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    14 IIESL Memb - Application PDF

    Uploaded by

    LakshithaGonapinuwalaWithanage
    This document is an application form for admission to membership of the Institution of Incorporated Engineers, Sri Lanka (IIESL). The form collects personal details of the applicant such as name, addresses, contact details, date of birth, civil status and preferred class of membership. It also requests details of the applicant's education qualifications, engineering qualifications, post-qualification experience, special training undergone, other professional qualifications and references from two proposers who are existing members of IIESL. The applicant declares that they will abide by the rules and regulations of IIESL and assist in its objectives. Relevant documents are required to be submitted along with the registration fee to support the application.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    14 IIESL Memb - Application PDF

    Uploaded by

    LakshithaGonapinuwalaWithanage
    148 views4 pages
    This document is an application form for admission to membership of the Institution of Incorporated Engineers, Sri Lanka (IIESL). The form collects personal details of the applicant such as name, addresses, contact details, date of birth, civil status and preferred class of membership. It also requests details of the applicant's education qualifications, engineering qualifications, post-qualification experience, special training undergone, other professional qualifications and references from two proposers who are existing members of IIESL. The applicant declares that they will abide by the rules and regulations of IIESL and assist in its objectives. Relevant documents are required to be submitted along with the registration fee to support the application.

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    ideal application important to everyone who studied engineering in Sri Lanka

    Original Title

    14 IIESL Memb.application PDF

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    This document is an application form for admission to membership of the Institution of Incorporated Engineers, Sri Lanka (IIESL). The form collects personal details of the applicant such as name, addresses, contact details, date of birth, civil status and preferred class of membership. It also requests details of the applicant's education qualifications, engineering qualifications, post-qualification experience, special training undergone, other professional qualifications and references from two proposers who are existing members of IIESL. The applicant declares that they will abide by the rules and regulations of IIESL and assist in its objectives. Relevant documents are required to be submitted along with the registration fee to support the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    148 views4 pages

    14 IIESL Memb - Application PDF

    Uploaded by

    LakshithaGonapinuwalaWithanage
    This document is an application form for admission to membership of the Institution of Incorporated Engineers, Sri Lanka (IIESL). The form collects personal details of the applicant such as name, addresses, contact details, date of birth, civil status and preferred class of membership. It also requests details of the applicant's education qualifications, engineering qualifications, post-qualification experience, special training undergone, other professional qualifications and references from two proposers who are existing members of IIESL. The applicant declares that they will abide by the rules and regulations of IIESL and assist in its objectives. Relevant documents are required to be submitted along with the registration fee to support the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    IIESL FORM -01

    Institution of incorporated Engineers, Sri Lanka.


    ESTABLISHED IN 1977, INCORPORATED BY AN ACT OF PARLIAMENT (ACT NO. 64 OF 1992 & AMENDED BY
    ACT NO. 11 OF 2000) OF DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA
    Membership Number
    511/1, Galle road, Rathmalana, Sri Lanka. Telephone : +94 11 2 611430
    Fax : +94 11 2637026 E-mail : [email protected]

    APPLICATION FOR ADMISSION TO MEMBERSHIP For office use only

    This form should be filled in BLOCK CAPITAL LETTERS


    SECTION 1 : PERSONAL DATA ABOUT THE CANDIDATE

    1.1 Name with initials Mr. / Miss / Mrs. / Ms. /

    1.2 Full Name

    1.3 Permanent Address

    Tel: Mobile E-mail :

    1.4 Official Address

    Tel: Mobile E-mail :

    1.5 Temporary Address

    Tel: Mobile E-mail :

    1.6 Preferred Mailing 1.3 1.4 1.5


    Address 1.7 National Identity Card Number /
    Passport Number

    Note: Any changes in the above addresses, Telephone numbers, etc., should be intimated to the Institution by the applicant. All correspondences will be directed
    to the last given “Preferred Mailing address(1.6)”.

    1.8 Date of Birth 1.9 Age 1.10 Civil Status 1.11 Class of Membership applied
    Single Married Companion Student Associate Associate Member Member
    d d m m y y y y Years
    1.12 If the candidate has at any time made an application requesting for membership of the institution, Please provide details.

    Section 2 : DECLARATION BY THE CANDIDATE


    I the undersigned, agree that, I will be governed by the act of incorporation and the Bye-laws and codes &
    Passport size
    professional ethics of the Institution as they now are, or as they may hereafter be altered. I will also assist in the
    advancement of the objectives of the institution as far as shall be in my power. In the event of my desire to
    photograph
    withdraw from being a member of the institution, I shall signify in writing to the Honorary Secretary of the (Please attach your
    Institution and shall also settle all outstanding dues before withdrawing my membership. photograph
    I certify that the particulars furnished by me in this application form are true & correct. I am aware that if the separately, if you
    particulars contained herein are found to be false or incorrect, I am liable to be disqualified before election to the are sending the
    applied class of membership and for cessation after the election at any instant. application via E
    mail.)
    Date : Signature of Candidate :

    SECTION 3 : DETAILS OF EDUCATION OF THE CANDIDATE

    1 of 4
    3.1 GENERAL EDUCATION

    FROM TO HIGHEST EDUCATIONAL


    SCHOOL ATTENDED
    yyyy mm yyyy mm LEVEL REACHED (OL/AL)

    3.2 ENGINEERING EDUCATION


    FROM TO
    yyyy mm yyyy mm
    UNIVERSITY / INSTITUTION COURSE OF STUDY FIELD OF ENGINEERING

    3.3 IN-PLANT TRAINING (IF APPLICABLE)

    FROM TO
    PLACE / ESTABLISHMENT NATURE OF TRAINING
    yyyy mm yyyy mm

    SECTION 4 : DETAILS OF EXPERIENCE AND SPECIAL TRAINING UNDERGONE BY THE


    CANDIDATE (If space not sufficient, please give details in an annexure)
    4.1 POST QUALIFYING EXPERIENCE (RELEVANT TO ENGINEERING TECHNOLOGY)
    Please indicate your experience details commencing from the present place of work

    INSTITUTION/
    FROM TO NATURE OF WORKDONE DESIGNATION
    ESTABLISHMENT

    4.1 Contr. On Page 3

    4.1 Contd. from Page 2

    2 of 4
    INSTITUTION/
    FROM TO NATURE OF WORKDONE DESIGNATION
    ESTABLISHMENT

    4.2 SPECIAL TRAINING (IN SERVICE)

    FROM TO INSTITUTE / NATURE OF


    yyyy mm yyyy mm ESTABLISHMENT TRAINING

    SECTION 5 : OTHER QUALIFICATIONS


    FROM TO DEGREE / DIPLOMA / CERTIFICATE, MEMBERSHIP OF PROFESSIONAL ORGANIZATIONS ETC.

    yyyy mm yyyy mm COLLEGE / UNIVERSITY / INSTITUTE COURSE OF STUDY FIELD OF SPECIALIZATION

    I certify that particulars given in section 3.1 to 5 are true & correct.

    Registration Fees, Copies of Certificates, Engineering Experience Reports & other documents as per the sheet "Instructions to applicant" (IIESL
    Form - 05) are enclosed in support of my application.

    Date Signature of Candidate

    Notes for the Guidance of proposers


    SECTION 6 : PROPOSERS In addition to complying with the basic requirements of the candidate, it is necessary, for all the classes - for the proposers to satisfy and
    to recommend to the institution that the candidate is up to the standard for the proposed class for consideration. Before signing you are
    requested to help the candidate by ensuring he/she has represented his/her case to the best advantage and provided adequate information

    3 of 4
    with supporting documents (attested photocopies wherever possible) to enable the Institution to reach decisions. You may be required to
    forward a confidential report if it becomes necessary.

    We the undersigned having read the particulars on this form, and from personal knowledge of the applicant propose Mr./Mrs./Miss/
    as a person in every respect worthy of the
    distinction of being elected a of the Institution. We hereby attest to the accuracy of the information given

    under 3.2, 3.3 , 4.1 , 4.2 , 5.0

    Name in Block capitals


    (Proposer 1)
    (Full Signature)

    (Signature Initials)
    (Membership Number) D D M M Y Y Y Y

    Name in Block capitals


    (Proposer 2)
    (Full Signature)

    (Signature Initials)
    (Membership Number) D D M M Y Y Y Y

    SECTION 7 : FOR OFFICE USE ONLY


    Index No.

    (a) Date of receiving the application


    D D M M Y Y Y Y

    Date of receiving Registration fee Amount Receipt No.


    D D M M Y Y Y Y

    (b) Originals of all the certificates were duly checked. The copies of the certificates submitted by the applicant are correct.

    D D M M Y Y Y Y
    Executive Secretary

    (c) Date of Entrance Examination /tacken


    / appeared for the professional Review
    Thesis accepted D D M M Y Y Y Y

    (d) Recommended for the election as a/an


    (Class of Membership)

    (e) Details of payments Membership subscription :


    Amount Receipt No.
    D D M M Y Y Y Y

    (f) Membership number allocated


    (g)
    Recommended by :
    Chairman / Membership
    Committee D D M M Y Y Y Y

    (H) Approved by the Council of Management

    Hony. Secretary / Executive Secretary President D D M M Y Y Y Y

    4 of 4

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