The Chartered Institute of Logistics & Transport in Hong Kong Application Form for Graduate Membership Section A: PERSONAL PARTICULARS (please write in BLOCK letters) Title: Mr. Mrs. Ms. Miss Other: English Name: (Surname) Chinese Name (if any): (Other name) CILT Membership No.: Passport/ HKID Card No.: (optional) Correspondence Address: Tel.: (Office) E-Mail: (Mobile) Section B: NATURE OF APPLICATION Upgrade/Re-title for to be a GRADUATE MEMBER (if you are applying for an upgrade/re-title for to be a “Graduate Member ONLY”, you need to complete the 1st page of this Application Form.) Apply for the GRADUATE MEMBERSHIP SCHEME (if you are also interested in applying for the “Graduate Membership Scheme”, please complete ALL SECTIONS in this Application Form.) Section C: ACADEMIC QUALIFICATION I declare that I have satisfied the Graduate Membership requirement by means of satisfactory completing: CILT fully accredited programme CILTHK Professional Qualifying Examination * Please attach copy(ies) of graduation certificate/ letter or transcript/ CILTHK letter(s) of PQE results. DECLARATION I declare that the information given above is true, correct and complete. I understand that if I willfully give any false information in this Application Form or withhold any material information, it will render me liable to disqualification for this application or termination of membership even already granted by CILTHK. Signature of Applicant: Date: NOTES FOR APPLICANTS Please carefully read the following notes before completing this form 1. Your application may not be further processed if you fail to provide sufficient supporting documents, and properly complete your application. 2. This application will be held in strict confidence and the information provided will be only used for membership evaluation/participation of scheme purpose in the Institute. 3. Annual Subscription Fee for Graduate Member (non-refundable): HK$520.00 Should there be any change or correction of personal particulars after submission of this application, please contact the Administration Office at (852) 2866-6336. For Office Use only: Date Received: Membership Number: Date Approved: Date Completed: Application Form for Graduate Membership GRADUATE MEMBERSHIP SCHEME (GMS) Section D: CAREER DEVELOPMENT Stream of Expertise/ Professional Development: Logistics Stream Transport Stream Employment History (in chronological order) Job No. Date (MM/YY) From To Full/ Part Time Name of Employer Appointment Held 1 2 3 4 Section E: PERSONAL PROFILE (Remarks: You may consider including the following points: A summary to introduce yourself; reasons for you to join the GMS; the ways how you design your plans under GMS to meet your career aspiration and career objectives in the next 5 to 10 years; details of your plans, your commitment towards fulfilling the goals stated; and all other relevant materials that would facilitate the Assessment Panel to consider your case.) Please use supplementary sheet if necessary. Page 2 Application Form for Graduate Membership Section F: CONTINUING PROFESSIONAL DEVELOP (CPD) PLAN Period Covered: to Key Knowledge Areas: Selection of one or more of the five professional areas for the GMS: Passenger Transport Transport Infrastructure and Network Planning Freight Transport International Trade and Transport Supply Chain Structured CPD Activities Date/ period What do I want to achieve? (Objective) How am I going to achieve this? (Action) No. of Hours a) Attendance at conferences, seminars of professional bodies b) Distance learning with feedback or some form of assessment c) Studying for a professional qualification d) Undertaking research e) Attendance at job related short courses f) Teaching and making presentations (repeated presentations of the course should not be considered) g) Writing of technical or professional articles, papers or books h) Undertaking technical research for a new piece of work i) j) Participating in seminar organised by CILTHK with similar nature in logistics & transport industry Participating in other activities (including site visit) recognised by CILTHK for CPD purpose Total CPD Hours: Note: (1) A plan with a minimum of CPD activities of 800 hours is required. (2) The total hours in any of the above 10 areas (a to j) shall be counted for a maximum of 200 hours. Page 3