PROFESSIONAL ADVICE REGISTER
SECURITY SPECIALIST APPLICATION FORM
Before attempting to complete your application, please read the following documents:
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Notes for Guidance on the Application Process.
The documents entitled Professional Advice Register Scheme & Regulations and Scheme & Regulations
specific to security specialists.
The Institute’s Codes of Conduct and Practice.
And if you are not already a member of the BCS:
 Introducing Professional Membership of the BCS
PLEASE COMPLETE THE APPLICATION FORM WITH A BLACK PEN.
1. PERSONAL DETAILS
Forenames:
Surname:
Title :
Date of birth :
Home Address:
Name of Employer (where appropriate):
Work Address (We shall use this address and tel/fax no., for
publishing in the Register, unless you specify otherwise) :
Telephone Number:
Fax Number:
Home:
Work:
Mobile:
Home:
Work:
E-mail address:
Web Site URL:
Qualifications:
Membership of other Professional Organisations/ Institutes:
BCS Membership Grade :
BCS Membership Number:
Year started in I.T.
Number of years in IS Security:
2. EXPERIENCE IN INFORMATION SYSTEMS SECURITY (a minimum of three years is required)
Dates
Client/Employer
REG/FORM/PAR 7.1v2/01/1102
Position held, job title or equivalent description
October 09
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3. FIELDS OF SECURITY FOR WHICH REGISTRATION IS REQUESTED - Areas of experience and competence
claimed e.g. Risk Analysis, Contingency and Business Resumption Planning, Network Security, Computer
Misuse, Security Audit etc.
Technical Fields:
Any specific Application or Industrial Fields:
Please attach a brief submission in support of your claim to competence in the field(s) shown (see guidance notes). Please
also provide a CV.
4. REGISTRANT’S STATEMENT (no more than 200 words)
Optional. This is an amplification of the information provided in Section 3. You may choose not to complete this.
Statements should be entirely objective and should provide an accurate picture of your expertise. General unquantified phrases
will not be accepted (e.g. well qualified, broad experience) As this statement will form part of the published Register, it is
important that you write legibly. Alternatively, you may, if you prefer, attach a typewritten statement.
5. GEOGRAPHICAL SCOPE
List the geographical areas in which you offer services.
REG/FORM/PAR 7.1v2/01/1102
October 09
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6. REFERENCES
Please provide two references from people who can vouch for your experience (Note: The BCS will seek references from those
named)
Name:
Name:
BCS Membership No. (if appropriate):
BCS Membership No. (if appropriate):
Address:
Address:
Telephone:
Telephone:
Fax:
Fax:
email:
email:
7. UNDERTAKINGS
I the undersigned hereby request that my name be entered on the BCS Professional Advice Register, and within the
Security Specialist section and hereby declare and agree as follows:
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I warrant that all the information given in this application is complete and correct.
I accept that any complaint made against me as a registered security practitioner will be dealt with under the Institute’s
general disciplinary code and I agree to co-operate with any investigation conducted under that process.
I will not wilfully give the Institute false, inaccurate, misleading or incomplete information.
I recognise that if at any time hereafter, in the opinion of those charged by the Institute with responsibility for maintaining
the Register, I do not have or no longer have appropriate skills, experience or integrity to be so registered, my registratio n
may be cancelled and/or the Institute may take other such action as it sees fit.
I am a fit and proper person to have my name included on the Register and undertake at all times to behave with probity
and diligence, to be of good reputation and character, and to avoid unethical and improper behaviour in the conduct of
business.
If any circumstances occur which would or might render any of this declaration false, inaccurate, misleading or incomplete,
I will notify the Institute forthwith in writing, giving full details.
Please complete this final section by hand and post the form to BCS (Membership and HEQ), Ground Floor,
Block D, North Star House, North Star Avenue, Swindon, Wiltshire SN2 1FA.
8. FEE
I enclose a cheque for £
made payable to The British Computer Society in payment of the Register Application fee.
Signature:
Date:
BCS
1st Floor, Block D, North Star House, North Star Avenue
Swindon, Wiltshire, SN2 1FA
Tel: 01793 417417 Fax: 01793 417444
Email: processing@hq.bcs.org.uk Web: www.bcs.org
Registered Charity Number: 292,786
REG/FORM/PAR 7.1v2/01/1102
October 09
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