NEHA Food Safety Training: Protecting Environmental Health through Education

Trainer Application

Join NEHA Food Safety Training’s international network of distinguished trainers! Registration is free, with a one-time administrative fee ($15) due upon approval of your application. Once your application has been processed, you will receive confirmation via e-mail. All applications are processed within two weeks.

Please provide as much information as possible so a clear determination can be made for approval. No test or continuing education is required to be registered, however, you may be asked to fax or mail supporting documentation. There are three competency requirements to become a Registered Food Safety Trainer.

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*Title:	e.g., Mr, Mrs, Ms, Dr, etc.
*First Name:	MI: *Last Name:
Credentials:	e.g., REHS/RS, CP-FS, etc (not required)
NEHA Membership:	Yes No (not required)
Employment Status:
Category:
Job Title:	(if applicable)
Full Company Name (no acronyms):	(if applicable)
In which counties, and states if more than one, do you plan to conduct training?

How will your training be conducted?

Do you train managers, food handlers, or both?

*Approximately how many training sessions do you (does your company) hold per year?

*On average, approximately how many individuals are in each of the training sessions?

Do you want to be included in NEHA Food Safety Training's online trainer directory? Yes No
NEHA Food Safety Training offers the Certified Food Safety Manager™ Exam provided by the National Registry of Food Safety Professionals®. If you plan to use another exam provider, please indicate below:

*How did you first hear about NEHA Training?
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*Contact Information:	Business Residential
Company Name:
*Shipping Street: (no P.O. Box)

*City:
*State/Province:
*Zip/PostalCode:
Country:
*Phone:	Fax:
Email:
Enter email again to confirm:
Competency 1 — Food Safety Knowledge Please describe your level of food safety knowledge. A verifiable credential from a college or university is required that encompasses one or more of the following topics: • Environmental/Public Health • Food Science or Technology • Food Establishment Management in the hotel, restaurant, or retail sectors • Microbiology • Culinary Skills • Food Safety Professional credentials are also acceptable in lieu of those from colleges or universities (i.e., Registered Environmental Health Specialist/Registered Sanitarian or Certified Food Safety Professional). Please note, Food Safety Manager certificates (such as ServSafe or NRFSP) do NOT meet this requirement. Competency 2 — Training or Teaching Skills Please describe your training or teaching qualification(s). If you do not have a formal qualification, but have training or teaching experience, please skip this section and go to Competency 3. *Competency 3 — Experience Please describe your recent employment history relevant to this application. Provide details of a food safety related job responsibility and/or training in one or more of the following areas: • Supervision of food preparation (experience in foodservice/catering industry should be of a technical nature, and at a managerial level) • Regulatory authority with food safety responsibilities • Quality assurance or control in a food operation Additional Comments: (not required)
Please carefully review your information before submitting. By submitting this online application, you confirm that to the best of your knowledge and belief the information provided is correct. Enter your electronic signature in the box below before submitting. Note: an electronic signature is your own chosen set of numbers and/or letters set between two forward slash marks in the signature block. For example: /John Doe Sr./
*Electronic Signature

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