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Administrator / Proctor Application

    This process will take approximately 30-40 minutes and needs to be completed in one sitting.

    To become a registered Test Administrator/Proctor with National Registry, complete the following:

    • Read the Test Administrator/Proctor Manual

    • Complete the online Test Administrator/Proctor Training Course

    • Complete the Test Administrator/Proctor Training Certificate Verification section. (You will need the Training Certificate of Completion)

    • Read, sign, and submit the Test Administrator/Proctor Agreement Form. (A copy of government issued identification must be included)

    • Read, sign, and submit the Test Administrator/Proctor Code of Conduct Form

    • Complete the Test Administrator/Proctor Shipping Information

    • Complete the Account Billing Information Form (For Newly Established Accounts)

    • Complete the Test Administrator/Proctor Reference Form by documenting three references. (At least two of these references must be from individuals who have known you for more than one year)

    • If you have taken the Food Safety Manager Certification Exam within a year of the date you submit the new application, your application will be placed on hold for 6 months

    Test Administrator/Proctor Training Certificate Verification

    You MUST complete the Test Administrator/Proctor Training Course and receive a Certificate of Completion before completing this application.

    Provide the information from your Test Administrator/Proctor Training Certificate of Completion to the fields below.

    Agreements

    1. I have agreed to serve as a Test Administrator/Proctor for National Registry of Food Safety Professionals'(National Registry) Food Safety Manager Certification Examination (Exam) and the International Certified Food Safety Manager Examination, hereafter referred to as the FSMCE and ICFSM.

    2. I have read the Test Administrator/Proctor Manual (Manual), and will strictly adhere to all standards of administration, confidentiality, and all procedures and instructions including the Code of Conduct as specified in the Manual.

    3. I will not sit for the FSMCE or ICFSM within a period of one year before serving as a Test Administrator/Proctor for the Exam, except at a Pearson VUE exam center (preapproval from National Registry required)

    4. I am submitting professional references from three individuals which I have known for more than one year.

    5. I understand that I can only serve as Test Administrator/Proctor for the first 35 examinees. Beyond that number there must be one Test Administrator/Proctor for every 35 examinees and I must return a signed Test Administrator/Proctor Agreement for each Test Administrator/Proctor.

    6. I will locate, select, train, and supervise all Test Administrator/Proctors, Readers and Translators.

    7. I agree that immediately upon receiving exam booklets, I will verify the shipment and notate on the Test Administrator/Proctor Inventory Form.

    8. I agree to keep the Exams under double-lock in secure storage or in my sole possession until administration.

    9. I agree to maintain the security of the Exams before, during, and after the Exam administration.

    10. I agree that I will not provide the Exam or copies thereof to anyone other than an authorized representative of National Registry.

    11. I agree that I will not share any credentials including logins, passwords or any identification provided by National Registry.

    12. I agree to comply with the procedures for handling and breach of security as outlined in the Manual.

    13. I will organize and administer all Exam site activities and procedures, including securing a site that conforms to the requirements specified in the Manual.

    14. I will accurately check examinees' government issued photo identification.

    15. I will not offer any hints, suggestions, definitions, or clues to the answer of an Exam item.

    16. If there are questions as to the understanding of an Exam item, I will provide the examinee with an Examinee Comment Form.

    17. I will ensure no talking or communication of any form between examinees occurs during the Exam.

    18. I will ensure all of the examinees' books and class materials are stored at the front or back of the room.

    19. Under no circumstances will I examine or discuss the Exam contents with the examinees before, during, or after the exam.

    20. I will ensure that no Exam materials leave the room with the examinees or have been photocopied.

    21. I understand that a representative of the National Registry may audit any administration of the FSMCE and ICFSM.

    22. I affirm that I am not an employee of any other ANSI/CFP accredited FSMCE and ICFSM organization.

    23. I understand that I cannot reproduce certificates or wallet cards, alter certificates or wallet cards, or otherwise misrepresent the information contained on the original document.

    24. I agree to take the Test Administrator/Proctor training course and non-disclosure every 3 years.

    25. I agree that the confidentiality and non-disclosure requirements set forth herein survive the expiration or termination of this Agreement.

    I hereby affirm that my responsibilities as a Test Administrator/Proctor are critical for a fair and equitable administration of the National Registry of Food Safety Professionals' Food Safety Manager Certification Examination Program to each examinee and that the Exam and its contents are intellectual property owned by National Registry.

    Confidentiality, Nondisclosure and Conflict of Interest: I may be afforded access to proprietary information, confidential documents, and Exam materials, and I hereby agree that I shall not disclose or provide to any person or entity, directly or indirectly, any information or pertaining to the preparation, Exam, and/or grading services provided by National Registry. I agree not to participate in any activity, either as a volunteer or for pay, in which there may be a conflict of interest with activities related to the National Registry examination programs and agree to bring potential or actual conflicts of Interest to the attention of National Registry. I agree that I will not examine any of the Exam materials, unseal any sealed Exam booklets, or divulge any Exam content with examinees before, during, or after the Examination. It is understood that all documents, Exam questions, or confidential information received from National Registry are and shall remain the exclusive property of National Registry, and that all documents or information shall be returned promptly to National Registry.

    Controlling Law/Venue: The validity, interpretation, and performance of this Agreement shall be controlled by and construed under the internal laws of the State of Florida, without regard to conflict of law principles. This Agreement shall not be construed for or against either party. Venue for any legal proceeding or action at law arising out of or construing this Agreement shall lie solely and exclusively in the state courts of Orange County, Florida, or the United States District Court for the Middle District of Florida, Orlando Division. Both parties acknowledge that this Agreement was created in and will be partially performed in the State of Florida, and therefore, each party agrees to submit to the exclusive personal jurisdiction of the State of Florida for a resolution of all disputes arising in connection with the interpretation, construction or enforcement of this Agreement, and each party hereby waives any claim or defense to such courts, including any claim or defense that such courts constitute an inconvenient forum.

    Attorney's Fees: If either party initiates or is made a party to legal proceedings in connection with this Agreement, then the non-prevailing party in those proceedings will pay the costs and reasonable attorneys' fees of the prevailing party.

    Severability: Legal unenforceability of a single provision in this Agreement shall not prevent enforcement of any other provisions of this Agreement.

    Contract Breach: Any breach of this Agreement, including inappropriate conduct such as lying or cheating while participating in an Exam which shall be deemed a material breach, shall permit National Registry to pursue all available legal remedies, including seeking monetary damages and injunctive relief in addition to resulting in future exclusion from any and all National Registry certification designations, examinations, and other programs. I understand that should I fail to follow the standards set forth by the National Registry, or the procedures provided in the Manual, my privilege as a Test Administrator/Proctor will be revoked and that National Registry shall have the right to announce and publish such revocation in whatever form and location(s) as National Registry deems appropriate in its sole discretion and in order to protect the public.

    New Accounts: I agree to abide by and adhere to all financial requirements as presented on the Account Billing Form.

    Code of Conduct

    I understand that my personal standards of honor and integrity must, at all times, be above reproach and I must conduct myself in a manner that reflects favorably on my profession. By doing so, I will strive to create an ethical climate within my organization, my industry and the community of clients which I serve; building honesty and trustworthiness in all relationships and ensuring reliability in performing my assigned responsibilities. I agree to:

    1. Be truthful and accurate in what I say, do, and write.

    2. Adhere to the law at all times.

    3. Promote and encourage the highest level of food safety within the industry.

    4. Not misrepresent nor permit misrepresentation of my qualifications or the qualifications of my associates.

    5. Maintain due regard for the environment and for the public safety, health, and well-being.

    6. Strive to maintain competence by remaining current with changes in the industry.

    7. Understand the certificate, logo, and marks for the FSMCE/ICFSM are the intellectual property of National Registry; and I will use such property only in a manner approved by National Registry.

    8. Uphold and follow all policies and procedures required by National Registry to remain in good standing.

    9. Report to National Registry any pending litigation and resulting resolution related to my work in food safety.

    10. Avoid any interest, activity, or influence which may be intended to influence a decision purely for personal gain and not in the interest of public safety.

    eSignature*

    Shipping Information

    Shipping Address Type*

    Identification

    Please attach a copy of your license, ID card, or passport.

    Identification

    Additional Information

    Years in Business

    Estimated # of Exams per Month

    Website URL (If none, type "none")

    Does your organization need training material?*

    Do you own the company?*

    Have you ever been an administrator for an ANSI/CFP accredited provider?*

    If so, have your privileges ever been revoked?*

    If yes, please explain:

    Do you have a relative that is a Test Administrator/Proctor for NRFSP?*

    If yes, who?:

    Billing Information

    All invoices are billed monthly - net 30 days.

    1. The credit card on file will be automatically charged for monthly invoices until credit is established and a written request is received from you. (This excluded government, school, and corporate accounts)

    2. Checks are made payable to National Registry of Food Safety Professionals (NRFSP) sent to PO Box 628244 Orlando, FL 32862-8244.

    3. NRFSP reserves the right to charge the credit card on file for all invoices more than 60 days past due.

    4. Your account will be inactivated if no exams are scored exams for a year. Account updates are required to reactivate account.

    Rush and Canceled Order Fees

    1. Exam orders placed within 9 business days or less of the date needed will be charged a $35 rush fee.

    2. Exam orders placed within 5 business days or less of the date will be charged an $89 rush fee. Call for international rates.

    3. Cancelled orders will be billed a $3 per exam ordered.

    4. Past due exams will be billed at $3 per exam.

    Credit Card Policy

    1. The credit card on file will be automatically charged for monthly invoices until credit is established and a written request is received from you. (This excluded government, school, and corporate accounts)

    2. National Registry of Food Safety Professionals reserves the right to charge the credit card on file for invoices 60 days past due.

    EIN#

    Billing Preference (Please choose and notify us how you would like to pay your invoices after credit is established)

    Is a PO required for billing?

    Contact name for PO#

    Due to PCI-DSS requirements, we cannot accept credit card numbers electronically. Please contact NRFSP Finance Department and provide Credit Card Information. Phone: 1-800-446-0257 Prompt # 2 for Finance.

    By completing this form, you authorize NRFSP to charge your card.

    Personal Guaranty

    The undersigned, in order to induce National Registry of Food Safety Professionals, to extend credit under the terms of the Agreement, hereby unconditionally and irrevocable guarantees to NRFSP the due and punctual payment of all amounts due under the Agreement or invoice submitted by NRFSP in the normal course of business, when and as the same shall become due and payable, whether at the times stated therein or herein or by acceleration or otherwise and costs and expenses of collection. Upon default or failure of your company in making any such payment when due (including any costs of collection), the Guarantor will forthwith pay the same. This guaranty is an absolute, unconditional, present and continuing irrevocable guaranty of payment and not of collectability. The Guarantor unconditionally and irrevocably waives each and every defense which, under principles of guarantee or surety ship law, would otherwise operate to impair or diminish the liability of the Guarantor, including any extensions of time for payment or the exchange, surrender or release of any merchandise. This guaranty shall be binding upon the successors and assigns of the Guarantor, and inure to the benefit of, and be enforceable by, the successors, assigns and endorsees of NRFSP. The Guarantor further agrees to all provisions in this agreement, including but not limited to, the provisions relating to governing law, venue, personal jurisdiction, and attorney’s fees for prevailing party.

    Name as it appears on card

    References

    Please provide three professional references below as required for approval as a Test Administrator/Proctor. It may be used instead of letter from references. Each reference must provide his or her contact information. All professional references must have known you for more than one year. Relatives may not serve as a reference.

    The following individuals have agreed to act as references to my professionalism and experience in areas that will enable me to fulfill my responsibilities and duties as described in the Test Administrator/Proctor Manual for the Food Safety Manager Certification Examination program. I have asked these individuals to attest to my qualifications because they have known me professionally, at least one year. Each individual has agreed to provide reference information to National Registry of food Safety Professionals when contacted.

    Reference 1

    Reference 2

    Reference 3