GPN Internship Application NOTE: There is no fee to join the Global Polygraph Network, but GPN does collect a referral fee for each assignment that is sent to a member or intern examiner. INTERN EXAMINER INFORMATION Examiner Name Mailing address Email address (required for assignments) Web site (a bank link is required) Phone number(s) Phone number we can supply to clients (if different) List all states and/or countries where you hold valid (current) polygraph licenses Polygraph-related professional memberships (APA, AAPP, etc.) List any high-profile cases, television shows, media events, specialized training, or any other information you would like to appear with your listing on an additional sheet TRAINING Name and location of primary polygraph school/s attended (or scheduled to attend) Graduation date (or anticipated graduation date) Certification date (if applicable) Certified for PCSOT testing Yes No EXPERIENCE Total number of exams completed of all types (do not include mock tests) Total number of domestic (relationship) exams administered Number of polygraph CE credits (hours) completed in the last 2 years Ever certified or approved as a polygraph expert in court Yes No TECHNIQUES Primary polygraph technique(s) used (be specific, ie. Utah ZCT, AFMGQT, Federal You Phase) Maximum number of different RQ’s allowed in a multi-issue exam EQUIPMENT Which polygraph instrument (make and model) do you own (or plan to buy) ? Using motion sensor pads to identify countermeasures ? Yes No Using motion sensor pads to identify countermeasures ? Yes No Ability to audio/video record the exams? Yes No PREFERENCES Will you provide EPPA exams and meet EPPA requirements ? Yes No Will you provide exams in a private home if requested ? Yes No Will you provide exams in a private home if requested ? Yes No Will you provide exams in a private home if requested ? Yes No Do you test pregnant women (with physician approval)? Yes No If yes, do you have restrictions (first trimester only, etc.)? Yes No Age of the youngest examinee you will test (with parental consent)? Interested in providing services for sporting tournaments ? Yes No Interested in providing services for television shows / media? Yes No Will you provide testing on weekends ? Yes No If yes, will there be an extra charge? Yes No Will you provide testing in the evenings (after 5:00 PM) ? Yes No If yes, will there be an extra charge? Yes No Maximum number of exams you can provide in one day Will you accept credit cards for payment (required) ? Yes No Do you have a valid Passport? Yes No In which languages can you test without using an interpreter ** ? Yes No ** GPN members must be willing to work with an interpreter if necessary SUBMIT
