CARD (attach a legible valid copy)
◊ SPECIAL TRAINING/FORMATION (attach a copy of certificates, and training course attestations, and of any other courses
necessary to update, for the applicable Regulations or Standards.
◊ WORK EXPERIENCE (attach documentary evidence to support the years requested by the scheme)
◊ AUDIT EXPERIENCE (attach ERCA AuditLog Form or Audit list signed and stamped by the CB of provenance, it must be clearly
stated the name of the Lead Auditor with which they were carried out audits in coaching and eventual Technical Expert ).
Note: ERCA or ERCA Representative is authorised to verify any information provided in this application, including its attachments . All
application materials that are submitted remain confidential.

ERCA (European Register of Certificated Auditors)

Rond Point Schuman 6, Box 5, 1040 Brussels, Brussels EU Commission Location, Belgium