Table 2. NAICS Codes9
Primary <strong>Safety</strong> SpecialtyCheck only one specialty that best describes your overallqualifications.ValidationB<strong>CSP</strong> requires applicants to disclose criminal convictions,disciplinary actions, and denial or revoked certifications, licensesand pr<strong>of</strong>essional registrations. B<strong>CSP</strong> uses its policy relating tocriminal convictions to determine whether the application canproceed or whether it will be terminated. In some cases, a B<strong>CSP</strong>attorney may contact the applicant to clarify information aboutthe conviction. A copy <strong>of</strong> the B<strong>CSP</strong> criminal conviction policyappears at www.bcsp.org/About_B<strong>CSP</strong>.B<strong>CSP</strong> also requires applicants to disclose any disciplinary actionsor denial <strong>of</strong> certifications, licenses or pr<strong>of</strong>essional registrationstaken against the applicant by the issuing certification boardor agency. B<strong>CSP</strong> determines whether the action should beconsidered in the certification application process.Applicants are required to provide disclosure <strong>of</strong>:• All felony convictions• All misdemeanor convictions within the past five (5) years(Minor traffic violations and petty <strong>of</strong>fenses DO NOT have tobe reported)• Any record <strong>of</strong> unethical behavior • Information related to having a pr<strong>of</strong>essional license orcertification denied, suspended or revoked for reasons otherthan not meeting qualifications, failure <strong>of</strong> examination, orfailure to pay renewal fees<strong>Application</strong> Payment Information• Indicate how you are paying your application fee.The application fee is nonrefundable and nontransferable.• If you pay by check or money order, fees must be inU.S. dollars and made payable to the <strong>Board</strong> <strong>of</strong> <strong>Certified</strong><strong>Safety</strong> Pr<strong>of</strong>essionals or B<strong>CSP</strong>. All checks must bedrawn on a U.S. bank. Attach the check or money orderto the front <strong>of</strong> the <strong>CSP</strong> <strong>Application</strong> Form.• If you pay by credit card, please record the type<strong>of</strong> card, credit card number, expiration date, the CVV/CVV2, billing address and name on card, sign your name,and enter the date. The CVV/CVV2 code is a 3- or 4-digitverification code on your credit card.This number is printed on the back <strong>of</strong> MasterCard, VISA, andDiscover/Novus credit cards in the signature area after thecredit card number. You can find the 4-digit number on thefront <strong>of</strong> American Express cards above and to the right or left<strong>of</strong> the credit card number.Pr<strong>of</strong>essional Advancement Mentor ProgramMany <strong>CSP</strong>s encourage, assist, or require fellow safetypr<strong>of</strong>essionals to pursue certification to advance their careers.B<strong>CSP</strong> recognizes these contributions through the B<strong>CSP</strong>Pr<strong>of</strong>essional Advancement Mentor Program. Applicantsand mentors can participate by completing a Pr<strong>of</strong>essionalAdvancement Mentor Program Form and submitting it with thecandidate’s application. Forms and more information are locatedat www.bcsp.org.Completing Pr<strong>of</strong>essional <strong>Safety</strong> Experience FormsBeginning with your current position, complete a separatePr<strong>of</strong>essional <strong>Safety</strong> Experience Form for each position for whichyou are seeking credit. If you held more than one position withan employer, you must complete a separate Pr<strong>of</strong>essional <strong>Safety</strong>Experience Form for each position.All sections must be completed. Please refer to page 3 for anexplanation <strong>of</strong> acceptable safety experience before completingyour forms. In the SUMMARY OF ACTIVITIES section writein each space the percent <strong>of</strong> time that you devoted to each <strong>of</strong>twelve major areas <strong>of</strong> pr<strong>of</strong>essional safety practice. All functions(A-L) must total 100%. Refer to Table 3 for a description <strong>of</strong> eachcategory.One <strong>of</strong> the most important items included with your applicationis the Pr<strong>of</strong>essional <strong>Safety</strong> Experience Form. Provide a completedescription <strong>of</strong> your three primary position functions that dealwith areas A through K. Do NOT provide a description for areaL (Functions that are not <strong>Safety</strong>, Health, or Environmental).Evaluators can only consider the information provided. Ifinformation does not clearly define job functions in detail, orgive specific examples <strong>of</strong> work activity, evaluators cannot awardcredit for the work experience.B<strong>CSP</strong> may request additional information to decide on credit for aposition, and such requests may delay the evaluation process. Donot submit formal job descriptions or resumes.Submitting Your <strong>Application</strong>Make a copy <strong>of</strong> all application materials for your records. Keeptogether multiple pages for each form and paper clip all materialstogether with the check or money order (if used) on top. Do notstaple the materials, bind them together or place them in a folder.Send materials to:<strong>Application</strong>s<strong>Board</strong> <strong>of</strong> <strong>Certified</strong> <strong>Safety</strong> Pr<strong>of</strong>essionals2301 W. Bradley AvenueChampaign, IL 6182110
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