Employment Application Arizona International Credential Evaluators PMB 124 2820 S Alma School Rd #18 Chandler, AZ 85286 Tel: (Toll-free) 1.888.252.3660 (Local) 602.773.1316 Fax: 623.687.9501 Email: info@iceinaz.com Web: www.iceinaz.comLast Name/Family Name*First/Given Name*Street Address*Address 2City*State*Postal Code*Daytime Phone Number*Fax NumberEmail Address* Date of Birth* Gender*MaleFemaleCountry of Birth*Country of Education*ServicesServices* Document-by-Document ($75.00) Course-by-Course ($125.00) GPA Required Optional Additional Fees 3 business day RUSH ($100.00) 1 business day RUSH ($175.00) Translation to conduct the evaluation ($100.00) International Express Mail ($70.00) Overnight Express Mail ($35.00—USA Only) Return Documents ($20.00) Priority Mail ($10.00—USA Only) Additional Copies ($10.00 each) Educational HistoryList all educational institutions attended. Write the name of each certificate or diploma in English and in the native language. Native language records must be accompanied by English translations for the documents you want evaluated. Primary SchoolName of InstitutionCountryDates of AttendanceDiploma/Certificate AwardedSecondary SchoolName of InstitutionCountryDates of AttendanceDiploma/Certificate AwardedYear of GraduationSecondary SchoolCountryDates of AttendanceDiploma/Certificate AwardedYear of GraduationCollege or University NameCountryDates of AttendanceDiploma/Certificate AwardedYear of GraduationCollege or University NameCountryDates of AttendanceDiploma/Certificate AwardedYear of GraduationAdditional Educational HistoryPlease provide information for any additional educational institutions.Additional Information(Optional) Name and Email of contact at business or school that you are applying to:Upload supporting documents, including native language records with English translations.Upload supporting documents, including native language records with English translations. Drop files here or Certification of the ApplicantI certify that, to the best of my knowledge, all of the information provided in this application is complete and correct. I certify that I have submitted all required documents, including native language records with English translations. I authorize Arizona International Credential Evaluators (AZICE), LLC to verify all submitted educational credentials in order to conduct a thorough and professional credential evaluation. I understand that evaluation reports prepared by AZICE are ADVISORY, and are NOT binding to any agency, institution or organization that uses them. I understand there will be no refund except as outlined in this application. I release Arizona International Credential Evaluators (AZICE), LLC from any liability for damages incurred by me, my representative, or any third party, resulting from the use of an evaluation report by me or any third party.Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Corporate Client Only Name on Credit Card or PayPal Account*Payment Method*PaypalCredit CardCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Total $0.00