Designations Form

Personal Information

Please indicate your name (including any initials used) exactly as it appears on your government-issued photo ID.

NOTE: Please be sure to fill out your profile online once your application for certification has been accepted.

Declaration and Signature of Applicant

Work Experience Requirements

Continuing Education Requirements

You are not required to submit your CE documentation on an annual basis, however from time to time some members may be subject to random audits.

Fit and Proper Requirement

Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, CIRO, Insurance Regulator, FINRA, etc.)?, Insurance Regulator, FINRA, etc.)?
Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt?
Have you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?
Have you ever been convicted of an offense under any financial services or consumer protection legislation in any jurisdiction (i.e., laws regulating the sale of securities, insurance, real estate, mortgages, etc.)?

If you have answered “Yes” to any of the questions above, please attach all relevant paperwork, including details of any punishment or disciplinary action taken. Any information you provide will be collected, stored and used in accordance with applicable law and our privacy policy and will be shared with the Designation Ethics Committee to determine your suitability for the designation.

* “Criminal offence” excludes an offence (i) under a provincial regulatory statute, such as the Highway Traffic Act, unless the provincial statute is specifically listed above and unless the provincial conviction involved an offence of dishonesty or theft, such as perjury or subornation of perjury, false statement, fraud, embezzlement, or false pretense, or any other offense the commission of which involves some element of deceit or untruthfulness, and (ii) an offence punishable by summary conviction only that is not an offence of dishonesty or theft.

Code of Ethics

As a designation holder and throughout my annual designation period, I agree that I will continue to uphold the Code of Ethics and abide by the Ethical Misconduct Process.

Work Experience – Verifier Information

Certification Mark License Agreement

I understand that CSI grants me license to use the Certification Mark for a one-year term and that if I do not renew my designation, CSI will terminate my license to use the Certification Mark. I also agree to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.