Application for Registered Martial Artist Status

Certified Applicants: Complete this form and the certification application that follows.

Download Paper Forms

Instructions

Thank you for your interest in the Registered Martial Artist™ and Certified Martial Artist™ programs. We believe in building a community of trustworthy individuals to carry on the invaluable life lessons and traditions found in the martial arts. Before continuing, please become familiar with our registration criteria, including the factors for disqualification. Those factors include criminal history, sex offender status, illegal immigration status, dishonorable military discharge, history of drug use, and mental illness.

Full disclosure on this application is required to become Registered and Certified.

Please read Registration Policies before proceeding. Also be aware of our Registration Criteria and be sure you are eligible for membership prior to starting your application.

This form facilitates the background investigation required for Registered Martial Artist and Certified Martial Artist status. Those applying for Certification must also complete the Certification application in addition to this form. All applicants must include a copy of their driver’s license, military ID, passport, or state-issued identification card as well as proof of citizenship, naturalization, or immigration status (green card). Those who have served in the military must also provide discharge paperwork. All documentation may be uploaded to this site after completing the below portion of the application.

Please complete all fields as completely as possible. Incomplete applications will not be accepted. There must not be any gaps in address history. All information supplied on this application will be investigated by a licensed private detective. Applications that contain information that is found to be misleading, omitted, incorrect, inaccurate, or incomplete in any way will be declined without refund.

The Martial Arts Certification Authority does not issue refunds of registration or certification fees for any reason.

All information supplied on this form is used for the purpose of evaluating the applicant’s eligibility for Registered Martial Artist status and for no other purpose. All information is kept private, except portions of the form specifically noted as public fields that will appear in the member’s public profile on the CertifiedMartialArts.com web site upon award of Registered Martial Artist status.

Note: The information on this form is private and for the use of certification and investigation officials only. Only your name, location display name, physical description, biography, and school information fields will be used on your public profile.

Personal Information
Please provide your full legal name along with current contact and address information. Your date of birth and social security number are required in order to verify information on this application.
First (Given) Name:
Middle Name:
Last Name (Surname):
Aliases / Prior Names
Email Address:
Password
(Confirm)
SSN:
Required for Identity, Citizenship, and Military Verification
Date of Birth:  
Place of Birth:
Height:
Weight: (in pounds)
Hair Color:
Eye Color:
Race:
Current Address:
City
State
Zipcode
Country
Home Phone
Work Phone
Cell Phone
Prior Address Information
Note: You must provide a complete address history for the past 10 years with no gaps or your application will be declined.
Press the Add Address button to create a new address. Be sure to fill in the dates lived at each address without any unexplained gaps between.
Prior Address 1
Prior Address:
Include city, state, postal code, country.
255 allowed characters.
Dates Lived at Address

Employment Information
Note: Please provide all previous employers for past the ten years.
Current Employer
Employer Name
Primary Employer - enter the name of the company you work for
Job Titles
Dates of Employment:
Employer Address
255 allowed characters.
Supervisor Name:
Supervisor Phone
Prior Employers
Prior Employer 1
Employer Name
Job Titles

Dates of Employment
Employer Address
255 allowed characters.
Supervisor Name
Supervisor Phone
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Display Information
Note: This information will appear on your public profile.
Location Display Name
Biography
255 allowed characters.
Affiliated Martial Arts School

Note: This information will appear on your public profile.
School/Dojo/Club Name
Enter name of school, club, or dojo you're primarily affiliated with.
School Location
255 allowed characters.
Enter City and State of the school from above.
School Website
Enter web site (http://www...) of the school from above.
School Phone
Enter public phone number of the school from above.
School Email
Background Information

Have you ever been arrested, charged, or convicted of any of the following:

Note: If you answer Yes to any of these question you must provide a detailed explanation or your application may be declined.

Sex Crimes: Sexual assault, harassment, or any other sex-related crime:
255 allowed characters.
Drug Crimes: Drug possession, distribution, or other drug-related crime:
255 allowed characters.
Violent Crimes: Assault, Battery, Domestic Violence, Child Abuse, Animal Cruelty, Gun/Weapon Charges, or any other violent crime?
255 allowed characters.
Drug Abuse: Do you have a history of abusing drugs (including prescription drugs) or alcohol?
255 allowed characters.
Mental Condition Do you have a history of mental illness, been admitted to a psychiatric facility, or been under the care of a psychiatrist for more than one year?
255 allowed characters.
Injury Claims: Have you ever been sued or named in a lawsuit, settlement, or judgment for any injury relating to the practice or instruction of martial arts or similar sports such as boxing or wrestling?
255 allowed characters.
Citizenship:
Must include place of birth 		Are you a citizen of the United States? If not, please indicate your immigration status, including any sponsorship information. If you were born outside the USA you must include documentation of citizenship or legal immigration status.

Military Service

If you ever served in the Armed Forces, including the Reserves, please include a detailed description of your military service and discharge. If you are currently and active member of the Armed Forces, please indicate your current assignment, location, and supervisor.

Note: You must provide a copy of your discharge paperwork if you were ever discharged from the Armed Forces.


Active Military If you currently an active or reserve member of the military, please include your current unit assignment, location, and supervisor name. Please attach a copy of your current military identification.
255 allowed characters.
Military Assignments/Dates Please list military unit assignments along with dates of service.
255 allowed characters.
Military Discharge Indicate the discharge type and date of discharge. Note: You must include documentation of your military discharge or your application may be declined.

Professional References

Each reference must be a non-family member (no relatives) that you’ve known for at least three years who can testify to your character. References may include co-workers, associates, and friends, but at least one of the references must be either a direct student, instructor, or peer martial artist who is familiar with you in a role as an experienced martial artist.

We will contact your first three references to schedule a 5-10 minute telephone interview.

First Reference - Name
Relationship
Phone Number
Other Phone Number
Professional Reference
Second Reference Name
Relationship
Phone
Other Phone
Professional Reference
Third Reference Name
Relationship
Phone
Other Phone
Additional Notes & Information

Please use this page to supply any additional information, notes, or answers to the above background questions that may help us process your application. Alternately you may type this page and submit it on a separate sheet of paper.

Notes
255 allowed characters.
  

Statement & Signature

I certify the information provided is complete, true, and correct to the best of my knowledge. I hereby authorize the Martial Arts Certification Authority and its parent company Atlantic Defense, as well as Sports Verification Services and the Surveillance Group to conduct a thorough background investigation on myself including criminal history, military service, immigration status, credit history, psychiatric history, employment history, and personal interviews with my employers, instructors, personal references, and any other party deemed necessary to establish my reputation as an upstanding member of the martial arts community.

I understand that as a condition of Registration and Certification I may be tested for the use of illegal drugs at any time and I hereby consent to such testing.

I understand and agree that my status, if granted, as Registered Martial Artist or Certified Martial Artist may be revoked at any time if I am found to be disqualified to hold the credential due to current or prior disqualifying factor, including but not limited to criminal charges, drug use, mental illness, illegal immigration status, or falsified information on this application.

I understand that application fees are non-refundable regardless of outcome.

Signature (print full name):

 

 
Certified Martial Arts


 

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