Surname / Given Name / Middle Initial
Part A. Work Information:
Present Position: / Job Title:Organisation:
Work: / Street/PO Box:
Suburb:
City & post code
Work Contact: / Phone:
Email:
Website:
A profile listing on the CDANZ website is a benefit of Professional Membership.
You will be contacted by CDANZ Administrator for more details once your application has
been approved.
Should you NOT want to be listed on the CDANZ website – please tick this box.
Part B. Alternate/Home Contact Information for CDANZ.
(These details are never listed on the website.)
Home address:Home phone(s):
Home Email:
Tick box / If you want CDANZ email to go to home/alternate email
Part C. Billing Address.Unless indicated below, your invoice will be addressed to you at your work address.
Tick box / If you want CDANZ invoice addressed to home addressArea:
Northland / Auckland / Waikato / Bay of PlentyHawkes Bay/Gisborne / Taranaki/King Country / Manawatu / Wellington
Nelson/Marlborough / Canterbury /Westland / Otago / Southland
______
A GST Tax Invoice will be emailed once your completed application forms have been received.
Professional Membership $253.00 (incl. GST) Plus / Initial Application or Rejoining Fee $115.00 (incl GST)(The $115 fee does not apply to members upgrading from Associate
Membership).
Current work environment
School / Tertiary Institution / Government Agency / Corporate HRPrivate Practice / Private Sector / NGO / ITO
Other (Please give details)
Current Career related services you provide: (Please tick)
1X1 career counselling/coaching / Group work / CV writing / Professional SupervisionProviding Career Information / Teaching / Research / Vocational Rehabilitation
Consultancy / Recruitment / Vocational Assessment
Other (Please give details)
Tick how many hours per week you work in the Careers Industry
Total years you have worked in the career industry to date
Qualifications: Please supply a verified copy of your Career Specific Qualification at NZQA Level 6 (minimum)
Highest CAREER SPECIFIC Qualification:Provider: / Year
Highest Formal Qualification:
Provider: / Year
Ethnicity
New Zealand Maori / Iwi/AffiliationsNew Zealand European/Pakeha / Pacifica / Asian / European
Other (Please give details)
Declaration:
No
on the CDANZ website. (You will be contacted for more details)
Yes / No / I give my consent for CDANZ National Executive Committee to release my name, phone number and e-mail
address to organisations with bona fide professional interests relating to career practice.
Yes / No / Do you have any criminal convictions, or are any charges pending, other than minor traffic infringements that in
any way impact on your ability to meet our Code of Ethics?
If so please describe:
Please note that if the Membership Officer has any concerns they will contact you for permission to do a Police Check.
By submitting this form, I declare that if granted membership of the Career Development Association of New Zealand (Inc), I will uphold and abide by the Constitution, Ethical Code of Conduct and Rules of this Association and, where possible, be actively involved in the Association’s activities. I confirm that the information contained in this application is true and accurate.
Signature:Place: / Date
Please ensure you have completed all the sections
Annual Professional Development / Signed the Declaration / C.V.Asked Referees to send Reports / A verified copy of Career Specific Qualification at NZQA Level 6 (minimum)
*Note: A verified copy is where you photocopy the original qualification and take the original and the copy to a JP or a lawyer for the copy to be certified as a true copy.Please email a scanned copy with the JP or lawyer signature. Keep the original on file for possible later verification.
Please email your application to .An invoice will be emailed to you for payment.
If no access to email, please post to CDANZ, PO Box 31 104, Ilam, Christchurch 8044.