APPLICATION FORM FOR CERTIFICATION

IRCA/103/06/1 Revised March 2006

Application Form for Certification IRCA/103/07/01

12 Grosvenor Crescent
For office use only (confidential when completed)
London SW1X 7EE
United Kingdom Date Received                
Tel: +44 (0)20 7245 6833
Application fee
Fax: +44 (0)20 7245 6755
INTERNATIONAL
REGISTER OF Email: [email protected] Certification no:
CERTIFICATED
AUDITORS Website www.irca.org                
CQI The Chartered Quality Institute

Part 1 Personal details

1 Title (Mr, Mrs, Ms, Dr etc) Male Female

Surname or family name

First or given names

Nationality

Date of birth

Please tick this box if you would like your home address to be your main address for our online register

Home or correspondence address

Country Postcode/Zip code

Name you wish to appear on your certification card

Telephone no. Fax no.

Email

Business details
Please tick this box if you would like your business address to be your main address for our online register

Name of organization

Address

Country Postcode/Zip code

Telephone no. Fax no.

Email

Types of certification for which you are applying

2 Quality Management Programme 2000 (QMS 2000) IRCA/602

Social Systems Programme (SS) IRCA/302

Sector/Programme (i.e. TickIT, Aerospace or Maritime)

Occupational Health & Safety Management Programme (OH&S) IRCA/502

Environmental Management Programme (EMS) IRCA/202

Information Security Management Programme (ISMS) IRCA/802

Information Technology Service Management Programme (ITSM) IRCA/1002

Food Safety Management Programme (FSMS) IRCA/902

 Education

3 Year Award

Course/subjects

Educational establishments

Qualifying authority

Year Award

Course/subjects

Educational establishments

Qualifying authority

Year Award

Course/subjects

Educational establishments

Qualifying authority

Membership of professional bodies

4 Professional body

Date elected Grade

Professional body

Date elected Grade

Professional body

Date elected Grade

Auditor training

5 From To

Name of organization conducting training

Title of course or training programme

Results Course certified by

From To

Name of organization conducting training

Title of course or training programme

Results Course certified by

Register information
 Register information
Please tick up to 6 of the 39 scopes (amalgamated from the NACE codes by European co-operation for
6 Accreditation) which can be supported by your experience:

1. Agriculture and fishing 17. Basic metals and fabricated 31. Transport, storage and
2. Mining and quarrying metal products communication
3. Food products, beverages and tobacco 18. Machinery and equipment 32. Financial intermediation; real
4. Textiles and textile products 19. Electrical and optical equipment estate and renting
5. Leather and leather products 20. Shipbuilding 33. Information technology
6. Wood and wood products 21. Aerospace 34. Engineering services
7. Pulp, paper and paper products 22. Other transport equipment 35. Other services
8. Publishing companies 23. Manufacturing not elsewhere 36. Public administration
9. Printing companies classified 37. Education
10. Manufacture of coke and 24. Recycling 38. Health and social work
refined petroleum products 25. Electricity supply 39. Other social services
11. Nuclear fuel 26. Gas supply 98. Other
12. Chemicals, chemical products 27. Water supply
and fibres 28. Construction
13. Pharmaceuticals 29. Wholesale and retail trade; repair of
14. Rubber and plastic products motor vehicles, motorcycles,
15. Non-metallic mineral products personal and household goods 99. Please tick the box if you are
16. Concrete, cement, lime, plaster etc. 30. Hotels and restaurants available for private work

Work experience

Please include a brief description of your general work experience and a detailed description of your sector/
programme related work experience (QMS, EMS, OH&S, FSMS, ISMS, TickIT, Social Systems, Aerospace, Maritime)
7 and the duration of your experience

From month/year To month/year

Job title

Name of organization and department

Work experience

Sector/Programme related experience & duration

From month/year To month/year

Job title

Name of organization and department

Work experience

Sector/Programme related experience & duration

From month/year To month/year

Job title

Name of organization and department

Work experience

Sector/Programme related experience & duration

From month/year To month/year

 Job title

Name of organization and department

Work experience

Sector/Programme related experience & duration

Declarations
I apply for certification and confirm that I understand and agree to the following conditions:
1. I shall observe and abide by the IRCA code of conduct.
2. The details which I have given on the application form (except personal details where indicated) will be published in the IRCA
8 register.
3. I shall declare any information that may reasonably be considered to affect adversely my ability to perform effectively my
audit obligations.

I confirm that the information contained in this application is correct to the best of 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 IRCA register. I also understand that, once certified, I am obliged to
notify IRCA without delay of any changes to my circumstances which, if declared when I made my first application,
might have caused IRCA to exclude me from the register.

Signed Date

Part 2 Sponsors
Declaration by proposer and seconder: I recommend the candidate as a person in every respect worthy of consideration
for certification. I confirm that I have satisfactorily verified the applicant’s compliance with the education, training and work
experience requirements of the applicable IRCA certification criteria.
9
Proposer’s name (block letters)

Professional qualifications/relationship to applicant

Business name and address

Postcode/Zip code

Telephone no. Fax no.

Email

Signed Date

Seconder’s name (block letters)

Professional qualifications/relationship to applicant

Business name and address

Postcode/Zip code

Telephone no. Fax no.

Email

Signed Date
 Part 3 Organizations employing auditors (OEA)

We, as an OEA recognized by IRCA, support the applicant for certification and confirm that we have satisfactorily verified
10 the applicant’s compliance with the education, training, work and audit experience requirements of the applicable IRCA
certification criteria.

Name of organization

Address

Postcode/Zip code

Telephone no. Fax no.

Signed on behalf of the organization employing auditors

Date

Name (block letters)

Position in organization

Application Checklist
(Please complete the checklist before sending in your application to IRCA for review)

I have:

Provided full mailing and business details (Section 1)

Specified the type of certification programme I wish to apply for (Section 2)
Included documentary evidence to support my technical & academic qualifications
Included a copy of my auditor training certificate, stating successful completion
Recorded sufficient work experience (Section 7) (Guidance note 7)
Recorded sufficient sector related experience stating duration (Section 7) (Guidance note 7)
Signed and dated the declaration (Section 8)
Obtained signatures from a proposer and a seconder (Section 9)
Included payment of the application fee

For applicants submitting IRCA/106 audit logs, we also need you to:
Complete your audit logs in full, paying close attention to the details required at the head of each column. Please ensure
that verification is obtained by the auditee

Total number of full system audits included

Total number of days on-site

Total number of days off-site

Supply the contact details of the directing and guiding Lead Auditor who may be required to attest to your competence
(Section 9 IRCA/106 audit log)

Please ensure that all information submitted is clear as any information that may be un-readable will delay the
processing of your application.
 Guidance notes for applicants

General Information

The following information is important. Please read it carefully before you complete your
application form. Should you need help in completing it, IRCA certification officers are always
available to advise you.

• We accept all correspondence in English, Chinese, Japanese, Italian or Spanish. For all
other languages we will need correspondence in support of the application to be in English
or accompanied by a certified translation.

• Please make sure that you complete all the appropriate sections of this form. If a section is
not applicable to you, write ‘N/A’. Complete Part 1 (1-8) and Part 2 (9) if you are applying
on your own behalf. Complete Part 1 (1-8) and Part 3 (10) if you are applying through
an organization employing auditors (OEA). Do not just write ‘see attached’, because we
will not be able to consider forms marked in this way. If there is not enough room in any
section to write all that you need to include there, then enter a brief summary and enclose
the full details on additional sheets (which will need to be verified by your sponsors). You
should only sign the form when you have checked that all relevant sections have
been completed correctly.

• Please enter details of your audit experience on IRCA/106 audit logs. You must make sure
that each entry in the audit log is verified either by your employer or by the auditee (the
company that employed you) and where appropriate the directing and guiding Lead Auditor.
We will not accept unverified entries. 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 application fee (this fee is not returnable).
Cheques, money orders etc. should be made payable to ‘IRCA’. An invoice will be supplied
on request. Do not send cash. If you are making an application you may pay by Visa, Amex
or Mastercard, and the appropriate form is available on our website.

• When we receive your completed application, we will send you an acknowledgement. We

will inform you whether your application has been successful as soon as the decision is
made.

• This programme is governed in accordance with English law and is subject to the exclusive
jurisdiction of the English courts.

Part I Information about you

1 Personal details
It is a condition of certification that details of your name and business will be published in the
register and included in the IRCA database. Therefore, under ‘Surname or family name’, you
must make sure that you enter your surname or family name, i.e. your main name that legally
identifies you on your passport and will enable us to access the information about you in the
IRCA database. If you also wish your home address to be entered in the register, please tick
the box provided. Additionally, please provide us with how you would like your name to appear
on your certification card, once certification has been awarded.
The register of auditors is available on our website: www.irca.org.
2
Type of certification for which you are applying
Please tick the box appropriate to the type of certification for which you are applying. If you
are applying for certification under one of the three sector programmes (TickIT, Maritime or
Aerospace), please make sure you indicate the name of the specific programme as well as
ticking the adjacent box. Further details of all the programmes are available on request.
3 Education
Enter details of your education (school, college, university etc). You must enclose
documentary evidence (photocopies are usually sufficient) which must be accompanied by
a translation into English, Chinese, Japanese, Italian or Spanish. For all other languages we
will need correspondence in support of the application to be in English or accompanied by a
certified translation.

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 Auditor training
You must have successfully completed: either an IRCA–certified auditor training course
presented by an IRCA–approved training organization or an auditor training course certified
by another training approval body recognized and accepted by IRCA as being of an equivalent
standard. The results you achieved must be supported by documentary evidence.

6 Register information
Please indicate the fields of experience that you wish marked against your entry in the register
by ticking the boxes of a maximum of six sectors in which you can claim experience. 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’. Please also indicate if you are available for
private work by ticking box 99.

7 Work experience
Enter your career details here, providing under ‘Job title’ a brief description of your general
work experience duties and responsibilities. Additionally, we need you to provide a detailed
description emphasizing experience relevant to the sector or programme (QMS, EMS, OH&S,
FSMS, ISMS, TickIT, Social Systems, Aerospace, Maritime) for which you are applying. List this
information in chronological order, beginning with your current or most recent experience.
You may submit further information on an additional sheet.

8 Declarations
You, as the applicant, must sign and date this section before passing the form to the proposer
and seconder.

EITHER

Part 2 Sponsors

9 The proposer and the seconder sponsoring you must then complete part 2.
A sponsor should ideally be a corporate member of a relevant professional institute and be
someone who has detailed knowledge of your work experience (e.g. your line manager). Both
proposer and seconder must have known you personally and your work for not less than two
years.

They should check that all statements in your application form and supporting documents are
complete and accurate before they sign the declaration.

OR

Part 3 Organizations employing auditors (OEA)

10 The relevant OEA’s authorized signatory must then complete part 3. This section should only
be completed if an applicant is applying through an IRCA approved OEA; these organizations
are listed on the IRCA website.

IRCA is an operationally independent division of the Chartered Quality Institute,

incorporated by Royal Charter and registered as charity number 259678
Headquarters and Registered Office: 12 Grosvenor Crescent, London, SW1X 7EE
 IRCA contributes auditor certification services
and value across a range of key industries:

www.irca.org

IRCA
12 Grosvenor Crescent
London SW1X 7EE
Tel +44 (0)20 7245 6833
Fax +44 (0)20 7245 6755
Email [email protected]