APPCIOS Application Form

Please copy and complete this form, and send it, along with your CV, to our Registrar, Tina Bool, at tina.bool@appcios.info

 

 

 

 

 

Application for APPCIOS Membership

 

Name: 

 

Home Address:

 

Home Telephone Number:

 

Work Address (if appropriate): 

 

Work Telephone Number (if appropriate):

 

Email Address:

 

Brief Current Employment Details: 

 

Names and email addresses of  two referees:

 

 

Supervisor’s name and email address (if applicable):

 

I attach my CV  (please tick):

 

DISCLOSURE OF CONVICTIONS ETC.

If you have been convicted of a criminal offence in any court in the UK or elsewhere, or have any proceedings commenced against you, civil or criminal, or by any professional body, you must inform the APPCIOS Accreditation eCommittee as part of this application.

I have read and understand this requirement to disclose (please sign):