Author: Certification Coordinator Title: Certification Application

Approved By: BOD for CP Document Type: Form

Issued: 03.02.2021 Confidentiality: Internal
Last Revised: N/A Reference No: CD-FO-30

TRECCERT CERTIFICATION APPLICATION FORM

In order to obtain TRECCERT certification, you will need to complete the certification application form.

APPLICATION INFORMATION
▪ Please read the guidelines and check the sections before filling the application form.
▪ Fill out the required information in UPPERCASE LETTERS in the PDF format.
▪ Name provided in the application shall match the legal document for certification purposes.
▪ Incomplete applications and missing documents will result in processing delays.
▪ Send your completed application together with all supporting documents to the TRECCERT
Certification Coordinator ([email protected]).

SECTION 1 – APPLICANT INFORMATION

PERSONAL INFORMATION
TITLE (MR., MRS., MS.) BIRTH DATE (DD-MM-YY)
FIRST NAME
MIDDLE NAME
LAST NAME
HOME ADDRESS
CITY
STATE/ZIP CODE
PHONE NUMBER
EMAIL ADDRESS
PRESENT EMPLOYER
JOB POSITION
BUSINESS NAME
BUSINESS ADDRESS
CITY
STATE/ZIP CODE
PHONE NUMBER
EMAIL ADDRESS
PREFERRED CONTACT INFORMATION
1. Preferred Mailing Address 3. Preferred Email Address
☐ Home ☐ Business ☐ Home ☐ Business

2. Billing Address 4. Preferred Phone Number

☐ Home ☐ Business ☐ Home ☐ Business

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 Author: Certification Coordinator Title: Certification Application
Approved By: BOD for CP Document Type: Form
Issued: 03.02.2021 Confidentiality: Internal
Last Revised: N/A Reference No: CD-FO-30

SECTION 2 – CERTIFICATION SCOPE

Please indicate the credential for which you are applying, and read the related certification
requirements.

CERTIFICATION PROGRAMS
☐ ISO/IEC 27001 Lead Implementer ☐ ISO/IEC 27001 Lead Auditor
To become a TRECCERT Certified ISO/IEC To become a TRECCERT Certified ISO/IEC
27001 Lead Implementer, an applicant shall: 27001 Lead Auditor, an applicant shall:

1. Pass the ISO/IEC 27001 Lead Implementer 1. Pass the ISO/IEC 27001 Lead Auditor
exam. exam.
2. Submit the application for certification. 2. Submit the application for certification.
❖ ISO/IEC 27001 Implementer ❖ ISO/IEC 27001 Auditor
▪ Have at least high school education ▪ Have at least high school education
▪ Have 3 years of general work ▪ Have 3 years of general work
experience and 1 year of information experience and 1 year of information
security experience (specific work security experience (specific work
experience) experience)
▪ Have at least 200 hours of ▪ Have at least 200 hours of auditing
implementation experience experience
▪ 1-2 years of general work experience ▪ 1-2 years of general work experience
are waived for obtaining Bachelor’s or are waived for obtaining Bachelor’s or
Master’s Degree. Master’s Degree.
❖ ISO/IEC 27001 Lead Implementer ❖ ISO/IEC 27001 Lead Auditor
▪ Have at least high school education ▪ Have at least high school education
▪ Have 5 years of general work ▪ Have 5 years of general work
experience and 2 year of information experience and 2 year of information
security experience (specific work security experience (specific work
experience) experience)
▪ Have at least 400 hours of ▪ Have at least 400 hours of auditing
implementation experience experience
▪ 1-2 years of general work experience ▪ 1-2 years of general work experience
are waived for obtaining Bachelor’s or are waived for obtaining Bachelor’s or
Master’s Degree. Master’s Degree.
3. Adhere to the CPE Program. 3. Adhere to the CPE Program.
4. Adhere to the TRECCERT Code of Ethics. 4. Adhere to the TRECCERT Code of Ethics.
5. Adhere to TRECCERT Certification 5. Adhere to TRECCERT Certification
Requirements. Requirements.

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 Author: Certification Coordinator Title: Certification Application
Approved By: BOD for CP Document Type: Form
Issued: 03.02.2021 Confidentiality: Internal
Last Revised: N/A Reference No: CD-FO-30

SECTION 3 – CERTIFICATION EXAM

Applicants are required to have passed the exam for a particular TRECCERT certification at
the time of this application.

CERTIFICATION EXAM
EXAM DELIVERY ☐ Classroom ☐ Online EXAM PASSED
(MM-YYYY)

EXAM CODE

SECTION 4 – EDUCATION
Please indicate the highest education level(s) attained at the time of this application.
EDUCATION
EDUCATION LEVEL FIELD OF STUDY
- -
DEGREE #1
NAME OF INSTITUTION
LOCATION
DEGREE EARNED
DATE AWARDED (MM-YYYY)
DEGREE #2 (IF APPLICABLE)
NAME OF INSTITUTION
LOCATION
DEGREE EARNED
DATE AWARDED (MM-YYYY)
DEGREE #3 (IF APPLICABLE)
NAME OF INSTITUTION
LOCATION
DEGREE EARNED
DATE AWARDED (MM-YYYY)

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 Author: Certification Coordinator Title: Certification Application
Approved By: BOD for CP Document Type: Form
Issued: 03.02.2021 Confidentiality: Internal
Last Revised: N/A Reference No: CD-FO-30

SECTION 5 – WORK EXPERIENCE

Please indicate the years of experience and project experience hours at the time of this
application in conformance with the certification requirements included in Section 2.

WORK DETAILS
EMPLOYER #1
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours
EMPLOYER #2
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours
EMPLOYER #3
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours
EMPLOYER #4
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

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 Author: Certification Coordinator Title: Certification Application
Approved By: BOD for CP Document Type: Form
Issued: 03.02.2021 Confidentiality: Internal
Last Revised: N/A Reference No: CD-FO-30

WORK DETAILS
HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)
___________________________________________ Hours
EMPLOYER #5
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)
JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours
EMPLOYER #6
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours
EMPLOYER #7
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours
EMPLOYER #8
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours
EXPERIENCE CATEGORY

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 Author: Certification Coordinator Title: Certification Application
Approved By: BOD for CP Document Type: Form
Issued: 03.02.2021 Confidentiality: Internal
Last Revised: N/A Reference No: CD-FO-30

WORK DETAILS
EMPLOYER #9
EXPERIENCE
☐ General Work Experience ☐ Specific Work Experience
CATEGORY
COMPANY NAME
ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours
EMPLOYER #10
EXPERIENCE
CATEGORY ☐ General Work Experience ☐ Specific Work Experience

COMPANY NAME

ADDRESS
(CITY/STATE)

JOB ROLE
START/END DATE -
(DD-MM-YY) - (DD-MM-YY)

HOURS OF PROJECT EXPERIENCE (IF APPLICABLE)

___________________________________________ Hours

EDUCATION WAIVER
To apply for an education waiver, please indicate the appropriate waiver categories and calculate
the total years of general work experience below and attach the relevant diploma(s) with the
waiver request.

☐1-year waiver for a bachelor’s degree

☐2-years waiver for a master’s degree
0
_______________________________ + _______________________________ = ___________________________________ Years
General Work Experience Education Waiver Total General Work Experience

Please fill out the Experience Verification form(s) to document the required
experience/project experience hours, and submit it together with this application.

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 Author: Certification Coordinator Title: Certification Application
Approved By: BOD for CP Document Type: Form
Issued: 03.02.2021 Confidentiality: Internal
Last Revised: N/A Reference No: CD-FO-30

SECTION 6 – DECLARATION

TERMS AND CONDITIONS

TRECCERT CODE OF ETHICS

I agree to:

▪ Act independently, with integrity and objectivity.

▪ Maintain a high standard of ethical and professional conduct.
▪ Protect confidential and proprietary information obtained in the course of becoming certified and
further professional activities.
▪ Comply with TRECCERT requirements, policies and rules relevant to a particular certification scheme.
▪ Comply with applicable laws and regulations of the place and field where professional activities are
performed.
▪ Not present fraudulent documents and evidence when applying for certification, recertification,
upgrades or transfers.
▪ Not share, disseminate, or otherwise disclose any information pertaining to the TRECCERT
examination materials, processes, platforms and related information.
▪ Not share, disseminate, or otherwise disclose any information pertaining to the TRECCERT
certification process and related information.
▪ Not practice during the period of any suspension, revocation or other restriction on certification issued
by TRECCERT.
▪ Place credential(s) on inactive status for any adversity that might interfere with their professional
practice.
▪ Not produce, publish and create false, deceptive or misleading advertisement related to TRECCERT
credentials or its certification process.
▪ Strive to increase the competence and prestige of the profession by upholding to the highest standards
of professional conduct related to the TRECCERT certifications.

I understand and abide to the followings:

▪ TRECCERT certifications are suspended or terminated for, but not limited to the following reasons:
failure to pay initial certification, recertification and annual maintenance fees, and failure to abide by
the TRECCERT Code of Ethics.
▪ TRECCERT recertification period is three (3) years, and that the cancellation of certification does not
forgo your liability of the certification fee.
▪ TRECCERT encourages its certified individuals to freely report any event or incident related to
TRECCERT ethics.
▪ Any breach of this Code of Conduct may lead to warnings, suspension, or withdrawal of certification, in
accordance with TRECCERT’s disciplinary procedures.

TRECCERT CPE PROGRAM

I have read and agree to the terms and conditions set forth in the TRECCERT Continuing Professional
Education (CPE) Program.

TRECCERT CERTIFICATION REQUIREMENTS

I understand and agree to the certification requirements set forth by TRECCERT. Please refer to our
TRECCERT Certification Rules and Policies (www.treccert.com/certification-of-persons/certification-
rules-and-policies/) for an overview of TRECCERT Certification Requirements.

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 Author: Certification Coordinator Title: Certification Application
Approved By: BOD for CP Document Type: Form
Issued: 03.02.2021 Confidentiality: Internal
Last Revised: N/A Reference No: CD-FO-30

TERMS AND CONDITIONS

DATA PROTECTION STATEMENT

▪ I understand and agree that all the information collected in this form is necessary and relevant for the
certification application. The information will be subsequently used for administration and business
purposes, in line with the requirements of the current data protection regulation.
▪ I understand and grant access to TRECCERT GmbH to access and disclose the certification status for
the purpose of verification, including necessary personal data, preceding the attestation of the
submitted certificate(s) or provided credential(s).
▪ I consent to TRECCERT GmbH using my personal data for the purposes described in this form and
understand that I can withdraw my consent at any time.

Please refer to our Privacy Policy (www.treccert.com/privacy-policy/) for an overview of your rights as a
data subject. If you wish to exercise any of these rights or have any question about the privacy policy,
please contact us at [email protected].

APPLICANT STATEMENT

I hereby agree to holding TRECERT harmless from any claim, complaint, or potential damage which may
arise by the action, or omission in connection with this application, including the failure to issue any
certificate to me, or my demands for forfeiture or re-delivery of the certificate.

I understand and agree that the decision whether I qualify for the certification depends solely and
exclusively to TRECCERT. By my signature, I acknowledge that I have read, understand, and
agree to the Terms and Conditions.

SIGNATURE (PRINT NAME)

DATE