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SD-SCD-QF30 Application for Product Certification Auditor
DTI BPS application form for product certification auditor
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R
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No.
Revision No.
SD-SCD-QF30
0
Effectivity Date:
Page
10 April 2017
1 of 2
BPS PRODUCT CERTIFICATION SCHEME
APPLICATION FOR
PRODUCT CERTIFICATION AUDITOR
CERTIFIED
Product Quality
SURNAME
FIRST NAME
ORGANIZATION
MIDDLE NAME
CERTIFIED
Product Safety
SUFFIX
DATE
:
CURRENT POSITION :
DATE OF BIRTH
:
PLACE OF BIRTH :
CITIZENSHIP
:
GENDER :
MARITAL STATUS :
ADDRESS:
TELEPHONE/ FAX NO:
SCOPE OF APPLICATION:
CELLPHONE NO.:
E-MAIL ADDRESS:
QUALITY MANAGEMENT SYSTEM (QMS) AUDITOR
PRODUCT AUDITOR
(If Product Auditor, please tick applicable product category box applied for)
Product
Group
Product
Category
A
Electrical
Products
Group
(EPG)
Mechanical,
Building and
Construction
Products
Group
(MBCG)
Chemical,
Consumer &
Other
Products
(CCOPG)
Specific Products
C
D
E
F
G
H
I
J
K
Household appliances (Small kitchen appliances and electric fans)
Household appliances (Air conditioners, refrigerators, laundry appliances, and audio/
video products)
Lamps and related products
Wiring devices
Wires and cables
Cement products
Steel products
Plastic pipes and conduits
Sanitary wares and ceramics
Wood products
Glass products
L
LPG cylinders & related products/system
M
N
O
P
Q
R
S
T
Monobloc chair/stools
Fire extinguishers
Automotive products
Helmets & related protective equipment
Medical grade oxygen
Fireworks/ matches/ lighters
Food and agricultural products
Brake fluid & related chemical products
Other products (please indicate)
B
U
No.
Revision No.
SD-SCD-QF30
0
Effectivity Date:
Page
F
O
R
M
10 April 2017
2 of 2
QUALIFICATIONS
EDUCATIONAL BACKGROUND
LEVEL
INCLUSIVE
YEAR
DEGREE
EARNED
FROM
TO
INCLUSIVE
DATE
NAME OF SCHOOL
REMARKS
COLLEGE
VOCATIONAL
GRADUATE STUDIES
WORK EXPERIENCE (within the the last 5 years only)
POSITION TITLE
NAME OF COMPANY
TRAINING (training/seminars attended within the last 5 years only)
TRAINING INSTITUTION
TRAINING COURSE
AUDIT EXPERIENCE (QMS/Product audits conducted within the last five years only)
COMPANY
AUDITED
AUDIT TYPE
(indicate QMS or Specific Product Audit)
DATE OF AUDIT
NO. OF HOURS
(Continue on separate sheet if necessary)
It is hereby certified that the information supplied herein by the undersigned is true and correct.
_______________________________________
Printed Name and Signature of Applicant
Subscribed and sworn to before me this _____ day of ___________ 20__. Affiant exhibiting to me his/her_____________________ with
No. ______________ issued on ________________ at _____________________.
Doc. No. : ___________
Page No. : ___________
Book No. : ___________
Series of : ___________
NOTARY PUBLIC
Note: If the product certification auditor applicant is foreign-based, this application should be authenticated by the Philippine Embassy/Consulate Office.
