Certification

AFE CERTIFIED PLANT MAINTENANCE MANAGER

INSTRUCTIONS

(Each application must meet the following requirements before it will be processed.) The application must be filled out completely and signed. All application and exam fees must be included. Please print or type all information. Upon submission of this application, you will receive employment verification forms. All fees are non-refundable. Applicants who meet the eligibility requirements must complete the application enclosed and mail it to:

Association for Facilities Engineering
12801 Worldgate Drive, Suite 500
Herndon, VA 20170

* required fields

GENERAL INFORMATION:

I'm attending A CPMM
Review Program:
 Yes   No
I will be attending:
Preferred Mailing to:
 Business   Home
*Your First Name:
*Your Last Name:
Your Middle Name:
Your Title:
Employer:
Business Address:
City:
State:
ZIP:
Business Telephone:
Business Fax:
Home Street Address:
City:
State:
ZIP:
Home Telephone:
*E-mail Address:
Date of Birth:
AFE Member: Yes   No


EMPLOYMENT

Please complete the following in reverse chronological order, full-time positions only, beginning with your present position. If further space is required to explain job responsibilities or to provide additional work experience, please list this in theAdditional Informationbox at the bottom of this section of the form.

* FROM: (Mo./Yr.) TO (Mo./Yr.):
*EMPLOYER'S NAME & LOCATION:
*IMMEDIATE SUPERVISOR'S NAME&TITLE:
*YOUR TITLE:
*Number of years of plant engineering / facilities management experience:
*Number of years of management level plant engineering / facilities:
*Duties and responsibilities:
FROM: (Mo./Yr.): TO (Mo./Yr.):
EMPLOYER'S NAME&LOCATION:
IMMEDIATE SUPERVISOR'S NAME&TITLE:
YOUR TITLE:
Number of years of plant engineering / facilities management experience:
Number of years of management level plant engineering / facilities:
Duties and responsibilities:
FROM: (Mo./Yr.): TO (Mo./Yr.):
EMPLOYER'S NAME&LOCATION:
IMMEDIATE SUPERVISOR'S NAME&TITLE:
YOUR TITLE:
Number of years of plant engineering / facilities management experience:
Number of years of management level plant engineering / facilities:
Duties and responsibilities:
FROM: (Mo./Yr.): TO (Mo./Yr.):
EMPLOYER'S NAME&LOCATION:
IMMEDIATE SUPERVISOR'S NAME&TITLE:
YOUR TITLE:
Number of years of plant engineering / facilities management experience:
Number of years of management level plant engineering / facilities:
Duties and responsibilities:
Additional Information:


EDUCATION

Highest Level Completed:
High School
College exp. - no degree
Vocational/Associate
Bachelor's
Master's
Doctorate

School Location Curriculum Dates
Attended		 Year
Graduated		 Type of
Degree


FEES

If you would like to be invoiced for your certification fees please fax a Purchase Order to (571) 766-2142.

PO Number:

Review program fees
AFE member: $1095
$1145 (late)
AFE non member: $1295
$1345 (late)
If you are attending a review program the following items are included:
  • 4 Days of Instructional Delivery
  • Instructor Handouts
  • Review Pak
  • Application/Exam Fees
Virtual Seminar fees
AFE member: $975
AFE non member: $1175
If you are attending a virtual seminar the following items are included:
  • All sessions
  • Instructor Handouts
  • Review Pak
  • Application/Exam Fee
Application fees for Self-Study or Exam Only
AFE member: $275
AFE non member: $460
 
Exam fees for Self-Study or Exam Only
Choose One: Online   Paper   None
*Note: Testing fee is $100 and will be added onto your bill.
 
CPMM Review Pack
Member: $125 (Includes $15.00 shipping)
Non-Member: $150 (Includes $15.00 shipping)
 


METHODS FOR PAYMENT

*Total Due $
*Credit Card Type: American Express    MasterCard   Visa
*Credit Card Number:
*Expiration Date: /
*Card Holder Name:
*Security ID:
*Billing Address:
*City:
*State:
*Zip:

* indicates a required field, if providing a PO number, please indicate the number in the PO number box above and proceed.

CERTIFICANT AFFIDAVIT and PLEDGE

The applicant acknowledges that the Certification Board of the Association for Facilities Engineering, by its usual standards and procedures, will investigate and compile a record with respect to all aspects of the applicant's career. The applicant agrees to provide any additional information in connection with the investigation as may be required. In consideration of the services to be rendered by the Certification Board, the applicant hereby releases, discharges and exonerates the Certification Board of the Association for Facilities Engineering, its officers, directors and agents from any and all liability of every kind and nature arising out of the procedures, information transmitted concerning the applicant, or action of the Board in approving or disapproving applications.

* By clicking the box, I hereby attest that the above information and its attachments are true and complete. I understand that the Association for Facilities Engineering certification programs will not discriminate among applicants as to age, sex, race, color, religion, national origin, disability, citizenship status or veteran status. I further pledge to maintain the highest ethical standards of practice in carrying out my assigned duties with regard to this certification.


 
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© 1999-2010 Association for Facilities Engineering
12801 Worldgate Drive, Suite 500, Herndon, VA 20170
Phone: (571) 203-7171 Fax: (571) 766-2142   -   Email: Info@AFE.org