APPLICANT ENDORSEMENT ASSISTANCE FORM

PLEASE USE ADOBE READER when filling out this form electronically
Please complete this form and mail, email or fax it, along with all
supporting documents referred to in this form to:
Mail: Email:
(ISC)2 Programs Programs@isc2.org
Attn: Endorsement Assistance
311 Park Place Boulevard Fax:
Suite 400 (727)786-2989
Clearwater, FL 33759
USA

Use this form only if you are unable to secure a qualified (ISC)² certified professional to endorse you. Endorsement by (ISC)²
may take up to 6 weeks.

You must provide the following supporting documents along with this form:
- Completed Job/Position Worksheets
- Proof of employment for all work experience claims
- Proof of waiver claim (certification or degree) if applicable
- Resume/CV with description of job duties as related to domains

Are you a CISSP holder in good standing : Yes No

CANDIDATE INFORMATION

Last Name/Surname:

First Name/Given:

Examination #:

EDUCATION/CERTIFICATION WAIVER
If certain circumstances apply and with appropriate documentation, candidates are eligible to waive a maximum of one year
of professional experience for education or for holding an additional credential on the (ISC)² approved list.

Approved Certificate (A list of (ISC)² approved certificates can be found for CISSP and for CCFP).
Name: Date:

Proof of certification is attached.

I am claiming a waiver for:

Bachelor Degree Master Degree
University Name: Date:

Major:

Proof of degree is attached.

APPLICANT ENDORSEMENT ASSISTANCE FORM REVISION DATE: 05/13/2015 VERSION 1.1 Page 1
JOB/POSITION WORKSHEET #1

Please complete the Job/Position Worksheet below for each position you are claiming as relevant work experience. We require
that you include proof of employment for each worksheet you complete. Proof should include, when applicable, a letter from
HR or supervisor, signed and on company letterhead.
Employer Name:

Date of Employment From: To:

Month Year Month Year

Supervisor or HR Contact: Name:

Phone: Email:

Job/Position Title:

Full-time Part-time

Were you paid for this position? Yes No

Domain Identification:
This job/position demonstrates experience in the following domains (List the domain name):

Position Duties and Responsibilities:

Proof of this job/position is attached

APPLICANT ENDORSEMENT ASSISTANCE FORM REVISION DATE: 05/13/2015 VERSION 1.1 Page 2
JOB/POSITION WORKSHEET #2

Please complete the Job/Position Worksheet below for each position you are claiming as relevant work experience. We require
that you include proof of employment for each worksheet you complete. Proof should include, when applicable, a letter from
HR or supervisor, signed and on company letterhead.
Employer Name:

Date of Employment From: To:

Month Year Month Year

Supervisor or HR Contact: Name:

Phone: Email:

Job/Position Title:

Full-time Part-time

Were you paid for this position? Yes No

Domain Identification:
This job/position demonstrates experience in the following domains (List the domain name):

Position Duties and Responsibilities:

Proof of this job/position is attached

APPLICANT ENDORSEMENT ASSISTANCE FORM REVISION DATE: 05/13/2015 VERSION 1.1 Page 3
JOB/POSITION WORKSHEET #3

Please complete the Job/Position Worksheet below for each position you are claiming as relevant work experience. We require
that you include proof of employment for each worksheet you complete. Proof should include, when applicable, a letter from
HR or supervisor, signed and on company letterhead.
Employer Name:

Date of Employment From: To:

Month Year Month Year

Supervisor or HR Contact: Name:

Phone: Email:

Job/Position Title:

Full-time Part-time

Were you paid for this position? Yes No

Domain Identification:
This job/position demonstrates experience in the following domains (List the domain name):

Position Duties and Responsibilities:

Proof of this job/position is attached

APPLICANT ENDORSEMENT ASSISTANCE FORM REVISION DATE: 05/13/2015 VERSION 1.1 Page 4
JOB/POSITION WORKSHEET #4

Please complete the Job/Position Worksheet below for each position you are claiming as relevant work experience. We require
that you include proof of employment for each worksheet you complete. Proof should include, when applicable, a letter from
HR or supervisor, signed and on company letterhead.
Employer Name:

Date of Employment From: To:

Month Year Month Year

Supervisor or HR Contact: Name:

Phone: Email:

Job/Position Title:

Full-time Part-time

Were you paid for this position? Yes No

Domain Identification:
This job/position demonstrates experience in the following domains (List the domain name):

Position Duties and Responsibilities:

Proof of this job/position is attached

APPLICANT ENDORSEMENT ASSISTANCE FORM REVISION DATE: 05/13/2015 VERSION 1.1 Page 5
JOB/POSITION WORKSHEET #5

Please complete the Job/Position Worksheet below for each position you are claiming as relevant work experience. We require
that you include proof of employment for each worksheet you complete. Proof should include, when applicable, a letter from
HR or supervisor, signed and on company letterhead.
Employer Name:

Date of Employment From: To:

Month Year Month Year

Supervisor or HR Contact: Name:

Phone: Email:

Job/Position Title:

Full-time Part-time

Were you paid for this position? Yes No

Domain Identification:
This job/position demonstrates experience in the following domains (List the domain name):

Position Duties and Responsibilities:

Proof of this job/position is attached

APPLICANT ENDORSEMENT ASSISTANCE FORM REVISION DATE: 05/13/2015 VERSION 1.1 Page 6
PROFESSIONAL WORK EXPERIENCE SUMMARY

Total the number of months of full-time experience you are claiming in each domain. Estimates are acceptable in situations
where job duties are split across multiple domains, but should not add up to more than your total actual experience.

Domain Identification: Total Number of Months

I claim a 12 month waiver for one of the following:

College Degree

Authorized Certification
Total Qualifying Months:

SUPPORTING DOCUMENTATION

I have included all of the following documentation to support my work experience claim:

Description of job duties as related to domains

Copy of Certificate/Diploma/letter from University or other to support my waiver claim (if applicable)

Proof of employment for each Job/Position Worksheet

Contact Information for supervisor/manager for each position listed (name, phone, and email).

APPLICANT ENDORSEMENT ASSISTANCE FORM REVISION DATE: 05/13/2015 VERSION 1.1 Page 7
"MEMBER IN GOOD STANDING"
To remain in good standing, members must:
1.) Abide by the (ISC)² Code of Ethics (https://www.isc2.org/ethics);
2.) Submit Annual Maintenance Fees (AMFs) upon receipt of annual invoices; and
3.) Obtain and submit the required Continuing Professional Education (CPE) credits.
4.) Agree to the terms of the (ISC)² Examination Agreement, which governs your relationship with (ISC)².

Upon certification, (ISC)² members may use their designations (CISSP, CAP, HCISPP, CSSLP, CCFP, CCSP, SSCP etc) subject to
(ISC)² Logo Guidelines - as long as their certification remains in "good standing".

Members in "good standing" have the right to elect (ISC)² Board directors, attend (ISC)²'s annual meeting, volunteer for various
committees and activities, provide endorsement of a candidate for an (ISC)² certification and participate on (ISC)²
Committees.

APPLICANT AGREEMENT

I as a candidate for this certification, hereby request (ISC)²'s assistance in the

endorsement process and authorize (ISC)² to provide my certification application, education/employment history, and other
relevant documents to an appropriate (ISC)² representative, to render an opinion as to my qualifications of certification and,
if appropriate, endorse my application. I agree to provide immediate, full and relevant feedback to any party reviewing my
qualifications for endorsement purposes. For such purposes, the following email address should be used:

E-mail:
In exchange for (ISC)²'s assistance in providing an appropriate (ISC)² certificate holder to review, and possibly, endorse, my
records for certification, I agree to hold (ISC)² and the selected (ISC)² certificate holder reviewing my records harmless for any
action or inaction that might arise from reviewing my records and rendering a professional opinion, whether positive or
negative, regarding my qualifications for certification by (ISC)².
I have read the (ISC)² Code of Ethics and hereby confirm that I will comply with it. All information provided by me in this
application is true to the best of my knowledge. (ISC)² may, at its sole discretion, make inquiry of individuals and organizations
directly or indirectly referenced in any part of this application to verify the accuracy and completeness of the information I
have provided. I agree to inform (ISC)², without delay, of matters that affect my ability to continue to fulfill the certification
requirements and remain in good standing including, but not limited to, a violation of the (ISC)² Code of Ethics. I further
agree to cooperate in any such investigation by (ISC)² regarding the information I have provided, including my criminal
history. I understand that providing any information that is fraudulent, or failing to completely or accurately disclose facts
known to me, or my failure to cooperate in any inquiry by (ISC)² into the information I have provided, will result in the refusal
of (ISC)² to issue the credential to me, and being forever barred from holding the credential.

I HAVE READ AND UNDERSTAND THESE STATEMENTS AND INTEND TO BE LEGALLY BOUND BY THEM.

Name: Examination #: Date:

Signature: Date:
(Print and sign or Digital Signature)

FOR OFFICE USE ONLY

I , hereby affirm that I am (in "Good Standing")

Select One:

Certification Number: Position/Job Title:

I give this endorsement freely and without any conflict of interest, am acting in my professional capacity recognizing that
material misrepresentations or omissions may make me subject to discipline, and recognizing that the integrity of the
certification depends upon the quality of my endorsement.

Date Endorser's Signature

© Copyright 2015 (ISC)², Inc. All rights reserved. All contents of this form constitute the property of (ISC)², Inc. and may not be copied, reproduced or distributed without prior written permission.
All marks are the property of the International Information Systems Security Certification Consortium, Inc.
APPLICANT ENDORSEMENT ASSISTANCE FORM REVISION DATE: 05/13/2015 VERSION 1.1 Page 8