EmailMe Form - Non Domestic Membership Application

About You

Title *

Forename *

Middle Name

Surname *

Former/Maiden Name

House No. / Name *

Postcode *

Email *

Phone Number *

Mobile Phone Number

Date of Birth *

DD / MM / YYYY

Gender *

Nationality *

Upload a copy of your Work Permit if not of UK origin

Upload a digital Photo of yourself *

Upload a copy of either your Driving Licence, Passport or Birth Certificate *

Passport Number

About your Employer / Company

Employers/Company Name *

Address Line 1 *

Address Line 2

Address Line 3

Post Town *

Postcode *

Website

Insurance Details

I would like Pay Per Click Insurance

I have my own Insurance Policy

Upload Insurance Certificate *

Accreditation you're applying for

Please select the strands you wish to apply for

Accreditation Strands *

Application Region

England & Wales

Northern Ireland

Scotland

Application Route (Qualification / APEL) *

Qualification

APEL (Transferring)

APEL Awarding Scheme *

Please confirm the Scheme who awarded the APEL

Software you will be using

Energy Performance
Certificate Software

Display Energy
Certificate Software

OrCalc

LifespanDEC

Air Conditioning
Inspection Software

Sterling E-volve

ACE Wizard

Your Qualifications

Qualification *

Certificate Number *

Date Awarded / Issued *

DD / MM / YYYY

Training Centre *

Awarding Body *

Upload a Copy of the Certificate *

Do you need to upload another certificate? *

Yes

No

Qualification *

Certificate Number *

Date Awarded / Issued *

DD / MM / YYYY

Training Centre *

Awarding Body *

Upload a Copy of the Certificate *

Do you need to upload additional certificates? *

Yes

No

Qualification *

Certificate Number *

Date Awarded / Issued *

DD / MM / YYYY

Training Centre *

Awarding Body *

Upload a Copy of the Certificate *

Details of Professional Conduct

Have you ever been convicted of a criminal offence in the UK or elsewhere? *

Yes

No

Please provide detials *

Have you had an application to another accreditation scheme or professional body refused at ant time? *

Yes

No

Please provide details *

Have any allegations of Breach of Professional Duty, any complaints or any claims been notified in the last 5 years, or are any actions pending? *

Yes

No

Please provide details *

Have you ever been refused Professional Indemnity insurance, or have any additional clauses and limits been imposed upon you? *

Yes

No

Please provide details *

Have you ever been disqualified as a Director *

Yes

No

Please provide details *

Have you ever had bankruptcy proceedings against you? *

Yes

No

Please provide details *

Have you ever been suspended or has your membership revoked by another accreditation scheme? *

Yes

No

Please provide details *

Are you currently a member of any other accreditation scheme? *

Yes

No

Please provide details including reasons for applying to an additional accreditation body *

Continuous Professional Development

Please provide details of all the CPD you have done in the last 2 years *

Upload a copy of your Lifelong Learning record

Declaration

Please read and tick the box

I understand and agree that information regarding the status of my membership with Sterling will be shared with DCLG, the Register Operator and other schemes who I am also registered with. *

Yes

Please enter todays date *

DD / MM / YYYY