IPMA-Canada s International Certification Program - Application Form

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1 IPMA-Canada s International Certification Program - Application Form Advancing Your Career begins with IPMA-CANADA Certification I am applying for IPMA-Certified Professional (IPMA-CP) designation I am applying for IPMA- Advanced Certified Professional (IPMA-ACP) designation 1. APPLICANT INFORMATION Please print clearly or type information if not filling in on-line: Dr. Mr. Ms. Miss. Mrs. Mail Certificate/Correspondence to: Last Name: Please check one Home Address First Name: Initial: or Business Address Job Title: Certificate in: English Organization: or French Address: City: Residence: Address: Prov./Terr.: Postal Code: City: Telephone: Prov./Terr.: Postal Code: Fax Number: Address : FOR IPMA-CANADA USE ONLY Name as it is to appear on Certificate: Reg. Number Region Code Appl. Rcpt. Appl. Rev. Region Appeal National Appeal Applic. Accept Applic. Proc. Authorized by: Signature: Date: Certification Application Form revised August,

2 2. ELIGIBILITY CRITERIA To be eligible for certification, you must: Be a member of IPMA-Canada in good standing; and Meet the required level of education/experience for the requested designation Meet the Technical Proficiency Requirements for the requested designation Pass the IPMA-Certification Exam Attend the IPMA-Canada Developing Leaders in Human Resource Management Workshop (IPMA-CP only) 3. EDUCATION SUMMARY (if applicable) College/University: Degree/Diploma/Certificate Awarded & Completion Date: College/University: Degree/Diploma/Certificate Awarded & Completion Date: Human Resource or Personnel Administration Focus: Industrial/Organization Psychology Focus: Please list other continuing education/ certificate courses or other HR development program and dates of successful completion. 4. EMPLOYMENT HISTORY (List most recent first please attach resume) Certification Application Form revised August,

3 5. PROFESSIONAL MEMBERSHIPS/AWARDS Please list membership in HR management/professional organizations and leadership positions held. Please list professional recognition/awards received. 6. PROFESSIONAL DESIGNATIONS HELD Please list professional designations received from other human resources or management organizations. Please note whether your designation is still current. Designation Date Awarded Current? 7. PUBLICATIONS Please list any articles, monographs, papers, or books you have published on human resource or management topics. Certification Application Form revised August,

4 8. CERTIFICATION REQUIREMENTS IPMA-Canada Certification Exam I have taken and passed the IPMA-Canada Certification Exam. Completion date: (confirmation is attached) I will take the IPMA-Canada Certification Exam once my technical proficiency has been accepted. I understand that the certification cannot be granted without successfully completing this exam. 9. CERTIFICATION REQUIREMENTS Technical Proficiency IPMA - CP To be certified as an IPMA Certified Professional, an applicant is required to: have two or three years experience (depending on level of education) at the journey level in at least one of the technical proficiency areas listed below; and attend the IPMA-Canada Developing Leaders in Human Resource Management Workshop. IPMA-ACP To be certified as an IPMA Advanced Certified Professional, an applicant is required to have exhibited proficiency at least three of the technical proficiency areas listed below or one journey and one mastery level. Employee and Labour Relations Organizational Effectiveness & Employee Learning Recruitment and Selection Classification Compensation Employee Benefits Diversity, Inclusion and Cultural Awareness HR Policy, Planning, Research and Analysis Health, Wellness and Safety Leadership Change Management Please provide a narrative explanation to support your application for the appropriate designation in accordance with the Mastery/Journey descriptors document found on the website: Certification Application Form revised August,

5 10. CERTIFICATION PROGRAM PAYMENT INFORMATION Initial application fee for an IPMA-Canada member is $ GST/HST I am an IPMA-Canada member. My membership ID # is: Cheque for: is enclosed, payable to IPMA-Canada Payment made via PayPal Date payment submitted: Please charge: to my: VISA MasterCard Credit Card #: Expiration date: Signature (required): I declare that all of the information contained on this form is accurate. I give the International Personnel Management Association-Canada permission to verify the information contained in this application. I understand that if any of the information contained in this application is false, that IPMA-Canada has the right to reject my application. Signature: Date: Scan and this form to: national@ipmaigp.ca Mail this form to: IPMA-Canada 20 Edwards Place, Mount Pearl, NL, A1N 3V5 For Additional Information: phone us at If your application is rejected for any reason, you will receive a refund of your application fee less a $25 processing fee. Thank you for your interest in the IPMA-Canada s International Certification Program Please make sure that you have included the following material/documentation: Completed Application form; Transcript of marks (if applicable) Résumé (in support of Section 4, page 2); Copy of most recent position descriptions if available (in support of Section 4, page 2); Narrative explanation (in support of Section 9, page 4); Cheque or credit card information if not using PayPal. Certification Application Form revised August,

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