Employment Verification Form

This form must be completed by an Authorized Representative of an CIRO Affiliated Firm.

If the candidate is not currently employed by an CIRO affiliated firm, they must obtain confirmation of employment verification in order to obtain the 50% discount. If the candidate is currently employed by an CIRO affiance firm, confirmation is not required.

Candidate’s Full Name *

First

Last

Checkboxes

By signing below I am confirming this candidate is required to re-enrol in the course to comply with CIRO Rule 2600 Part II A rewrite requirements.

Name of Authorized Representative *

Title of Authorized Representative *

CIRO Affiliated Firm Name *

Billing Account Code (if applicable)

Email *

Signature *

Clear Signature