CCST Examination Application

DIRECTIONS: Complete all sections of the application in ink after reading through the CCST Program Handbook. Exam is given in
English. Original Applications are required—photocopies or faxes do not qualify. Incomplete applications will be returned unprocessed.
It is your responsibility to thoroughly review all requirements and apply for the level at which you are qualified. ISA
reserves the right to audit information provided in this application before or after you take any level CCST exam.

1. Applicant Information (Please print or type.)

Prefix: ❑ Mr. ❑ Mrs. ❑ Ms. ❑ Miss ❑ Other____________________________________________________________
Last Name_________________________________________ First Name______________________________________________ MI__________
(you must provide your name as it appears on your photo identification)
Membership: ❑ ISA ❑ IBEW ❑ UA Member Number:__________________________________________________________________
Job title_________________________________________________ Company Name________________________________________________
Preferred Mailing Address: ❑ Home ❑ Office All ISA-related materials will be mailed to this address unless you notify ISA.
Street Address__________________________________________________________________________________________________________
______________________________________________________ Mail Stop_____________________________________________________
City____________________________________________________ State/Province_________________________________________________
Postal Code______________________________________________ Country______________________________________________________
Telephone (_______)_______________________________________ Fax (_______) ________________________________________________
Email Address __________________________________________________________________________________________________________
Current Supervisor’s Name_________________________________________________ Title___________________________________________
Address___________________________________________________________________________________________________________
City__________________________________________ State/Province_________________ Postal Code______________________________
Telephone (_______)_______________________ Fax (_______) _____________________ Email Address ____________________________
If you have a disability or religious obligation that requires testing accommodations, please check the appropriate box. Attach documentation of your disability or
religious obligation to this application and provide an explanation of the testing accommodation you require.
❑ Religious obligation ❑ ADA defined disability

2. Job and Industry Classification

Check your primary job function: Check the industry you are currently employed in:
❑ Control Systems Engineering (B) ❑ Chemicals (2800) ❑ Petroleum Refining & Related Industries (2900)
❑ Measurement, Testing, Quality, or Standards ❑ Construction (1700) ❑ Pharmaceuticals (2830)
Engineering (I) ❑ Education (8200) ❑ Systems Integration (7370)
❑ Networking/Communication Systems (AP)
❑ Electronic & Other Electric Equipment (3600) ❑ Textiles (2200)
❑ Plant Engineering, Operations, and Maintenance (E)
❑ Production Engineering (D) ❑ Food (2000) ❑ Transportation (3700)
❑ Systems Design Engineering (S) ❑ Government (9100) ❑ Utilities (4900)
❑ Technical or Engineering Support (K) ❑ Industrial Machinery & Equipment, ❑ Utilities—Pipelines except Natural Gas (4600)
❑ Other______________________________(P) including Computers (3500) ❑ Utilities—Water/Wastewater (4940)
❑ Technician—Other (T) ❑ Instrumentation, Measurement,Analysis, & ❑ Valves, Fittings, Fabricated Metal
❑ Technician—Electrical (TE) Control Apparatus (3800) Products (3400)
❑ Technician—Instrumentation/Control (TI)

3. Exam Selection Information

Level
Refer to www.isa.org/examschedule to review information about electronic testing procedures, testing windows, and private/special event exam scheduling. It is
your responsibility to thoroughly review all requirements and apply for the level at which you are qualified. Check only one level.
Applying for: ❑ Level I ❑ Level II ❑ Level III

Format
❑ Electronic exams—Testing must be completed within the next two exam testing windows.
❑ Private exam site or special event paper/pencil exam—application must be postmarked to ISA six weeks prior to the exam date.
Date to Test______________________________________________ City, State____________________________________________________
(ISA cannot process your application without a date and location for private or special event exam sites.)
CCST Exam Application 1
4. Employment Summery
Starting with your current job and working back, complete the information below to document your professional work experience. Make copies of this page as
needed. You must include all information for each position listed or your application cannot be processed. Military experience must be written
here and documented with a copy of your DD214 as well as a written description of your duties. ISA may contact current and former employers to verify the
provided information.

Employer______________________________________________________________________________________________________________

Address_______________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Supervisor’s name__________________________________________ Telephone (_________)__________________________________________

Your position title________________________________________________________________________________________________________

Dates of experience/employment from______________________________________ to ________________________________________________

Description of job duties and responsibilities____________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Employer______________________________________________________________________________________________________________

Address_______________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Supervisor’s name__________________________________________ Telephone (_________)__________________________________________

Your position title________________________________________________________________________________________________________

Dates of experience/employment from______________________________________ to ________________________________________________

Description of job duties and responsibilities____________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Employer______________________________________________________________________________________________________________

Address_______________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Supervisor’s name__________________________________________ Telephone (_________)__________________________________________

Your position title________________________________________________________________________________________________________

Dates of experience/employment from______________________________________ to ________________________________________________

Description of job duties and responsibilities____________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________
CCST Exam Application 2
5. Education/Training
Please include all information for each degree listed if you wish to use education or apprenticeship/training to qualify for CCST.
Note: If your application is audited, you must provide an official transcript to verify the academic work.

Registered Apprenticeship/Training

Degree name___________________________________________________________________________________________________________

Institution name_________________________________________________________________________________________________________

City, State_____________________________________________________________________________________________________________

Beginning date_____________________________________________ Ending date___________________________________________________

Date awarded____________________________________________

Diploma/CST Associate Recognition: Date awarded____________________________________________________________________________

College (Associate)

Degree name___________________________________________________________________________________________________________

Institution name_________________________________________________________________________________________________________
City, State_____________________________________________________________________________________________________________

Beginning date_____________________________________________ Ending date___________________________________________________

Date awarded____________________________________________

College (Bachelor’s)

Degree name___________________________________________________________________________________________________________

Institution name_________________________________________________________________________________________________________

City, State_____________________________________________________________________________________________________________

Beginning date_____________________________________________ Ending date___________________________________________________

Date awarded____________________________________________

6. Compliance with Certification Criteria and Qualifications

I certify that the information I have provided in this application is complete and not guarantee a level of performance by a professional in a particular situation,
accurate to the best of my knowledge and belief. I authorize ISA to contact and ISA does not guarantee the competency or performance of any certified
my current and any former employers and educational institutions to verify individual.
the provided information, and I waive any and all rights of confidentiality or I understand and agree that any certification granted by ISA does not constitute
privacy with regard to the release of all employment or educational information licensure to practice or provide services, whether for a fee or not, when required
relevant to my application to ISA for recognition as a Certified Control Systems by federal, state, or local law. I further understand and agree that I must apply
Technician. for any state required licenses for practice in the specialty field only through the
I understand that if my application is audited, I will be responsible applicable state agencies.
for providing ISA verification of employment and education within I understand that all material submitted related to this application becomes the
sixty (60) days of audit notification using the documents in Appendix property of ISA upon receipt and that none of the materials will be returned to
A of this application. me. ISA will release no information contained in the application materials to any
I hereby waive and release ISA, my current and former employers, and any third party. I understand that the policy and procedures for appealing a decision
educational institutions I have attended, and their respective officers, directors, of the Certification Board are available upon request.
and representatives, from any claims arising from the disclosure of such I understand that any certification by ISA is limited to a three-year period and
information to ISA for the purposes of ISA evaluation of this application. I must be renewed in a timely manner in order to continue as a CCST.
understand that ISA will reject any application that contains false or fraudulent
information, and that, in that event, I will not receive reimbursement of any I have read the CCST Handbook and understand the requirements for the
fees paid, nor credit for any examinations taken. If the fraud is discovered after certification for which I am applying. I agree to follow the ISA Code of Ethics. I
certification is awarded, certification will be revoked. agree that I will not discuss exam questions with any other person.
The CCST program provides recognition and documentation of a professional’s I understand that if my application does not meet the requirements, I will not be
knowledge, experience, and education in automation. Certification status does able to test until deficiencies are resolved. If certified, I hereby request that ISA
include me in any published listings of CCSTs.
______________________________________________________ __________________________________________________________
signature of applicant date

CCST Exam Application 3

7. Fees Fees for the CCST exam vary depending on the level and location you choose. See below.

Certification Level Price for Member Price for Affiliate Members, Exam Format
Community Members and List
Levels I and III $331 $415 Electronic or Paper and pencil private exam sites–all locations
Level II $315 $397 Electronic or Paper and pencil private exam sites–all locations

Your application cannot be processed if payment is not enclosed. The application fee is subject to change. If after review of your application
you do not meet the eligibility requirements, a $50 processing fee will be charged and the remainder of the application fee will be refunded. It
is your responsibility to thoroughly review all requirements and apply for the level at which you are qualified. If you are not sure which level
you qualify for, contact ISA at +1 919-549-8411.
Check applicable box and enclose payment in US dollars. Purchase Orders are not accepted.
❑ Check (payable to ISA) ❑ Credit Card (check one): ❑ American Express ❑ MasterCard ❑ Visa ❑ Discover Card
❑ Certified check Account #___________________________________________________________________________________
❑ Money order Expiration Date________________________________________________________________________________
❑ Wire Transfer Authorized Credit Card Holder’s Signature_____________________________________________________________
❑ Check here if you have registered for the ISA CCST exam review course (TS00) and plan to take the CCST exam. The exam fee will only be waived if you
qualify and your training registration is verified.
Payments to ISA for the Certified Control Systems Technician Program are not deductible as charitable contributions for federal income tax purposes; however,
they may be tax deductible as ordinary and necessary business expenses. Please consult your tax advisor.

If a current CCST referred you to the CCST program, please In addition, you may also provide the individual’s name and employer:
provide his/her certification number here: _______________________________________________________________
__________________________________________ ______________________________________________________________

8. Submitting the Application Two options are available to return application materials:
1. With check or money order payment 2. With credit card payment
(through regular postal delivery) (and for overnight delivery)
ISA ISA
Certified Control Systems Technician Program Certified Control Systems Technician Program
P.O. Box 12277 67 T.W. Alexander Drive
Research Triangle Park, NC 27702-2277 USA Research Triangle Park, NC 27709 USA
Phone: +1 919-549-8411

Materials sent to any other address will be returned. Fax and email applications are not accepted.

By completing this form, you acknowledge that ISA needs the information requested here to provide you with the best possible service.
Occasionally, we make this information available to companies whose products or services may be of interest to you. Review ISA’s complete Privacy Statement at
www.isa.org/lawyer or request a copy by calling +1 919-549-8411.
❑ Do not release my name and contact information to companies selling products and services.
❑ Do not call me about ISA activities.

CCST Exam Application 4