Instructor Application

First Name

Last Name

Email

Phone/Mobile

Address

Address Line 1

Address Line 2

City

State

Zip/Postal Code

Country

Upload a photo of yourself for your Instructor Card

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Image Guidelines

Clear headshot, face fully visible
Good lighting
No filters or heavy editing
Follow size/cropping rules
Maximum size 1 MB

Prerequisites

Please enter the name of the agency that issued your prerequisite certification. For certifications other than NovoScuba, please select the agency that certified you and upload a copy of your certification card. To avoid delays ensure that your image clearly shows your full name, certification level, certification date and certification agency.

Independent Diver / Open Water Diver

Please enter the name of the certification agency that issued your Independent Diver/Open Water Diver certification

Dive Explorer / Advanced Diver

Please enter the name of the certification agency that issued your Dive Explorer / Advanced Diver certification

Rescue Diver

Please enter the name of the certification agency that issued your Rescue Diver certification

Divemaster

Please enter the name of the certification agency that issued your Divemaster certification

First Aid and CPR (within the last 24 months)

Date First Aid and CPR Recognition Issued

Please enter the name of the agency that issued your First Aid and CPR recognition

Your First Aid and CPR recognition is older than 24 months. Please add recognition within the last 24 months

Upload your certification card(s) for courses not certified through NovoScuba

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Missing PADI Certification Card? Use PADI Diver Verification to access your certification records

Missing SSI Certification Card? Use SSI Diver Verification to access your certification records

Missing RAID Certification Card? Use RAID Diver Verification to access your certification records

Missing SDI Certification Card? Use SDI Diver Verification to access your certification records

Missing CMAS Certification Card? Use CMAS Diver Verification to access your certification records

Diving Medical

Date of Diving Medical

Please upload your current diving medical. Your medical must be dated within the last 12 months

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Your Instructor Course Information

First Name

Last Name

Instructor Trainer Number

Date Instructor Course Completed

Store Name

Store Location

City

State

Zip Code

Country

I hereby declare that all the information I have provided is true and accurate to the best of my knowledge. I have read the Membership Agreement and hereby consent and agree to the terms and conditions in their entirety. I understand and agree that any criminal conviction on my part involving abuse of a minor or sexual abuse of an adult occurring either during or prior to my membership with NovoScuba, will be automatic grounds for denial or termination of my NovoScuba Membership. I hereby certify that all the above statements are true and correct to the best of my knowledge.

Signature

Sign Here

Date / Time