PERSONAL DETAILS

TITLE: (Mr, Mrs, Miss, Ms), etc.................... SURNAME..................................................

FORENAME(S)............................................ DATE OF BIRTH.........................................

ADDRESS........................................................................................................................

...................................................................................................... POSTCODE..............

DAYTIME TEL.............................................. HOME TEL..................................................

FAX NO........................................................

E-MAIL..............................................................................................................................

ACADEMIC/PROFESSIONAL QUALIFICATIONS

DIPLOMA IN WELFARE STUDIES

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

CERTIFICATE IN WELFARE STUDIES

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

FOUNDATION IN WELFARE STUDIES

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

*OTHER QUALIFICATIONS (RECOGNISED BY IOW)

1. .....................................................................................................................................

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

2. .....................................................................................................................................

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

3. .....................................................................................................................................

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

*OTHER QUALIFICATIONS

1. .....................................................................................................................................

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

2. .....................................................................................................................................

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

3. .....................................................................................................................................

DATE PASSED.........................................

AWARDING BODY ...........................................................................................................

*ENCLOSE COPIES OF QUALIFICATIONS

PRESENT EMPLOYER

ADDRESS.........................................................................................................................

............................................................................................... POSTCODE......................

VOLUNTARY ORGANISATION

ADDRESS.........................................................................................................................

............................................................................................... POSTCODE......................

PLACE OF EMPLOYMENT

ADDRESS.........................................................................................................................

............................................................................................... POSTCODE......................

DATE COMMENCED................................

JOB TITLE........................................................................................................................

PLACE OF WORK

ADDRESS.........................................................................................................................

............................................................................................... POSTCODE......................

DATE COMMENCED................................

JOB TITLE........................................................................................................................

Note. If you have been in your current employment less than 2 years, we may need to obtain a further reference from your previous employer.

ENCLOSE: CURRENT JOB DESCRIPTION AND PERSONAL DEVELOPMENT PLAN.

REFERENCES

GIVE NAME AND ADDRESS OF 2 REFEREES, ONE BEING YOUR CURRENT EMPLOYER OR, IF VOLUNTARY WORK, YOUR SUPERVISOR.

1. NAME............................................................................................................................

ADDRESS.........................................................................................................................

............................................................................................... POSTCODE......................

TELEPHONE.........................................................................

2. NAME............................................................................................................................

ADDRESS.........................................................................................................................

............................................................................................... POSTCODE......................

TELEPHONE.........................................................................

DECLARATION

I apply to be elected a member of the Institute of Welfare in the Membership category appropriate to my qualifications and experience, and agree to be bound by the regulations governing such membership.

I DECLARE THAT:

1. I have never been dismissed from any welfare related employment for any form of professional misconduct

2. I have no convictions that are considered unspent within the terms of the relevant legislation.

SIGNED:....................................................................

DATED:........................................

FOR OFFICE USE ONLY

Date received................... Registration fee rec’d £................. Acknowledged...................

Grade............................... Date notified................... Subscription amt £...................

Cheque no....................... Cert. issued..................... Membership No:...................

Centre....................................................................

GUIDANCE NOTES

1. Unspent convictions MUST be disclosed in consideration of the application. The information disclosed will be treated in strict confidence. If in doubt, any past disclosure should be made.

2. The Institute reserves the right to ask for further information, or to pursue any enquiry relevant to the application. You may be requested to provide original qualifications.

3. Applicants may attach any further information to their application, if deemed helpful.

4. All information supplied will be held in confidence by the Institute in accordance with the Data Protection Act.

5. The Institute has strong professional values and is committed to equality of opportunity.

6. A £30.00 non-returnable registration fee must accompany the application. Students currently enrolled for the Welfare Certificate and Diploma courses are exempt.

CHECKLIST BEFORE POSTING APPLICATION

1. Have you completed all sections of the form?

2. Have you enclosed the £30.00 registration fee?

3. Have you enclosed your current Job Description and Personal Development Plan?

4. Have you enclosed copies of qualifications, where applicable?

5. Have your Referees agreed your use of their names?

6. Have you completed the Declaration?

If you answered yes to all the above, then forward your application to:

Institute of Welfare
Newland House
2nd Floor
137-139 Hagley Road
Edgbaston
Birmingham
B16 8UA

Tel: 0121 454 8883
Fax: 0121 454 7873
Email: info@instituteofwelfare.co.uk

We look forward to receiving your application