Version Control Document title: Application form for Certification [intacs06-005e_cert_appliction V6.2.docx] Version: Version 7.0 Release date: July 1 st 2018 Distribution Status Public Released 1
Return this application to your responsible accreditation body: ECQA European Certification & Qualification Association (for all assessment models except Automotive SPICE ) VDA-QMC (for Automotive SPICE ) ECQA GmbH Rechte Kremszeile 62 3500 Krems Austria Behrenstraße 35, 10117 Berlin Germany E: info@ecqa.org T: +49 (0)30 89 78 42 0 F: +49 (0)30 89 78 42 605 E: automotivespice@vda-qmc.de Application for Certification by intacs 1 st Application Re-Application If Re-Application please fill in your current / former Assessor ID: Application for Certification as Provisional Assessor ISO/IEC 15504-5 Provisional Assessor TestSPICE TM Provisional Assessor Automotive SPICE Competent Assessor ISO/IEC 15504-5 Competent Assessor TestSPICE TM Competent Assessor Automotive SPICE Principal Assessor ISO/IEC 15504-5 Principal Assessor TestSPICE Principal Assessor Automotive SPICE Instructor for Provional Assessor courses ISO/IEC 15504-5 / TestSPICE Instructor for Provional Assessor courses Automotive SPICE Instructor for Competent Assessor courses ISO/IEC 15504-5 / TestSPICE Instructor for Competent Assessor courses Automotive SPICE Please read all Notes - Supply all the information requested in this form - This form must be completed in full, however additional information supporting the application may be appended or attached - Copies of qualifications must be attached to this application - Work experience must be verified by the sponsor 2
Contact Details Family Name: First Name Initials: Title: Date of Birth: Private Address Street P.O. Box Postal Code... Street Postal Code... City Country Phone Number Fax Number... email Business Address Company Name P.O. Box Postal Code... Street Postal Code... City Country Phone Number Fax Number... email Invoice Address Company Name Contact... Purchase Number UID... Street P.O. Box Postal Code... Street Postal Code... City Country Phone Number Fax Number... email Declaration I apply for certification with the International Assessor Certification Scheme. I have read and agree to abide by the Code of Conduct. I agree to the publication of my name, contact and certification details in a register. I declare that the information provided is correct to the best of my knowledge. I agree that my renewal is automatically done in a yearly schedule and the yearly certification fee is invoiced to me. This regulation is valid for each year of certification and is automatically prolonged to the following year until it isn t cancelled latest to 30th of September of the actual certification year. I agree that my name and current qualification level is published at the website of intacs (www.intacs.info). Signature of Applicant Date 3
Applicant Sponsors Each applicant shall be sponsored by either their employer or by two other people who have a business relationship with the applicant. Sponsors are responsible for providing independent verification of the information contained in this application. In doing so, sponsors are requested to: 1. Ensure that the information contained in the application detailing work experience of the applicant is accurate 2. Only sponsor an applicant where information can be verified from personal knowledge or where objective evidence has been reviewed Applicant Sponsor Full Name: Full Name: Relationship to applicant Relationship to applicant Business Name and Address Business Name and Address Postcode/Zip Postcode/Zip Country Country Phone Phone Fax Fax Email Email Signature of sponsor: Date: Signature of sponsor: Date: 4
Industry Experience The industry fields selected must correspond with work and assessment experience included in this application. Mark the appropriate fields Mark the appropriate fields Mark the appropriate fields 00 Other 10 Health and pharmaceutical 20 Retail 01 Aerospace 11 Information Technology / software 21 Space 02 Automotive 12 Insurance 22 Telecommunications 03 Banking 13 Leisure and tourism 23 Travel 04 Construction 14 Manufacturing 24 05 Consumer goods 15 Media (television, radio) 25 06 Defense 16 Petroleum 26 07 Distribution/logistics 17 Public administration 27 08 Education 18 Public utilities (gas, water. Electricity) 28 09 Finance (excluding banking) 19 Research 29 Education and training Year Educational establishment Course / Program I didn t attend a training course yet. I am registered for following training course: Provider Date Venue Membership of professional bodies *) Year Membership grade Name of professional association *) Tick in names of additional memberships, like PMI, VDI, or other Assessor scheme like CMMI. Present Position 5
Name of Employer: Company & Department/business unit: Title of your position: Person you are reporting to: Please describe your current responsibilities in detail 6
Code of Conduct By signing the application declaration the applicant agrees to abide by the Code of Conduct and shall: Professionalism 1. Exercise honesty, objectivity, and diligence in the performance of their duties and responsibilities. 2. Maintain high personal standards of moral responsibility, character, and business integrity and treat customers, colleagues, competitors, and others in a respectful, polite and honest manner. 3. In the practice of their profession, shall be ever mindful of their commitments, agreements and obligation to maintain the high standards of competence, morality, and dignity promulgated by this code of conduct. 4. Not engage in acts or activities that are discreditable to their profession, their organization, customers, competitors, partners and others 5. Exhibit loyalty in all matters pertaining to the affairs of their organization or to whomever they may be rendering a service. However, they shall not knowingly be party to any illegal or improper activity. 6. Undertake only those services that they can reasonably expect to complete with professional and full technical competence and exercise honesty, objectivity, and diligence in the performance of their duties and responsibilities. 7. Ensure that when they are performing services for another party, they do not actively solicit business from the customer for themselves or their organization. When approached by a customer while performing services for another party, they are to defer the discussion to a time outside the scope of the immediate work. When these discussions occur, they are to be conducted in a manner that is consistent with their contractual agreements. 8. Do not make assertions about outcomes such as maturity levels or other findings before or during an assessment or any other diagnostic activity. 9. Do not unfairly influence diagnostic methods such as assessments in any way, including coaching people to provide false or misleading information. Confidentiality 1. Protect the identity of their customers and intacs TM unless you have explicit permission or a legal obligation to disclose it. 2. Be prudent in the use of information acquired in the course of their duties. They shall not use confidential information for any personal gain nor in any manner that would be contrary to law or detrimental to the welfare of their organization, customers, competitors and community members. 3. Respect the ownership of intellectual property and stay informed of, and comply with, applicable laws to preserve the integrity of their work products and services and that of others. 4. Ensure that they have the right to use intellectual property, respect copyrights, trademarks, and service marks and give appropriate references and credit to materials and sources. Competence 1. Cooperate in the development and interchange of knowledge for mutual professional benefit. 2. Continually strive for improvement in their proficiency, and in the effectiveness and quality of their service. 3. Maintain and improve their professional competency through continuing education and experience according to the intacs TM rules. Conformance 7
1. Not to act in any way that would prejudice the reputation of intacs TM, certification bodies and assessor certification. 2. Exercise due care to ensure that they act in conformance intacs TM rules and adhere to intacs TM regulations and procedures 3. Make sure that their work, services and duties comply with ISO/IEC 15504 and other applicable standards. Objectivity 1. Ensure that customers, partners and community members understand whom they represent (e.g. the certification body, intacs TM, their organization, their partner or third parties) in professional activities. 2. Refrain from entering any activity that may be in conflict with the interest of their organization or would prejudice their ability to carry out objectively their duties and responsibilities. When conflicts of interest are unavoidable, disclose the potential conflicts to affected stakeholders, including their own organization, and intacs TM. Take immediate action to minimize the impact or eliminate the conflict. 3. Avoid misrepresenting their organization, their customers and partners such as by violating contractual restrictions (e.g. territory restrictions, commercial versus internal use, limited training audiences that appear in certain agreements), or falsifying financial reports or fees. 4. Not accept anything of value such as gifts, amenities or gratuities from an employee, client, customer, supplier, or business associate of their organization that would impair or be presumed to impair their professional judgment and integrity. 5. Reveal all material facts known to them that, if not revealed, could either distort reports of operation under review or conceal unlawful practices. 6. Do not cheat or allow cheating on examinations, exercises, or other evaluations of knowledge, skill, or expertise. 7. Do not let themselves be influenced to promise outcomes before you have the data to justify them and exercise due care to ensure the accuracy and authenticity of information gathered from others. 8. Seek information and resolution to issues directly and factually rather than through hearsay or third parties. Automatic Renewal Process By signing the application declaration the applicant agrees that a renewal process is automatically initiated on the timely basis as defined in the intacs TM procedure Assessor Certification and the yearly certification fee is automatically invoiced to the sponsoring company. This automated process remains active and valid until it is cancelled to the 30th of September at the latest. 8
Work Experience Please complete showing your most recent position first. (Please tick in the employments of at least the last 5 years to show evidence for your experience in domains) Employment 1 From (month/year) To (month/year) Employing organization Your position Your responsibilities Employment 2 From (month/year) To (month/year) Employing organization Your position Your responsibilities Employment 3 From (month/year) To (month/year) Employing organization Your position Your responsibilities Employment 4 From (month/year) To (month/year) Employing organization Your position Your responsibilities 9
Application Checklist Declaration signed by applicant Application signed by sponsor(s) COPIES of education certificates Completed and approved assessment log (not required for Provisional Assessor) Completed and approved observation log (required for Instructors) Fees Do not send any fees with your application. Certification Fee will be invoiced parallel to confirmation of reception of the application. 10