Validated Scrutineer’s Application Form
If you would like to be considered for the Society’s pool of validated Scrutineers, please complete and return this form,
together with all required documentation to the Fellowship Office, janine.benn@geolsoc.org.uk.
(NB – Please complete even if you have acted as a Scrutineer in the past)
Title:
First Names (in full):
Surname:
Fellowship No:
Date obtained Chartership status:
Email:
Telephone: landline:
mobile:
Areas of Expertise – Please select up to six categories from the list below which most closely match your area(s) of
expertise, ranking them in order from 1 (most closely matches) to 6 (least closely matches)
Archaeology
Biology
Chemistry
Climate Change
Computer Science
Data Management
Contaminated Land
Curating & Archivism
Earth Systems Science
Education
Engineering Geology
Environmental Sciences
Geochemistry
Geomaterials
Geomorphology
Geophysics
Geotechnics
Hydrology
Hydrogeology
Management
Mapping
Marine Studies/Oceanography
Mathematics
Metamorphic Geology
Mineral & Ore Deposits/Mining
Mineralogy
Natural Hazards
Oil & Gas
Palaeontology
Physics
Planetary/Meteoritic Geology
Quarrying
Quaternary Geology
Remote Sensing
Sedimentology
Soils
Statistics
Stratigraphy
Structural Geology
Tectonics
Volcanic & Magmatic Geol
Waste Management
other*
other*
other*
* If an area of your expertise is not given in the table above, please enter it (them) in the box(es) named ‘other’
Current job title & details of employer, if in employment, or most recent employer if not currently in employment
Have you acted as a Scrutineer for the Geological Society in the past?
Yes
If yes, please state how many times:
2–5
>10

5 – 10
Have you enclosed a copy of your CV? (2 sides of A4, maximum)




Yes


No

1


I agree that all data provided on this form can be used by The Geological Society in the course of the
Chartership Interview process and, as such, may be distributed only to members of staff and other Chartered
Fellows of the Society directly involved in the working of that process.
I agree that my name, speciality and regional group affiliation can be made public via the Society website and
other publications.
I declare that I am currently following a personal programme of CPD
Signed:
Jan 2016
Date: