Forstaregister Use Only

APPLICATIONFORMFORCERTIFICATIONOFMSPROFESSIONALS

ForSTAREGISTER use only

Date received: ____/____/______

Application fee: ______

Certification No: ______

Part 1

PERSONAL DETAILS*

Name:
Name (in Latin characters):
Nationality: / Date of birth:
Home address:
Postcode: / Tel.no:
Fax no: / Email:

*Please declare if you have any disability and the help you need during the exam:

BUSINESS DETAILS*

Name of organization:
Address:
Postcode: / Tel. no:
Fax no: / Email:

GRADE OF CERTIFICATION FOR WHICH YOU ARE APPLYING

Step 1: Choose one or more Management Systems:

ISO 9001 ISO 14001 ISO 22000 ISO 31000 OHSAS 18000 ISO 27001ISO 17021

Step 2: Choose one or more certification grades:

MS Provisional Auditor MS Auditor MS Lead AuditorMS Internal Auditor

MS Consultant MS Manager Transfer* (Please choose the grade mentioned above)

*For Transfer requirements please check PC.R2000 Regulation for MS Professionals

I wish to receive a receipt or invoice

Name: ______(personal or business).

VAT No: ______Tax office: ______

If you do not wish your address to be included in the certified professionals registry please sign here: ______

EDUCATION

Year / Award (Diploma) / Title of studies / Education evidence / Educational institute / for STAREGISTER use

MEMBERSHIP OF PROFESSIONAL BODIES

Professional body / Date elected /

Registration number

/ for STAREGISTER use

STAREGISTER (as IPC full member) recognize the IPC personnel certifications issued to similar scope by other MLA Participating Bodies as being equivalent to the corresponding grades to the IPC certifications which it issues.

STAREGISTER co-operate with other Participating Bodies in exchanging relevant information, necessary to safeguard the integrity and credibility of the certification programs, and of this Agreement, consistent with its commitment to maintain confidentiality including appropriate details of a certified person or applicant or recognized training course; this is applicable only on request of certified person or recognized training course institute.

For more information about IPC MLA signatory

FORMALMSTRAINING (continual training, courses etc)

From / To / Title of course / Name of organization conducting training /

Training evidence

/ for STAREGISTER use

PC.F2000-5/21.09.2017

APPLICATIONFORMFORCERTIFICATIONOFMSPROFESSIONALS

SECTOR INFORMATION

Pleasetickupto 5 ofthe 39 fields (source:IAF ID1:2014 - IAF Informative Document for QMS and EMS Scopes of Accreditation)) which can be supported by your experience:

 / 1. Agriculture and fishing /  / 23. Manufacturing not elsewhere classified
 / 2. Mining and quarrying /  / 24. Recycling
 / 3. Food products, beverages and tobacco /  / 25. Electricity supply
 / 4. Textiles and textile products /  / 26. Gas supply
 / 5. Leather and leather products /  / 27. Water supply
 / 6. Wood and wood products /  / 28. Construction
 / 7. Pulp, paper and paper products /  / 29. Wholesale and retail trade, repair of motor vehicles, motorcycles, personal and household goods
 / 8. Publishing companies /  / 30. Hotels and restaurants
 / 9. Printing companies /  / 31. Transport, storage and communication
 / 10. Manufacture of coke and refined petroleum products /  / 32. Financial intermediation, real estate and renting
 / 11. Nuclear fuel /  / 33. Information technology
 / 12. Chemicals, chemical products and fibres /  / 34. Engineering services
 / 13. Pharmaceuticals /  / 35. Other services
 / 14. Rubber and plastic products /  / 36. Public administration
 / 15. Non-metallic mineral products /  / 37. Education
 / 16. Concrete, cement, lime, plaster etc /  / 38. Health and social work
 / 17. Basic metals and fabricated metal products /  / 39. Other social services
 / 18. Machinery and equipment /  / 98. Other
 / 19. Electrical and optical equipment
 / 20. Shipbuilding
 / 21. Aerospace
 / 22. Other transport equipment

PC.F2000-5/21.09.2017

APPLICATIONFORMFORCERTIFICATIONOFMSPROFESSIONALS

WORK EXPERIENCE

Position 1 / Position 2 / Position 3
From month / year
To month / year

Position in the organization

Name of organization
Object of organization

MS work experience

for STAREGISTER use

PC.F2000-5/21.09.2017

APPLICATIONFORMFORCERTIFICATIONOFMSPROFESSIONALS

DECLARATION

IapplyforcertificationandIconfirmthatIunderstandandagreetothefollowingconditions:

IreadandIacceptthe terms and the requirements of STAREGISTER Certified MS Professionals Regulation PC.R2000.
I shall observe and abide by STAREGISTER Code of Ethics.
The details which are given in my application form can be published in the STAREGISTER and IPC registry.
I shall declare any information that may reasonably be considered to affect adversely my ability to perform effectively my obligations as STAREGISTER Certified MS Professional.
I agree that I will keep all the information and documentation related to STAREGISTER exams confidential and will not share anywhere.
I agree that STAREGISTER may publish my registry (my name, surname and certificate no on the web-site

Iconfirmthattheinformationcontainedinthisapplicationiscorrecttothebestof my knowledge and belief. I understand and accept that, if I provide incorrect information or withhold relevant, requested information, I am likely to be excluded or removed from the STAREGISTER registry. Ialsounderstand that once certified, I am obliged to notify STAREGISTER without delay of any changes which, if declared when I made my initial application, might have caused STAREGISTER to exclude me from the registry.

Signature ______Date ______

GUIDANCE NOTES FOR APPLICANTS

General information

Thefollowinginformationisimportant. Pleasereaditcarefully before completion of your application form. Should you need help in completing it, STAREGISTER certification officers are always available to advise you.

Pleasefillclearly. Ifweareunabletoreadanysectionofthisform, we will have to return it to you and ask you to complete a new form. This means that it will take longer to deal with your application.
All your correspondence and other documentation that you submit in support of this application must be in English language or accompanied by a translation of the original.
Please make sure that you complete all the appropriate sections of this form. If a section is not applicable to you, write ‘N/A’. If there is not enough space in a section, enter a brief summary and enclose the full details on additional sheets of paper. You should only sign the form when you have checked that all relevant sections have been completed correctly.
In the caseof applicationforcertificationas MS Auditor, the candidate will receive an audit log with the application form. Please enter details of your audit experience on it. If a single log sheet is not sufficient, you may either photocopy the one supplied or ask us to supply you with more. Youmustmakesurethateachentry in the audit log is verified either by your employer or by the auditee (the organization being audited). Not verified entries will not be accepted. Please note that all details submitted in support of applications from all certified auditors will be subject to periodic verification.
Please do not forget to enclose the current certification fee (this fee is not refundable). You may ask for the fees and bank account information from STAREGISTER Offıces which you may see on from STAREGISTER e-mail or .

Inthiscasethereceipt should be sentbythe applicant to STAREGISTER by e-mail or it should be attached on the application form.

Cash payment orcash paymentsent by post will not be accepted.

Whenwereceiveyourcompletedapplication, we will send you an acknowledgement. We will inform you whether your certification is awarded or not, as soon as the certification decision is taken.

Part 1 INFORMATION ABOUT YOU

1.Personal details

Details of applicant (Name and Address) will be published in the registry of certified professionals and will be included in the STAREGISTERdatabase. In case you do not wish your home address to be entered in the registry, please sign the appropriate box in the first page.

2.Grade of certification for which you are applying.

Please tick the appropriate box indicating the type and group of certification for which you are applying.

3.Education

Enter details of your education (school, college, university etc). You must enclose documentary evidence (photocopies are usually sufficient), accompanied by a translation into English language.

4.Membership of professional bodies

Enter details of the professional bodies of which you are a member, quoting your membership number in each case.

5.Formal MS training

Itismandatorythatyouhavesuccessfullycompleted: eitheraSTAREGISTERcertifiedtrainingcoursepresentedbyaSTAREGISTERapprovedtrainingcourseproviderora trainingcourserecognizedbySTAREGISTERasbeingofanequivalentstandard. The results you achieved must be supported by documentary evidence. Sector based schemes may require special training. If in doubt, please contact us for details.

6.Register information

Pleaseindicatethefieldsofexperiencethatyouwishmarkedagainstyourentryintheregisterbytickingtheboxesofamaximumoffivesectorsinwhichyoucanclaimexperience. If there are other sectors not listed here in which you can claim experience, please tick box 98 and describe them in the space provided after “Other”.

7.Work experience

In this section, enter your career details, providing under ‘Job title’ a brief description of your duties and responsibilities emphasizing experience relevant to the sector or scheme for which you are applying. List this information in chronological order, beginning with your current or most recent experience.

STAREGISTER will focusatdetailsofyourMSexperienceandotherMSrelatedworkexperience.

8.Declaration

The applicant must sign and date this section.

______

PC.F2000-5/21.09.2017