Application for Certified Practicing Status

Click here to download Application form in pdf format

CP Grade being applied for (circle as appropriate)	SUPERVISOR (CPQS)	MANAGER (CPQM)		ARE YOU APPLYING FOR BLASTING ENDORSEMENT?
Name (print):	(Title) (Given names) (Surname)
IQA Membership No:		Membership grade:
Mailing address: (Include all details - state, postal code, country. This address may be published in the CP Register)



Phone (w)			Facsimile
Phone (mobile)			Phone (h)
E-mail

In support of my application I attach:-

my detailed curriculum vitae, OR statement of employment OR work history and qualifications
the testimonials showing contact details for verification as required including referee names and addresses for at least two (2) referees as required under the Rules
my payment (payable to The IQA) of the fee for accreditation ($200.00) You can also pay securely online (Visa and MasterCard) If paying online you will need to provide your IQA Member number.

I certify, by signing this application, that:

1. I shall abide by the Rules of the Board of Certified Practitioners, the Code of Conduct of The Institute of Quarrying Australia (The Institute) relating to the QMCS and any other Code in force in The Institute.

2. I have not been found to be in breach of the Code of Conduct (referred to above) or those of any other learned or professional society or institute, and there are no such cases pending against me.

3. I acknowledge that I will be required to certify each year, on renewal of my Institute membership, that I continue to comply with the criteria in the Rules of the Board of Certified Practitioners for On-going Professional Development, which require an average of 30 hours each year, as well as an average of an additional 200 hours of experience, both calculated over a rolling period of three years.

4. I agree that my compliance with the OPD requirements as detailed in my log-book may be audited.

5. I consent to the publication of my title and full name, my Institute membership grade, my Certified Practitioner grade and month and year of accreditation, and any other detail about my qualifications and professional experience as a Certified Practitioner, which the CP Board may consider it is reasonable to include in the CP Register.

6. I have not been found guilty of any criminal act or offence and there are no such charges pending against me.

Signature: ..................................................... Date: .............................

TWO REFEREES' TESTIMONIALS ARE ATTACHED

(both testimonials need to include contact details for verification by the CP Board if necessary)

RULES OF THE CP BOARD

If the CP Board accepts an application it will notify you, register the essential details and destroy the paperwork. If the application has been for a re-admission, the date recorded will be the date of the decision for re-admission except in special cases. If the application is rejected you will be notified and given the grounds on which the rejection is based as well as advice that you may appeal the rejection. Where an application is rejected (for whatever reason), the fees associated with that application (or renewal) will be forfeited.

CODE OF CONDUCT

Members of The Institute who are eligible to gain accreditation under The Institute's CP system are committed by this Code as published on The Institute's website www.quarry.com.au

PLEASE DIRECT APPLICATION AND ATTACHMENTS (Work history/CV, Testimonials and Fee or online payment fee receipt) TO:

1. Secretary, Board of Certified Practitioners
The Institute of Quarrying Australia
PO Box 6447
NORTH RYDE NSW 2113

2. Fax: 02 9484 0766

3. E-mail: general-manager@quarry.com.au