Analytics Magazine Analytics Magazine, January/February 2014 | Seite 111

CAP® Certification Application and Agreement (cont.) Please PRINT the following information in your certificate application. 3 Professional Analytics-Related Experience ________________________________________________________________________________________ Job Title Employer ________________________________________________________________________________________ Employer Street Address City State/Province/Territory Zip/Postal Country _______________________________________________________________ Employer Phone number _______________________________________________________________ Years of analytics experience (overall) Dates of experience ________________________________________________________________________________________ Description of analytics role/responsibilities Primary contact who is not a close relative for verification purposes on professional analytics experience: ________________________________________________________________________________________ First name Relationship (circle one) Supervisor Project sponsor Last name Project manager Client Other (please specify)________________ ________________________________________________________________________________________ Email address Phone number Note: All applicants must have a previous employer/supervisor who is not a close relative of applicant submit the Confirmation Statement on Analytics Soft Skills to INFORMS before certification status can be granted. A copy of this Statement is provided in the Candidate Handbook. Candidates may apply for certification and take the certification examination prior to the receipt of this statement by INFORMS, but final certification status cannot be granted until all application documents, including an official signed statement are received by INFORMS. Special Accommodations Request _____ Please check here if you are requesting special accommodations for your examination. Please submit the Certification Special Accomodation form found in the Appendix of this handbook. All supporting documentation must be included with your application and submitted within the required time frame in advance of your anticipated examination date. INDUSTRY CLASSIFICATION Indicate ALL areas of your professional analytics and OR/MS activities. 4 Agriculture, Forestry, Fishing Analytics Arts and Entertainment Chemical/Process Construction Education eCommerce Environmental Finance/Insurance Govt (non-military) Healthcare Info Systems & Tech Law Enforcement Manufacturing Marketing Military Mining, Oil/Gas NonProfit Payment Information Certification/examination fees (payable in U.S. dollars) ____ INFORMS member $495 ____ Nonmember $695 Note: Member rates apply only to current INFORMS members in good standing as of the date this application has been submitted or certification partners. Pharmaceuticals Real Estate Retail Telecommunications Transportation/Warehousing Utilities, Water/Power Please send completed forms to either certification@informs.org, fax to 443.757.3515, or mail to: Certification Manager IN