FULL MEMBERSHIP AND CHARTERED ENVIRONMENTALIST (CEnv) APPLICATION FORM

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1 For office use only Full June 15 Reference FULL MEMBERSHIP AND CHARTERED ENVIRONMENTALIST (CEnv) APPLICATION FORM Please read the guidance found in Guide to Full Membership of IEMA (MIEMA) and Chartered Environmentalist (CEnv) before completing this application form. NB. In order to apply for Full Membership and CEnv you must be a member of IEMA. Personal Details: Title Surname Membership Number (if already a member) Full Employer/Organisation Name First Name Date of Birth If you are not currently a member of IEMA or any of your details have changed, please complete the sections below. NB. All future correspondence will be sent to this address. Correspondence Address Town County Postcode Country Complete this section only if it is different to the Correspondence Address Billing Address Town County Postcode Mobile Telephone Home Telephone Business Telephone Supporting Documents Checklist: For your Membership application to be processed, please include 4 copies of the following: A completed application form Supporting Paper: no more than 2000 words Full Curriculum Vitae: no more than 4 sides of A4 Witness statements, completed and signed by two witnesses Colour copy of photo ID e.g. driving licence or passport The Interview Assessment Interview assessments for this level are normally completed using a webcam and audio setup. However, a face-to-face interview can be scheduled, with all costs payable by the candidate. I would prefer to have a face-to-face interview at my own cost I have a registered disability and would like IEMA to contact me to explain interview assessment options. IEMA has a policy to ensure no candidate is disadvantaged during assessment. If you have any special requirements that may affect your application, please enclose details in a covering letter to accompany your application. Please note that you must disclose any special requirements at the start of the application process. Anything not disclosed at this time cannot be relied upon later. 1

2 Membership and Registration Tick Fee Existing Member of IEMA applying for Full Membership/Dual/CEnv I am a current IEMA Full Member and wish to achieve CEnv status I am not a Member of IEMA and would like to join as an Affiliate and Full/Dual/CEnv I have CEnv status through another professional body and wish to achieve IEMA Full Membership and can then transfer my CEnv status should I require Declarations I confirm that I have read and understood the criteria and application guidance for IEMA Full Membership and CEnv and believe I fulfil the requirements. I understand that CPD is essential to maintaining my membership and will be required on an annual basis. By signing this form I declare that I have read and understood the Code of Practice for IEMA and Society for the Environment and will endeavour to uphold these principles in my professional capacity, and in order to maintain my IEMA Full and CEnv status. By signing your name on this form, you confirm that the information supplied is complete and accurate and you understand that your application or resulting qualification/membership may be withdrawn at a later date if the information is found and proved to be false and/or misleading. Membership and registration fees are nonrefundable. Incomplete applications will not be accepted. NEXT STEPS 1. Complete this form and supporting documents, ensuring you sign and date it and that the required number of copies are included. 2. Return the form and supporting documents, in person, to an IEMA member of staff or alternatively post it to the IEMA Membership Team at: IEMA, City Office Park, Tritton Road, Lincoln. LN6 7AS UK. 3. Payment must be received in order to process your application. Please complete the payment details section. 2

3 CODES OF PRACTICE As a Full Member of IEMA I will: As a Chartered Environmentalist I will: Uphold and promote the environment and sustainability profession; Act in accordance with the best principles for the mitigation of environmental harm and the enhancement of environmental quality; Exercise honesty, impartiality, diligence and objectivity in my professional work; Support and promote sustainable action and challenge environmentally unsustainable action; Work to, and promote, high standards and best practice in the environment and sustainability profession; Ensure that professional judgement is not influenced by a conflict of interest and I shall make all relevant parties aware where there is such a conflict; Strive to ensure that the uses of natural resources are fair and sustainable taking account of the needs of a diverse society; Use my skills and experience to serve the needs of the environment and society; Serve as an example to others for responsible environmental behaviour; Not engage in conduct involving dishonesty, fraud, deceit or misrepresentation or discrimination; and Acknowledge my limitations of competence and not undertake work which I know is beyond my professional capability; Commit to maintaining my personal professional competence and strive to maintain the integrity and competence of my profession. Develop and maintain standards of professional competence and knowledge through a combination of training, learning and practical experience and through the support of others; In giving advice, make the relevant person(s) aware of the potential consequences of actions; and Endeavour to be an innovative, lateral thinker in the pursuit of environmental improvement and sustainability. 3

4 Witnesses Two witnesses are required to verify that the paper submitted is both a fair and representative account of the candidate s experience in relation to the criteria for Full Membership. Witnesses cannot be the applicants IEMA mentor. One or both witnesses should have an environmental/ sustainability background and it is preferable but not compulsory if at least one is an IEMA Full and/or Chartered Environmentalist member. Examples of a witness include line manager, colleague and/or client. Original copies of witness statements are preferred however scanned copies are accepted. By signing this witness statement you are confirming you have: Verified that the supporting paper, CV and other information provided in this application is a fair representation of the candidate s skills and experience. That you know the candidate in a professional capacity. Witness one Name Employer Professional Qualifications (e.g. MSc, MIEMA, CEnv etc.) Relationship to candidate Address Telephone Witness two Name Employer Professional Qualifications (e.g. MSc, MIEMA, CEnv etc.) Relationship to candidate Address Telephone 4

5 Payment Details: Please tick your preferred payment method. Please note that fees are non-refundable. If you would prefer to pay for your registration by credit or debit card over the telephone, please submit your application and supporting documents and tick the box below. It is not necessary to make 4 copies of the payment details section. Receipts are automatically ed once payment has been taken. I would like to pay over the telephone. Please contact me. I would like to pay by Credit/Debit Card: Mastercard Visa UK Maestro Visa Debit Visa Electron Credit Card Information: Card Holder s Name and Initials Start Date Issue Number (if paying by UK Maestro) Signature Card Number Expiry Date CVN (last 3 digits on the back of your card) Date 5