ITIL® Master Qualification: Candidate Application Form

Completion and submission of this form is the mandatory first step for candidates in the ITIL Master Qualificationcertification process.

This application form is designed to identifythe candidate and the candidate’s pre-requisite criteria, basic information about their intended documentation (which should demonstrate their suitability for the credential), their proposed timeline for submission of the required documentation for assessment and details of their sponsoring organisation.

Completing this Application Form

It is recommended that candidates read or refer to the following documentation, for full details of the application and assessment process, the pre-requisites for eligibility, what is required to demonstrate suitability and the evaluation process:

  • ITIL Master Candidate Guidelines
  • ITIL Master QualificationPROPOSALRequirements and Scope Document
  • ITIL Master Qualification WORK PACKAGE Requirements and Scope Document
  • ITIL Master Referee Statement

Format of Application Form

This form must be completed in full and submitted in order for an application to be accepted and processed.

Any supporting documentation required (i.e. CV / Resume, copy of certificates etc) must be supplied with this completed application form.

Submission of Completed Form and Supporting Documentation

Completed applications and supporting documentationshould be submitted to your chosen Examination Institute together with the required fee for certification.

Section A: Candidate Details

The following personal informationshould be provided in order to process this application.

Mandatory fields are marked with an * :

Title(e.g. Mr / Mrs etc)
First Name(s)*
Last Name*
Full Postal Address*
House No. / Name
Road / Street
Town / City
County / State
Postal / Zip Code
Country
Daytime Telephone number*
Mobile Telephone number / [optional]
Email Address*
Preferred contact details (if different from above)
Language of submission*
Unique Candidate Identification information*
In order to ensure we can individually identify each candidate, we require all candidates tocomplete two out of the five possible unique identifiers below. Please note that this information will be used by the Accreditor only for verification purposes only and will not be passed on to any third party.
1. Date of Birth (dd/mm/yyyy) //
2. Place of Birth
3. Mother’s Maiden Name
4. National ID Number
5. Memorable Password (max 6 digits)

Section B: Pre-Requisites for Eligibility

All candidates must provide the following information in order to confirm their eligibility for assessment under the ITIL Master Qualification. Please note that all of the information provided below will be verified with the relevant institution / organisations.

Mandatory fields are marked with an *:

Certification
In order to apply for ITIL Masterqualification, you must hold the ITIL Expert Level Certificate in IT Service Management. Please complete the information below to provide the required confirmation:
Name of awarding Examination Institute*
ITIL Expert Certificate / Candidate Number*
Please confirm that a copy of your ITIL Expert Certificate is attached?* / Please tick [electronic copies accepted]
Proof of Experience
In order to apply for the ITIL Master qualification, you must have at least 5 years experience in ITSM in leadership, managerial, or senior advisory roles which must be documented and reflected in your Resume / CV.
You may also attach supporting statements from referees to verify your experience in IT Service Management. Please note that if you provide any statements to support your application, you must ensure that every reference is clear, relevant, and from an individual who has given permission for their statement to be used.
A candidate must also have an extensive base of practical “hands-on” ITIL experience and be able to demonstrate active involvement in implementation of the practices, in order to meet the requirements for the qualification.
In addition, it is a critical requirement that candidates can provide sufficient evidence of their role in the assignments and/or proof that they carried out the tasks.
Please confirm that a copy of your Resume / CV is attached?* / Please tick [electronic copies accepted]
Please list any other ITIL credentials you may hold?*
Please list any other Service Management related credentials?*
Please confirmif any supporting statements are attached? / Please tick [electronic copies accepted]
If supporting statements have been provided, please confirm how many?
Please list the practical “hands-on” experience to demonstrate your active involvement within your CV*

Section C: Submissions

The ITILMaster is a demonstration based qualification. In addition to the pre-requisites for eligibility, achieving the ITIL Master will require submission of substantial, structured documentation which meets theRequirements and Scope asdefined in the guidance documentation outlined at the beginning of this document.

All candidates must provide the following information in order to confirm the proposed timeline and high level information on the submission of the relevant components of the qualification for assessment.

Mandatory fields are marked with an *:

Timelines for Submission of Qualification Components
Please confirm the date you intend to submit your completed Proposal Submission (dd/mm/yyyy)*:
Please confirm the date you intend to submit your completed Work Package(dd/mm/yyyy)*:
Proposal Information
Please confirm your Proposal Submission title (if known at this time):
Please provide a brief description of the proposal submission contents and scope title (if known at this time):
Sponsoring Organisation Information
Is an organisation sponsoring your application for the ITIL Master qualification?*
Please provide details of the organisation (name, address, sector)*:
Will confidential or sensitive information about this or any other organisation be included in your documentation?* / Please tick [electronic copies accepted]
If so, please confirm the action you will be taking to ensure that the appropriate permission has been granted to provide such information in your submissions*:

Section D: Confirmation of Personal Details and Data Protection

The Official ITIL Accreditorwill also hold a publicly available register for all successful ITILMaster Candidates online, which will include candidate name, date of certification and a unique ITIL Master Certification Registration number, for purposes of result verification requests from employers and candidates themselves.

If you donot want your name to be included on the online ITILSuccessful Candidate Register please place a tick in the box below.

Please note if you select this option and change your mind at a later date, you may incur an additional administration charge for your name to be added.

I do not want my results included on the online successful candidate register

Section E: Candidate Declaration

To support my application and registration for the ITIL Master Qualification, I hereby confirm the following:

  • That I have the necessary permission to provide all of the information in this Proposal to the Official ITIL Accreditorfor the purposes of certification for the ITIL Master Qualification.
  • That I will comply with the Terms and Conditions of certification as summarised with this form (see Criteria for Certification section).
  • That the information I have given on this form is correct and that I understand and agree to the use of my personal details described within the criteria for certification.

Signature
Date (dd/mm/yyyy)

The Official ITILAccreditorreserves the right to withhold all certification results until all fees are paid.

The Official ITILAccreditorreserves the right to withhold the issue of certificates if the required information is not provided.

IMPORTANT INFORMATION:

Criteria For Certification

Pre-Requisite Checks

The Official ITILAccreditorwill require all pre-requisites for taking an examination / entering for assessment for a qualification, to be satisfied by candidates prior to their results and certificates being issued. Results and certificates may be withheld until such time as confirmation is gained of pre-requisites being completed.

Withdrawal of Certification

The qualification may not be awarded, or may be subsequently withdrawn from a potentially successful candidate if, after investigation, it is found that the holder has brought the qualification into disrepute, for example by making false claims in their written submissions, or providing falsified evidence.

All candidates will be required to sign a declaration at time of submission to confirm that they adhere to the terms and conditions of certification, as outlined above.

Data Protection

The Official ITIL Accreditorcomplies with all relevant and current Data Protection Act (DPA) laws within all countries of operation.

The Official ITIL Accreditorwill also hold a publicly available register for all successful ITIL Master Candidates online, which will include candidate name, candidate number, date of certification and a unique ITIL Master Certification Registration number, for purposes of result verification requests from employers and candidates themselves.

The register will be held on the following website: .

Appeals

All appeals will be considered in line with the Official ITIL Accreditor’s Complaints, Issues and Appeals process. For more information, please contact your Examination Institute.

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