C|EH Exam Eligibility Application Form

EC-Council

EC - C ouncil

C|E H E xam E ligib il it y A ppl ic at io n F o r m

Eligibility requirements
In order to be eligible to attempt the CEH certification examination, you may:a) Attend Official Training
Attend an official CEH instructor-led training (ILT), computer-based training (CBT), online live
training, or academic learning.
b) Attempt Exam without Official Training
In order to be considered for the EC-Council certification exam without attending official training,
you must:
a) Have at least two years of information security related experience.
b) Remit a non-refundable eligibility application fee of USD 100.00
c) Submit a completed Exam Eligibility Form.
Application Submission Steps
Step 1: Complete the application form and request your current/former Boss/ Supervisor/ Department head to fill and sign verification section.
Step 2: Attach a copy of your Drivers License or any valid government approved Identification
licenses (e.g: passport)
Step 3: Fax the above documents to +60 3 7956 6585 or Scan the documents and email them to
certmanager@eccouncil.org
Step 4: Remit a non-refundable eligibility application fee of USD 100.00 through our website
www.eccouncil.org/orders.htm
Step 5: EC-Council will contact your current/former Boss/ Supervisor/ Department head to verify
your application
Step 6: If your application is approved you will receive your eligibility code within 2 weeks time.
Note: We treat personal information securely and confidentially. EC-Council adheres to strict US privacy laws
and will not disclose the submitted information to any third party apart from your Boss/ Supervisor/ Department head for verification purpose.

EC-Council reserves the right to revoke the certification status of candidates who attempt this exam
without a valid eligibility code.

EC-Council C|EH Exam Eligibility Application Form

EC - C ouncil

C|E H E xam E li g ib il it y A ppl ic at io n F o r m

Applicant Information
First Name : ..........................................................

Last Name : ..........................................................

Proof of Identity

: ............................................................... (Attach Passport/Identification Card copy)

Residence

: ......................................................................................................................................

Address

: ......................................................................................................................................

City/State/Province

: .................................................................................................................................

Zip/Postal Code

: .....................................................

Phone Number

: .................................................................................................................................

Email Address

: .................................................................................................................................

Country : .....................................................

Experience Qualifications
Company Name

: ....................................................................................................................................

Company URL

: http://.........................................................................................................................

Job Title/Position : ....................................................................................................................................

No of years with this employer

: ............................................................................................................

No of months of security related work experience with this employer

Type of security related work

: ............................................

: ............................................................................................................

Experience qualifications certified by supervisor/agency representative:

.....................................................................................................................................................................
.....................................................................................................................................................................
.....................................................................................................................................................................
.....................................................................................................................................................................
Supervisor Name : .....................................................

EC-Council C|EH Exam Eligibility Application Form

Position : .....................................................

EC - C ouncil

C|E H E xam E l ig ib il it y A ppl ic at io n F o r m

Where would you like to take the exam?
VUE Testing Center

Prometric APTC Testing Center

Statement of Compliance
The objective of the certification Certified Ethical Hacker is to introduce, educate and demonstrate
hacking techniques and tools for legal security testing purposes only. Those who are certified by
EC-Council in this discipline acknowledge that such certification is a mark of distinction that must be
both earned and respected.
In lieu of this, all Certified Ethical Hackers pledge to fully support the Code of Ethics. Certified professionals who deliberately or intentionally violate any provision of the Code will be subject to action by
a review panel, which can result in the revocation of the certification.
To this end, you will not exploit the thus acquired skills for illegal or malicious attacks and you will not
use such tools in an attempt to illegally compromise any computer system. Additionally you agree to
indemnify EC-Council and its partners with respect to the use or misuse of these tools, regardless of
intent. You agree to comply with all applicable local, state, national and international laws and regulations in this regard.
I certify that I meet the experience and/or training requirements to apply to become a Certified Ethical Hacker. The information contained in this application is true and correct to the
best of my knowledge. I understand that if I engage in any inappropriate, unethical, or illegal
behavior or activity, my CEH status can be terminated immediately.

................................................................

................................................................

Candidates Signature

Date

EC-Council C|EH Exam Eligibility Application Form

EC - C ouncil

C|E H E xam E li g ib il it y A ppl ic at io n F o r m

TO BE COMPLETED BY THE VERIFIER
Please Print
Name

: .................................................................................................................................

Title

: .................................................................................................................................

Company

: .................................................................................................................................

Address (including
city, state, and postal
code)

: .................................................................................................................................
.................................................................................................................................
.................................................................................................................................

Phone Number

: .................................................................................................................................

Email Address

: .................................................................................................................................

(Company E-mail address is required. Your verification will not be processed if you use free e-mail
accounts such as hotmail/yahoo/gmail/rediffmail etc.)
How long have you known the candidate and in what capacity?
.......................................................................................................................................................................
.......................................................................................................................................................................
Does/did the candidate have minimum of 2 years of IT security experience in your company?
Yes

No

I agree that EC-Council to contact me, for verification purpose.

................................................................
Verifiers Signature

EC-Council C|EH Exam Eligibility Application Form