EPA Secon 608 Cerficaon - Esco Institute
EPA Secon 608 Cerficaon - Esco Institute
EPA Secon 608 Cerficaon - Esco Institute
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Application for Test Administrator (Proctor)<br />
P.O. Box 521, Mount Prospect, IL 60056 TOLL FREE: 1(800)726‐9696 FAX: 1(800)546‐3726 www.escogroup.org<br />
Applicant Informa�on<br />
First Name: __________________________________________ M: ____ Last Name: _________________________________________________<br />
Social Security #: _________‐‐‐_______—__________ Home Ph: (______) ___________________ Cell Phone: (______) _____________________<br />
Home Address: ______________________________________________________________________________________ Apt #: ______________<br />
City: __________________________________ State: ______ Zip Code: ____________ Proctor Experience: _______________________________<br />
Company Informa�on:<br />
Organiza�on: __________________________________________________________Title:____________________________________________<br />
Physical Address: ________________________________________________________________________________________________________<br />
City: __________________________________ State: ______ Zip Code: ____________ Email:___________________________________________<br />
Phone: (_____) _____________________ Ext________ Fax: (______) _______________________ Supervisor:____________________________<br />
Type of Business: Wholesaler Manufacturer Associa�on<br />
High School College JATC Prison Training Co. Gov’t<br />
______ Yes! Please refer my loca�on for tes�ng. _______ No. Please don’t refer exam candidates to my loca�on.<br />
Billing Informa�on:<br />
Contact: _______________________________________________________ Company _______________________________________________<br />
Address: ________________________________________________ City: _______________________ State: _______ Zip Code: ______________<br />
Phone: (_____) ____________________________________Ext________ Fax: (______) ______________________________________________<br />
Proctor Agreement<br />
I hereby apply for appointment as a registered proctor. Once I am appointed<br />
as an authorized Proctor, I shall at all �mes be held responsible for the security<br />
and safekeeping of all exams. By signing this Proctor Applica�on I agree to,<br />
and am legally bound by the following terms: I shall:<br />
�� Keep all exams in a locked and secure area (i.e. safe, cabinet, closet) un�l<br />
needed for tes�ng.<br />
�� At no �me give any other person access to Exams online or other secure<br />
areas of any website used for tes�ng.<br />
�� At all �mes strictly adhere to all verbal and wri�en instruc�ons set forth<br />
by the ESCO Ins�tute and the <strong>EPA</strong> pursuant to test administra�on and<br />
supervision.<br />
I agree to read the proctor manual containing the test administra�on proce‐<br />
dures, I understand that all exams unless otherwise stated ‐ are closed book,<br />
proctored exams, Shall give prompt no�ce of any changes in my address,<br />
phone, fax number or e‐mail, employment, etc. I acknowledge that if I violate<br />
these terms in any manner, the ESCO Ins�tute reserves the right to suspend or<br />
revoke/terminate my appointment as an authorized Proctor. Upon my revoca‐<br />
�on/termina�on I shall immediately return all tes�ng materials to the ESCO<br />
Ins�tute. The ESCO Ins�tute reserves the right to accept or reject any or all<br />
por�ons of this applica�on. My signature means that I have read and agree to<br />
the condi�ons for exam administra�on<br />
X ________________________________________________________________<br />
Date _____________________________________________________________<br />
31<br />
Exams You Want To Conduct<br />
ESCO Ins�tute <strong>EPA</strong> Sec�on <strong>608</strong> AC&R Cer�fica�on<br />
ESCO Ins�tute <strong>EPA</strong> Sec�on 609 MVAC Cer�fica�on<br />
AC&R Safety Coali�on Universal R‐410A Cer�fica�on<br />
HVAC Excellence Hea�ng Electrical Air Condi�oning Technology<br />
H.E.A.T. High School Assessments Gas Version Oil Version<br />
H.EA.T. Plus, Hands On Performance High School Assessment<br />
HVAC Excellence Employment Ready Cer�fica�ons (Post <strong>Secon</strong>dary)<br />
HVAC Excellence Professional Level Wri�en Technician Cer�fica�ons<br />
HVAC Excellence Master Specialist Hands‐On Technician Cer�fica�ons<br />
Carbon Monoxide Safety Assoc. Exams<br />
Green Awareness Cer�fica�ons<br />
Paper tes�ng<br />
Tes�ng Op�ons<br />
Online Tes�ng Both<br />
For ESCO Use Only 2012CAT<br />
EID _________________ Approved by __________ Date___________________
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