Career Appraisal Application FormICE 3126

Before completing this form please consult MGN 11 which is available on the ICE Website. Note the time typically taken to process and assess your application. Allow enough time between receiving the result of your Career Appraisal and submitting a Professional Review application for your to act on any recommendation made.

As a Career Appraisal will be carried out to authenticate your E/IPD and CPD for only one grade of membership, you must signify by ticking the one box below, at which grade of membership you wish your application to be considered. You must also ensure that your educational base is acceptable for that grade.

Chartered Member (CEng MICE) Member (IEng MICE) Member (MICE) Associate Member (AMICE)Chartered Environmentalist Associate Member (CEnv AMICE) Technician Member (EngTech TMICE)

Personal information:ICE Membership No:(If applicable)                 Current Grade:

(If applicable)       Year of admission:(If applicable)      

Surname:       Title:      First name(s):       Date of Birth:      Nationality:       Gender:      Please tick to confirm that you are not registered on a Training Agreement with any Professional Engineering Institution (see MGN 11)

Home Address:icAddress Line 1:      Address Line 2:      Address Line 3:       Telephone:      Country:       Fax:      Postcode:       Contact e-mail:      

Employment:Employers name:       Position held:      Address Line 1:       Start Date:      Address Line 2:      Address Line 3:       Telephone:      Country:       Fax:      Postcode:       Contact e-mail:      

Academic Qualifications (Undergraduate and Post Graduate)

Awarding College/University

(in order attained)

Qualification(HND, BEng,

BSc etc)

Course Title Attendance Type

(Full, Part time, sandwich etc)

Class(1st, 2;i,

etc)

Start Date (mm/yy)

End Date(mm/yy)

                                         

                                         

                                         

Initial Professional Development Page 1 of 2 Version 2 Revision 4 – 01 August 2013ICE3126 Registered Charity 210252 & Scotland SC038629

Please ensure you have included the following with your completed and signed application form:A Professional Development (PDR) & Record and Development Action Plan(DAP):refer to ICE 3006A for guidanceA copy of the Development Objectives (plus Environmental Development Objectives if seeking CEnv) :refer to ICE 3005A for guidance (and also to ICE3008A if seeking CEnv)A 2000 word experience report:Cross-referenced to the Environmental/Development Objectives

Detailed CV*A certified copy of your academic qualifications (even if you are a current member of ICE, this is still required)

**Application Fee - Details available on the ICE website (http://www.ice.org.uk/fees)

1. Pay Online - (Should you wish to follow this method then payment must be made before sending your application) You are now able to pay for your Career Appraisal application via the ICE website using a debit or credit card. To pay online please go to www.ice.org.uk/fees and select the pay online button located next to the application fee you wish to pay.

Please note you will be asked to log into your MyICE account before being redirected to the secure payment system. If you are not already registered with MyICE please register online. Once you have paid online you will receive a payment confirmation email from the ICE which contains an eight digit reference number (please provide this reference number below). Reference Number:       2. Pay with application To submit a credit or debit card payment with this application please download and complete ICE3180. Alternatively if you wish to pay by Cheque, please make the Cheque payable to ‘Institution of Civil Engineers’.

**Regardless of payment being made, the application must still be received before the deadline for submission in order to be considered. This is available on the website (www.ice.org.uk/keydates) *Certification of Qualifications

A photocopy of any qualifications held must be submitted with this application and certified as a true copy. If evidence of the qualifications are not submitted/authenticated, a delay to the processing of your application may occur.

The certified copy must be a "true copy of the original" of your academic qualification AND your University lecturer, senior member of your employing company, or a Corporate ICE Member, must write the following in blue or black pen directly onto the proof of academic qualification:

"I confirm this to be a true copy of this applicant's qualification and recommend him/her as a Graduate to ICE"Signature:Name (clearly printed):Date:Employing organisation/university or college: PositionA contact telephone number or email address: ICE Membership Number (if applicable):

Please Note: All documentation provided must be copies of the original, as these documents will not be returned after the assessment. Also documents not in English, should be accompanied by an English translation certified as correct by an official translator, senior member of your employing company or a corporate ICE Member.

Important undertaking to be signed by the candidateI agree that the College(s) from which I graduated may release details of my qualifications to the Institution of Civil Engineers and I agree that if any of the qualifications I have claimed are found to be false, the Institution of Civil Engineers may inform any other interested third parties such as my employer, any other professional bodies of which I am a member and any qualifying body from which I claimed a false qualification, and the Institution of Civil Engineers may also provide copies of the documents containing these false details to these other interested third parties. 

I also understand that if any of my qualification(s) is/are identified as false my application will be rejected and the Institution will notify the person(s) supporting my application of the reason why my application has been rejected.

I declare the information in this application to be complete and correct.

Signed:       Date:      

Data Protection Act (DPA) 1998: The Institution of Civil Engineers and Thomas Telford Ltd maintain data on all members. We also maintain data on non-members who use our services. This includes addresses, email addresses, professional history and interest where notified. This will be used confidentially for normal purposes, including subscription collection, mailing of publications and notification of conferences and events. Your name and grade will be displayed on our online Members’ Directory (if professionally qualified with the Institution). Overseas members may have their data transferred to International Country representatives for administration of local events in their country of residence. Members data will also be shared with the ICE Benevolent Fund.

We also use the information to target journals, training and other services we provide. If you do not wish to receive information of this type, please inform the Data Protection Officer, in writing or at the email address given below.

We generate significant income on your behalf from carefully screened third parties who can offer you services; we only arrange this where we believe most of our members and customers will welcome the opportunity. This helps pay for enhanced services. If you do not wish to receive such information, please inform the Data Protection Officer, in writing or at the email address given below.

If you have any queries regarding data protection, please contact The Data Protection Officer, The Institution of Civil Engineers, One Great George Street, Westminster, London SW1P 3AA, or email dataprotection@ice.org.uk

Initial Professional Development Page 2 of 2 Version 2 Revision 4 – 01 August 2013 ICE3126 Registered Charity 210252 & Scotland SC038629