Application
for Chartered
Membership
Personal Information Form Professional Review:
All Chartered Membership Pathways
How
to complete this form
It is important that you use the most up to date version of Adobe programme
available.
(Please use the Adobe programme instead of Adobe online. Using an online version may cause errors on the form)
This form requires signatures for declarations and verifiers.
How to fill, sign, and send your PDF form:
47
Digital Signatures
2
APPLICANTS DECLARATIONPERSONAL INFORMATION FORM CURRENT EMPLOYER DETAILS EMPLOYER DECLARATION
Checklist:
Privacy Statement
Submissions made through a PR Provider
(named below)
UPLOAD PASSPORT PHOTOGRAPH
https://smallpdf.com/jpg-to-pdf
UPLOAD
Personal Information Form
Introduction
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APPLICANTS DECLARATIONPERSONAL INFORMATION FORM CURRENT EMPLOYER DETAILS EMPLOYER DECLARATION
1 Royal Charter & Bye-Laws
https://www.ciob.org/about/who-we-are
2 Criminal convictions
gov[email protected]g.uk
3 Insolvency/Bankrupt
gov[email protected]g.uk.
4 Information on this application
On signing this declaration, I declare:
■
■
■
Applicant’s Declaration:
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APPLICANTS DECLARATIONPERSONAL INFORMATION FORM CURRENT EMPLOYER DETAILS EMPLOYER DECLARATION
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APPLICANTS DECLARATIONPERSONAL INFORMATION FORM CURRENT EMPLOYER DETAILS EMPLOYER DECLARATION
CIOB Mentoring via the Pushfar platform
Mentoring from a colleague
Submitted the application through a provider
Attended a CIOB workshop
None
of the above
Other
Support
There is a range of support available to you that is highlighted in the Guidance Notes. To help us understand how many people are accessing the
support and which support is most effective, please select which support option you used, if any.
Company Name:
Company Address:
Job Title:
Date from: Date to:
Current Employment Details
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APPLICANTS DECLARATIONPERSONAL INFORMATION FORM CURRENT EMPLOYER DETAILS EMPLOYER DECLARATION
Employment Status
Permanent Employee
Temporary Employee
Self-Employed
Currently unemployed
Your Certificate
If successful, please indicate your preferred title for your certificate.
This does not affect the designation MCIOB.
Chartered Builder
Chartered Construction Manager
Your membership card is available as a physical card or a digital version.
You can only have one membership card.
Please state your preference.
Digital
Physical
7
Your Employer or Professional Body Verifier
This section should be signed by either your line manager or another person in a more senior position than yourself. Please note this will be checked against the
organisation chart you have submitted. Or a Chartered Member of CIOB or another Professional Body can sign. Please refer to the guidance notes for more details.
I confirm that the photograph on this application is a true likeness of the applicant
I confirm that I have read the PR report, and the examples provided in all the sections are a true and accurate description of the competencies and work carried
out by the applicant.
APPLICANTS DECLARATIONPERSONAL INFORMATION FORM CURRENT EMPLOYER DETAILS EMPLOYER DECLARATIONAPPLICANTS DECLARATIONPERSONAL INFORMATION FORM CURRENT EMPLOYER DETAILS EMPLOYER DECLARATION
How many years have you known the applicant?
Your signature:
Name:
I confirm that the applicant has shown a commitment to advancing their own learning and Continuing Professional Development
In what capacity do you know the applicant? Your
Job Title:
Email:
I am a Chartered member of (if applicable) :
Membership number:
(please note we may contact you at any time in relation to this application)
178
Your Employer or Professional Body Member Verifier
A Secord verifier is only required if the first verifier is unable to verify all sections of the report.
This section should be signed by either your line manager or another person in a more senior position than yourself. Please note this will be checked against the organi-
sation chart you have submitted. Or a Chartered
Member of CIOB or another Professional Body can sign. Please refer to the guidance notes for more details.
APPLICANTS DECLARATIONPERSONAL INFORMATION FORM CURRENT EMPLOYER DETAILS EMPLOYER DECLARATION
How many years have you known the applicant?
Your signature:
Name:
I confirm that the photograph on this application is a true likeness of the applicant
I confirm that I have read the PR report,
and the examples provided in all the sections are a true and accurate description of the competencies and work carried
out by the applicant.
I confirm that the applicant has shown a commitment to advancing their own learning and Continuing Professional Development
Email:
I am a member of (if applicable) :
Membership number:
In what capacity do you know the applicant? Job Title:
Thanks for applying
V4_July2024
