APPLICATION FOR CAREER ASSESSMENT (TYPE or BLOCK CAPITALS please)
Surname:
Current Employer:
Forenames:
Home address:
Business address:
Tel:
Email:
Job Title:
Preferred address for correspondence:
Home
Business
Tel:
Mobile:
Email:
DOB:
Title (Mr/Ms/Miss/Mrs):
Qualifications (please list all relevant qualifications & attach copy parchments)
Qualification
Awarded
Grade
Awarded
Institution/University
Duration
of
course
Full time/ Part
time
Discipline
Entry Year
Graduation
Year
Grade of membership / registration for assessment
Tick appropriate
Grade
Eng Tech
I Eng
CEng
Membership of Professional Bodies
Name of Organisation
Abbreviated title
Current or past
Year of admission
Area of specialism: (tick up to three boxes)
Accident investigation
Bridges/Structures
Contracts Management
Development Control
Drainage
Highway Engineering
Highway Construction Maintenance
Highway/Road Design
Planning
Surveying
Traffic Engineering Management
Traffic Signs/Signals
OTHER:……………………………………….
Experience:
Please attach:
A detailed copy of your most recent verified curriculum vitae.
A copy of your professional development record.
A 2000 word Experience report
Statement by Applicant
I hereby apply for a Career Assessment by the INSTITUTE OF HIGHWAY ENGINEERS and enclose the non-refundable
fee of £50 as listed on my completed Payment Form. I declare that the information I have given is complete and correct.
Signature:
FOR OFFICE USE ONLY:
Date received:
Date acknowledged:
Date:
Date to ASP:
Date of response from ASP:
Amount Paid:
INSTITUTE OF HIGHWAY ENGINEERS, De Morgan House, 58 Russell Square, London, WC1B 4HS.
Tel: 020 7436 7487 Fax: 020 7436 7488
Email: membership@theihe.org
A4 - Career Assessment Application
September 2015