· web viewplease indicate grade or seniority level held. 2. describe the main purpose or...

Please read the Membership Regulations, Code of Professional Conduct and Competency Framework found on the CIEEM website before completing this form.

Please ensure that:1. all declarations have been signed;2. copies of appropriate certificates/course content are enclosed with your application; and3. payment has been authorised.

Failure to complete this form fully and accurately will delay admission.

Please type in the boxes provided, remembering to check spelling and adhere to word limits where applicable.

PERSONAL DETAILS

Surname: Forename(s): Title:

Employer: Position:

Home Address: Work

Address:

Postcode: Postcode:

Home Email: Work Email:

Home Tel: Work Tel:

Which is your preferred contact address? (please tick) Home Work

How did you learn about CIEEM?

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Chartered Institute of Ecology and Environmental Management

Application for Associate Membership

http://www.cieem.net/data/files/Resource_Library/Membership/Revised_CF/Competency_Framework.xlsx

http://www.cieem.net/professional-conduct

http://www.cieem.net/eligibility-information

DETAILS OF HIGHER EDUCATION

1. This section must be completed fully; do not cross refer to a CV. A CV may be appended in addition.2. Photocopies of all relevant qualifications, including degree certificates, must be appended to the

application.3. A list of degree courses transcripts or a syllabus summary listing main subjects studied and/or

details of modules taken within the degree must be included unless the degree course was accredited by CIEEM during the period of study.

Degree Course TitleDates

(from – to)Institution/Awarding Body

CIEEM Accredited Degree (Y/N)

Qualification and Classification

OTHER QUALIFICATIONS

Please list any other nationally-recognised relevant qualifications (e.g. diplomas, certificates) resulting from examination or other form of assessment.

Year Qualification Awarding body or organisation Grade (if appropriate)

RESEARCH AND PUBLICATIONS RECORD

Please continue on a separate sheet if necessary, or incorporate with your CV.

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MEMBERSHIP OF PROFESSIONAL BODIES AND LEARNED SOCIETIES

Please list all Professional Bodies and Learned Societies of which you are a member.

Professional body Membership category (if relevant)

Date accepted into this category

DETAILS OF CURRENT PROFESSIONAL ACTIVITY

Current Employment Status

(e.g. Self-employed, employed, volunteer)

Position Full/Part time?

Employer Commencement Date

Description of current professional role(s)

1. Please indicate grade or seniority level held.

2. Describe the main purpose or scope of the role.

3. Give details of some relevant tasks or projects undertaken.

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PREVIOUS RELEVANT EXPERIENCE

Summary of all previous relevant projects/appointments held in the past 10 years (including periods of voluntary work, work undertaken whilst self-employed and previous posts with a current or previous employer if relevant). If you wish to attach a CV in support of your application please append.

1. Begin with the most recent.2. Dates (month/year) must be given.3. Part time (PT) work must be detailed in full (i.e. number of days per week and/or month).

CONTINUING PROFESSIONAL DEVELOPMENT (CPD)

Please describe any relevant training or Continuing Professional Development undertaken, e.g. courses organised by CIEEM, other training provider or by your employer.

Date of activity

No ofhours

Title & Description of CPD activity Provider

Structured or unstructured(S or U/S)

Knowledge area or skill developed and how it has been applied to your professional practice (max 100 words)

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Start date

End date

Employer, Organisation or Client

Role

Permanent FT/PT or contract (see 3 above)

Paid/Unpaid

Actual time in role

Relevant duties and/or experience (including projects, responsibilities)

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SPONSORS

Two sponsors are required to support this application and to confirm the accuracy of the information contained within it. At least one sponsor must be an Associate member (or above) of CIEEM. The second sponsor should ideally also be a member of CIEEM but if this is not possible they should be a member of a similar professional body at an grade equivalent to the CIEEM Associate grade or, if this is not possible, a professional colleague. Sponsors cannot be related to applicants.

As sponsors of this application we encourage you to read through the information available on our Sponsors Resources web page - www.cieem.net/sponsors-resources - to ensure that you feel able to support this application. If you would like sponsors’ information to be emailed to you please contact the membership team via [email protected] or on 01962 868626.

As a sponsor you may be in breach of the Chartered Institute’s Code of Professional Conduct (or that of another professional body of which you are a member) if you knowingly endorse false claims of competence. In the interests of clarity, further information may occasionally be sought from sponsors.

In order to sponsor this applicant please:1. complete the relevant sponsor statements for all of the competencies you feel qualified to support

as evidenced by the applicant in the ‘summary of competence’ section of the form; 2. supply your personal details in the ‘Declaration by Sponsors’ section of the form and sign the

declaration statements.

Data protection:By agreeing to act as a sponsor you will be providing CIEEM with some of your personal data. If you are a current CIEEM member we may use this data to update our records where it differs from that which we currently hold about you and for the duration of the applicant’s membership should your own membership cease. If you are not currently a CIEEM member we will securely retain this information:

for the duration of the assessment and appeals processes; for the duration of the applicant’s membership if this application is successful; for a limited time in line with our retention policy if this application is unsuccessful.

We will only share this information with relevant parties integral to our assessment, appeals and disciplinary processes. We will never share or sell your information to any other organisations without your consent. We will never send you information unrelated to this application without first obtaining your consent. Thank you.

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mailto:[email protected]

http://www.cieem.net/sponsors-resources

SUMMARY OF COMPETENCE

Applicant

With reference to CIEEM’s Competency Framework please provide evidence of your relevant skills and experience. Associate member applicants are expected to be able to demonstrate that they have reached the Capable1 level of competence in a total of seven competencies, one of which must be Professional Conduct. A minimum of three of the competencies should be from the ecological/environmental list and two from the transferable list (other than Professional Conduct)

More information about how to complete this section of the application form, including the STARE method, is available in our Detailed Guidance Document.

Please note that there is a maximum of 250 words per competence and a minimum of 100 words. Use the drop down boxes to select your competency choices and ensure you structure your evidence using the STARE method.

Sponsors

Please state beneath the evidence for each competency why you consider the applicant is suitable for Associate membership of CIEEM. With reference to the applicant’s choices of competency from the Chartered Institute’s Competency Framework, please comment on their evidence of competence as described on this application form at the Capable level, and confirm whether or not you are in agreement with each of these.

Competency 1Competency Transferable Level Professional Conduct: (Mandatory) Transferable Capable

Relevant Evidence (minimum 100 – maximum 250 word limit)

First sponsor statement in support of competency (approximately 100 - 150 word limit)Please provide your sponsor statement below:

☐ I confirm I have read and agree with the statements provided for this competency.☐ I am unable to endorse the statements provided for this competency.Second sponsor statement in support of competency (approximately 100 - 150 word limit)Please provide your sponsor statement below:

☐ I confirm I have read and agree with the statements provided for this competency.☐ I am unable to endorse the statements provided for this competency.

1 Has the knowledge and experience essential to carry out standard tasks unsupervised confidently and consistently well. Is likely to need to seek advice before carrying out complex or non-standard tasks.

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http://www.cieem.net/data/files/Resource_Library/Membership/Revised_CF/Competence_Levels.pdf

Competency 2Competency Transferable Level

Choose an item. Transferable Capable





Competency 3Competency Transferable Level

Choose an item. Transferable Capable





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Competency 4Competency Ecological/environmental Level

Choose an item.

Ecological/Environmental Capable






Choose an item. Ecological/Environmental Capable





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Choose an item. Ecological/Environmental Capable





Competency 7For your final competency choice you can choose either an Ecological/environmental or Transferable competency. Please make your selection from one of the two drop down lists in the left hand column.Competency Ecological/environmental or Transferable Level

Choose an item.

Choose an item.Choose an item. Capable





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DECLARATION BY SPONSORS

FIRST SPONSOR

Name:

Position:

Are you a CIEEM member? Yes ☐ No ☐

Capacity in which you know the applicant: (e.g. colleague, manager)

Qualifications/ professional memberships: (e.g. BSc, MSc, CEnv, CEcol, MCIEEM)

Address:

Postcode:

Email:

Tel:

As a sponsor of this applicant you are asked to confirm that:

a) you have read the CIEEM Competency Framework, Code of Professional Conduct and the Membership Regulations – available on our Sponsors Resources webpage

☐

b) you consider the applicant to be a person of integrity and that he/she is suitable for election to the grade of Associate membership;

☐

c) to the best of your knowledge the applicant has practised, currently practises and is likely to continue to practise in a manner which accords with the principles and objectives of the Chartered Institute’s Code of Professional Conduct;

☐

d) to the best of your knowledge all the information contained in the application is accurate. ☐

Signed: Date:

OFFICE USE

Sponsor approved: Comments requested: Comments received:

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SECOND SPONSOR

Name:

Position:

Are you a CIEEM member? Yes ☐ No ☐

Capacity in which you know the applicant: (e.g. colleague, manager)

Qualifications/ professional memberships: (e.g. BSc, MSc, CEnv, CEcol, MCIEEM)

Address:

Postcode:

Email:

Tel:

As a sponsor of this applicant you are asked to confirm that:

a) you have read the CIEEM Competency Framework, Code of Professional Conduct and the Membership Regulations – available on our Sponsors Resources webpage

☐

b) you consider the applicant to be a person of integrity and that he/she is suitable for election to the grade of Associate membership;

☐

c) to the best of your knowledge the applicant has practised, currently practises and is likely to continue to practise in a manner which accords with the principles and objectives of the Chartered Institute’s Code of Professional Conduct;

☐

d) to the best of your knowledge all the information contained in the application is accurate.☐

Signed: Date:

OFFICE USE

Sponsor approved: Comments requested: Comments received:

Whilst we prefer a signed hard copy of the sponsor form, we understand this is not always possible. Scanned or electronic signatures will be accepted, however, to enable the application to be processed, we will confirm your sponsorship of the applicant for Associate Membership via your personal email account.

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DECLARATION BY APPLICANT

By entering my name in the box below, I certify that the information in this application to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my application for Membership subject to approval by the Governing Body of the Chartered Institute of Ecology and Environmental Management (CIEEM). I agree that details pertinent to my application and membership history will be held and used by CIEEM, under the terms of the Data Protection Act 1998, for the purposes of establishing and maintaining membership of, or support for, CIEEM or providing and administering activities for members. I confirm that I have read and agree to be bound by the terms and conditions of membership stated in the Membership Regulations or any subsequent amendments thereof. I confirm that I have read and agree to be bound by the Code of Professional Conduct or any subsequent amendments thereof. I understand that my application for membership may be refused, or my membership may be later withdrawn, if I have provided false or untrue information or if I am found not to have complied with the Membership Regulations or Code of Professional Conduct.

Signed: Date:

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PAYMENT INFORMATION

Initial payment* Future payments

£160.00 - UK £130.00 - UK

£110.00 - Ireland £80.00 - Ireland

£95.00 - Outside UK and Ireland £65.00 - Outside UK and Ireland

* This initial payment includes a £30.00 (inc. VAT) administration fee

Please note that: Your initial payment may be made by cheque or debit/credit card, but cannot be paid by Direct Debit

in the first year. Members admitted in July, August or September, are entitled to membership until 30th September

of the following year. All subsequent subscriptions are payable annually on 1st October. Payment will be processed and your application acknowledged upon receipt. Any charges incurred by CIEEM due to declined cheque payments will be your responsibility. Receipts for subscriptions and any appropriate refunds are provided at the time of admission to the

Chartered Institute. When the Membership Admissions Committee has considered your application appropriate refunds

are provided if the grade offered is different from that for which you applied.

Please tick one box and complete details as appropriate:

I enclose a cheque, payable to CIEEM for the amount of: £160.00 (£110.00 Ireland, £95.00 outside UK and Ireland)

I wish to pay by debit/credit card, please charge to my account the amount of: £160.00 (£110.00 Ireland, £95.00 outside UK and Ireland)

Card number: Start date: End date:

Name on Card:

Issue number: Security no:

Address of cardholder:

Signature: Date:

Please invoice for the amount of: £160.00 (£110.00 Ireland, £95.00 outside UK and Ireland)

Employer’s name:

Invoice address:

Invoice Postcode:

Invoicing details (e.g. purchase order no):

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PROFESSIONAL INDEMNITY AND PUBLIC LIABILITY INSURANCE

Members of CIEEM are required to ensure that they are insured for any work they might undertake. In many cases this requirement will be satisfied by your employer. Where this is not so, members – especially applicable for those in consultancy practice – are required to have adequate insurance cover, usually Professional Indemnity and Public Liability. You may be required to show proof of this from time to time. The CIEEM scheme – only available to Fellows, Full Members, Associate and those in retirement – is highly recommended. Details of the scheme are made available to all new members and you can apply on approval of your membership.

APPLICATION CHECKLIST

Please tick the boxes below to confirm that:

You have signed the declaration and dated this application

Your sponsors have signed and dated this application, and if they are not CIEEM members you have enclosed a copy of their CV’s

You have enclosed photocopies of your degree certificates

You have included a transcript or list of your degree modules

You have included the correct payment or authorisation

You have spell checked your application

You have completed answers where applicable within the required word limits

PLEASE NOTE: PROCESSING OF THIS APPLICATION TAKES A MINIMUM OF THREE MONTHS BUTFAILURE TO COMPLETE THIS FORM ADEQUATELY WILL DELAY ADMISSION

Please post this form to:

CIEEM, 43 Southgate Street, Winchester, Hampshire SO23 9EH

Or email it to [email protected]

08/2017

· web viewplease indicate grade or seniority level held. 2. describe the main purpose or...

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