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BICSc Individual Membership

Individual Membership Application Form

Application Reference:(for office use only)

Individual Member Application Form

To apply for BICSc Individual Membership please complete the form below, select the print button to print the form and sign it before sending it to us. Please note that your details will not be transmitted across the internet during this process.

To apply for BICSc Individual Membership please complete the form below, ensuring it has been signed by both the applicant and a supporting client, then send it to address at the bottom of the form.

All fields marked with an asterisk * are mandatory

Personal Information

Please send all correspondence to my: * Home Address Work Address

Your full name:

Title

Firstname(s) *

Surname *

Your Address: *

Address Line 1 *

Address Line 2:

Address Line 3:

Town: *

County:

Postcode *

Telephone Number: *

Land Line Number (e.g. 01604 123456): *

Mobile Number (e.g. 07786 123456):

Employment Information

Position held: *

Enter the position you currently hold

Company Name: *

The name of the company you are currently employed by

Your Address:

Address Line 1 *

Address Line 2:

Address Line 3:

Town: *

County:

Postcode *

Telephone Number: *

Telephone Number (e.g. 01604 123456):

Fax Number (e.g. 01604 654321):

Email Address:

Email (e.g. name@yourdomain.com):

Website Address:

URL (e.g. www.yourdomain.com):

Is the Company a BICS Corporate Member: * Yes No

I wish to pay by: * Cheque Credit Card Annual Direct Debit Invoice Company

Payment by Direct Debit is subject to 5% discount

Career Information

Please list your employment over the last 10 years

Employer 1

Job title

Date From (dd/mm/yyyy)

Date To (dd/mm/yyyy)

Employer 2

Job title

Date From

Date To

Employer 3

Job title

Date From

Date To

Employer 4

Job title

Date From

Date To

Employer 5

Job title

Date From

Date To

Please indicate how many years in the cleaning industry you have spent as the following: *

As a Cleaner:

As a Supervisor

As a Manager

Qualifications

Please list all relevent qualifications. (These will assist in accurate grading of your application) Qualification #1

Title

Year Obtained

Obtained from

Qualification #2

Title

Year Obtained

Obtained from

Qualification #3

Title

Year Obtained

Obtained from

Qualification #4

Title

Year Obtained

Obtained from

Qualification #5

Title

Year Obtained

Obtained from

Qualification #6

Title

Year Obtained

Obtained from

Please list your membership to other organisations in the cleaning or related industries:

Have you previously been a member of the Institute: * Yes No
If yes please provide either your old membership number or approximate date of joining

If accepted, to which region do you wish to belong

You must now print out the form using the button on the right, sign the form, and send it to us for processing at the address shown on the form

Declaration

I declare that the information supplied in this application is correct to the best of my knowledge and belief. If accepted I will always seek to abide by the Institute Code of Practice and use my best endeavours to support the Aims and Objectives of the Institute.

* Signed:

* Date:

This application must be supported by a BICSc member, a colleague or client

* Name of supporting Member:

Membership Number:

* Date:

* Signature:

Submitting Your Application

Please send completed forms to:

Membership Services
The British Institute of Cleaning Science
9 Premier Court,
Boarden Close,
Moulton Park,
Northampton,
NN3 6LF

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