CEng/IEng Professional Registration

Application Form
V11.1 February 2014
A Your Details
Title First Name Family Name
Post Nominals Date of Birth
DD!!""""
#ome A$$ress

%ounty&tate Postco$e %ountry
#ome Phone !obile #ome 'mail
Preferre$ Venue for (nter)ie*
Name of Professional +e,istration A$)isor -P+A. -if applicable.
Please specify your gender: !ale Female
B Current Employment
'mployer /ob Title
Business A$$ress
%ounty&tate Postco$e %ountry
Business Phone Business 'mail
Which address ould you li!e all correspondence sent to" #ome Business

C Your E#pertise
$elect the sector most rele%ant to you and refer to the guidance notes for the detailed list of e#pertise:
Aca$emia Built 'n)ironment DefenceArme$ Forces Desi,n 0 Pro$uction
'ner,y (nformation 0 %ommunication Transport
E#pertise: &ther:
D 'em(ership
You must (ecome a mem(er of the IE) (efore su(mitting an application for professional registration*
"ou can apply to become a member of the ('T at ***.theiet.or,1oin Please pro)i$e your membership number in the space
pro)i$e$ belo*.
!embership Number2
E Registration
Please indicate (elo hich category of registration you ish to apply for:
(ncorporate$ 'n,ineer -('n,. %hartere$ 'n,ineer -%'n,.
Pa,e 1 of 3
The (nstitution of 'n,ineerin, an$ Technolo,y is re,istere$ as a %harity in 'n,lan$ an$ 4ales -No. 211014. an$ &cotlan$ -No. &%056786.
CEng/IEng Professional Registration
Application Form
V11.1 February 2014
+ Education
&tart Date 'n$ Date %ourse9ualification Title '$ucational 'stablishment %lassification FTPT&4
Distance :earnin,
, Professional De%elopment or )raining $chemes -if applica(le.
&tart Date 'n$ Date %ompany Accre$itation number -if applicable.
/ Professional $er%ices0 Papers Presented etc*
Date Title
I Accounta(ility Diagram
Pa,e 2 of 3
The (nstitution of 'n,ineerin, an$ Technolo,y is re,istere$ as a %harity in 'n,lan$ an$ 4ales -No. 211014. an$ &cotlan$ -No. &%056786.
CEng/IEng Professional Registration
Application Form
V11.1 February 2014
1 Career /istory
&tart'n$
Date
'mployer 0 /ob Title ';perience
Pa,e 5 of 3
The (nstitution of 'n,ineerin, an$ Technolo,y is re,istere$ as a %harity in 'n,lan$ an$ 4ales -No. 211014. an$ &cotlan$ -No. &%056786.
CEng/IEng Professional Registration
Application Form
V11.1 February 2014
Note2 The information pro)i$e$ abo)e *ill be use$ to carry out an initial assessment of your application. As a result of this
initial assessment you may be re<uire$ to pro)i$e further information to support your application.
Pa,e 4 of 3
The (nstitution of 'n,ineerin, an$ Technolo,y is re,istere$ as a %harity in 'n,lan$ an$ 4ales -No. 211014. an$ &cotlan$ -No. &%056786.
CEng/IEng Professional Registration
Application Form
V11.1 February 2014
2 Declaration
( un$erstan$ an$ consent to the information pro)i$e$ on this form bein, processe$ by the ('T for its sole use an$ that of its
associate$ or,anisations= inclu$in, the 'n,ineerin, %ouncil for re,istration purposes= as *ell as my :ocal Net*or>= for the
purpose of promotin,= $eli)erin, an$ impro)in, my e;perience of the ('T an$ its pro$ucts an$ ser)ices or such other purposes
as are $escribe$ in the ('T Pri)acy &tatement. (f either no* or in the future ( am base$ outsi$e the 'uropean 'conomic Area
-the ?''A@.= my information may be transferre$ outsi$e the ''A -for e;ample to my :ocal Net*or> or ('T Alobal Bffice. to
enable me to benefit from the ('T opportunities o)erseas or= *here re<uire$= to enable the ('T to meet any le,al or other
le,itimate obli,ations in that country.
The benefits of ('T membership are en1oye$ by our members ,lobally. #o*e)er= if you $o not *ish to recei)e notification of ('T
pro$ucts an$ ser)ices *hich may be of interest an$ benefit to you -by post or electronic means. please tic> this bo;.
( $eclare that the statements ma$e on this form are to the best of my >no*le$,e true. ( a,ree to comply *ith the +oyal %harter
an$ ByeCla*s an$ +ules of %on$uct of the (nstitution of 'n,ineerin, an$ Technolo,y -('T. an$ un$erstan$ that this is a
commitment to beha)e ethically *ithin my profession. ( *ill $o my best to promote the interests of the ('T. ( confirm that ( ha)e
not committe$ any offence of *hich the ('T *oul$ re<uire me to ,i)e notice un$er its +ules of %on$uct. The +ules of %on$uct
an$ the +oyal %harter an$ ByeCla*s are publishe$ on the *ebsite ***.theiet.or,byela*s
&i,nature of %an$i$ate Date
3 $upporters4 Details
(= the un$ersi,ne$= support the can$i$ate from professional >no*le$,e as *orthy of consi$eration for 'n,ineerin, %ouncil
re,istration an$ ( en$orse the content of this application.
$upporter 5 -man$atory.
Name
-print.
&i,nature
-si,n.
Date
A$$ress for communication
Postco$e Phone 'mail
'% +e,istration type -if applicable. e.,. %'n,= ('n, !embership of 'n,ineerin, (nstitutions e.,. !('T= F('T
!embership Number -if applicable.
$upporter 6 -man$atory.
Name
-print.
&i,nature
-si,n.
Date
A$$ress for communication
Postco$e Phone 'mail
'% +e,istration type -if applicable. e.,. %'n,= ('n, !embership of 'n,ineerin, (nstitutions e.,. !('T= F('T
!embership Number -if applicable.
$upporter 7 -optional.
Name
-print.
&i,nature
-si,n.
Date
A$$ress for communication
Postco$e Phone 'mail
'% +e,istration type -if applicable. e.,. %'n,= ('n, !embership of 'n,ineerin, (nstitutions e.,. !('T= F('T
Pa,e D of 3
The (nstitution of 'n,ineerin, an$ Technolo,y is re,istere$ as a %harity in 'n,lan$ an$ 4ales -No. 211014. an$ &cotlan$ -No. &%056786.
CEng/IEng Professional Registration
Application Form
V11.1 February 2014
!embership Number -if applicable.
8otes for $upporter-s. 9 Before si,nin, the application form= you are re<ueste$ to ensure that the presentation of the form is to
the can$i$ateEs best a$)anta,e an$ pro)i$es a$e<uate information to enable the ('T to reach a $ecision. Please note you *ill be
re<uire$ to complete an (n<uiry Form on the can$i$ateEs eli,ibility for re,istration.
Return this form together ith the appropriate fee to: The (nstitution of 'n,ineerin, an$ Technolo,y= +e,istration 0 &tan$ar$s=
!ichael Fara$ay #ouse= &i; #ills 4ay= &te)ena,e= &A1 2A"= FG
Pa,e 7 of 3
The (nstitution of 'n,ineerin, an$ Technolo,y is re,istere$ as a %harity in 'n,lan$ an$ 4ales -No. 211014. an$ &cotlan$ -No. &%056786.
CEng/IEng Professional Registration

%hec>list

/a%e you: Yes/8o
1. +ea$ the ,ui$ance notes $ocument on ho* to complete your application.
2. %omplete$ all sections of the form electronically. -Note C "our application *ill be scanne$ upon
receipt= therefore please $o not bin$ or ,lue sheets or place in presentation fol$ers. %olour
an$ ,rey become unrea$able *hen copie$ an$ shoul$ therefore not be use$..
5. 'nclose$ a copy of your further or hi,her e$ucation certificate-s.= si,ne$ by one of your
&upporters as a true copy of the ori,inal.
4. %learly mar>e$ your position on the Accountability Dia,ram in &ection (= an$ put the $ates you
hel$ that position.
D. &i,ne$ the Declaration.
7. %hec>e$ that your &upporters comply *ith the re<uirements as $etaile$ in the ,ui$ance notes.
3. Bbtaine$ the si,natures of your &upporters an$ re<ueste$ them to complete an (n<uiry form.
6. 'nclose$ the appropriate application fee *hich is payable to the (nstitution of 'n,ineerin, an$
Technolo,y.
8. +etaine$ a copy of your application.
Please send your completed form and payment to:
The (nstitution of 'n,ineerin, an$ Technolo,y
+e,istration 0 &tan$ar$s
!ichael Fara$ay #ouse
&i; #ills 4ay
&te)ena,e
&A1 2A"
FG
Pa,e 3 of 3
The (nstitution of 'n,ineerin, an$ Technolo,y is re,istere$ as a %harity in 'n,lan$ an$ 4ales -No. 211014. an$ &cotlan$ -No. &%056786.