Please tick the award you are registering for:
Foundation
Award in HR Essentials Award in L&D
Intermediate
Award in HR Award in L&D
Advanced
Award in HR
Award registration form
Please return this form to:
Membership Administration
Chartered Institute of Personnel and Development
151 The Broadway
London
SW19 1JQ
UK
Alternatively, you can email your completed form to:
memadmin@cipd.co.uk
D D M M Y Y
Please read these notes before completing the form
T
o help us process your application promptly, please write clearly and use block capitals throughout, following any
instructions carefully. If your form is not completed correctly, this may delay your application.
Provided we have all the details we need, we’ll send your registration number within ten working days of receiving your
form. If you haven’t received these details after ten working days, please call us on 020 8612 6208.
Existing CIPD members
If you’re already a member, you’ll still need to complete this form so that we can update your records. If you’ve paid
your subscription fee for 2017–18, you don’t need to pay any registration fees.
Home details
Address ..............................................................................................................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
Town ...................................................................................................................
County ....................................................................... Postcode.....................
Country ..............................................................................................................
Email ...................................................................................................................
Tel ........................................................................................................................
Work details
Job title ..............................................................................................................
Organisation .....................................................................................................
Address ...............................................................................................................
...............................................................................................................................
Town ...................................................................................................................
County ..................................................... Postcode ......................................
Country ..............................................................................................................
Email ...................................................................................................................
Tel ........................................................................................................................
Current CIPD membership number (if applicable) .................................................................................................. Grade ........................................................
Title Mr
Mrs Miss Ms Dr ........................................................................................... Other (specify).......................................
.................................................................................................................................................................................................
First name ..................................................................................................................Last name ........................................................................................................
The name you supply will be used on any certificates and correspondence sent by us, so please state the name you’d prefer us to use.
Male Female Date of birth
/
/
If you’re working in a ‘politically sensitive’ area (such as the armed forces, central government, police), please supply either a home or business address, not both.
Section 1 – Your contact details
Mobile .................................................................................................................
By providing your mobile number, you are giving us permission to use it from time to time in order to contact you for the purposes of informing you
about your membership by SMS. However, we will not use it for direct marketing campaigns.
For your security and peace of mind, CIPD and its subsidiaries will not supply your details to any other organisation for marketing purposes. By
submitting this request you confirm that you agree to the use of your information as set out in our Privacy Policy (see cipd.co.uk/absite/privacy or call
+44 (0)20 8612 6208 for more details, including how to let us know if for any reason you would not like to receive marketing communications from us).
My preferred daytime telephone number is:
Home
Work
Twitter handle ..................................................................................................
LinkedIn profile ...............................................................................................
Section 2
To be completed at your centre
Name of programme manager/tutor ...............................................................................................................................................................................................
Name of centre .......................................................................................................................................................................................................................................
Programme title .....................................................................................................................................................................................................................................
Programme start date ................................................................................. Programme finish date .........................................................................................
Method of study
Full-time
Part-time Other (CIPD Flexible Learning, supported distance learning etc)
Student’s Unique Learner Number (ULN)
(if applicable)
Centre Learning Provider Number (UKPRN)
(if applicable)
I have checked section 2 and confirm this candidate is enrolled with us for the programme stated above.
Programme manager’s/tutor’s signature ........................................................................................................................... Date .................................................
Section 3
Please complete this section by noting the unit(s) you are registering for:
Unit(s) title: .............................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................
Section 4
Candidate declaration
I confirm that the above statements and information are correct to the best of my knowledge.
Signature .................................................................................................................... Date ....................................................................
click to sign
signature
click to edit
click to sign
signature
click to edit
Section 5 – Registration fees
All amounts are shown in pounds sterling. If you prefer, you can make a payment by cheque in Euros using an exchange rate of £1 = €1.20.
If you pay by credit/debit card, your card provider will use their own exchange rate.
Registration fee
To register for your award you’ll need to pay a registration fee of £30. You can pay by credit/debit card or cheque.
Cheques should be made payable to the ‘CIPD’ and stapled to the form. If you’re using a company cheque to pay for your registration
fee, please ensure that your name is clearly stated on the back.
Registration fee £30
For oce use only
Registration number .............................................
Please indicate your preferred payment method
Please find enclosed a cheque for £30
If you would like to pay by credit card, please give us the best telephone number to contact you on and we will call you to
take your payment.
Telephone .........................................................................................
Section 6 – About you
P
lease take a moment to tell us what’s important to you by completing the questionnaire below.
1 Your role – please tell us which of the following best describes your role (choose one)
1 I work for an organisation in an HR role
2 I work for an organisation in an L&D role
3 I work for an organisation in an HR and L&D role
4 I work for an organisation in a role in another
HR specialism
5 I don’t work in HR but have responsibility for it
6 I am a self-employed independent consultant
7 I work for an HR/L&D consultancy
8 I work for a management consultancy
9 I work for a supplier of services to the
HR/L&D community (excl. consultancies)
2 Please select your main areas of interest (choose one or more)
1 Change management
2 Coaching/mentoring
3 Corporate social responsibility/
sustainability/governance
4 Diversity and inclusion
5 Employer branding
6 Employee communications
7 Employee engagement
8 Employee relations/trade unions
9 Employee well-being
10 Employment law
11 Health and safety
12 Human capital/metrics
13 HR systems and technology
14 International HR
15 International reward/expatriate
management
16 Leadership and management
development
17 Leading and managing the HR function
18 Learning and development strategy
19 Occupational psychology
20 Organisation design
21 Organisation development
22 Employee benefits
23 Performance management
24 Public policy issues
25 Recruitment and selection
26 Reward
27 Shared services
(including HR outsourcing)
28 Talent management/
succession planning
29 Technology-based training
30 Learning and training delivery
31 Learning and training design
32 Workforce planning
33 Neuroscience
34 Absence/working time
35 Other (please specify)
......................................................
......................................................
......................................................
3 Do you work in a specialist role? Yes No
If yes, what is your area of specialism?
(choose one number from the list above)
4 What is your job level? Please read the descriptions and select which best applies to your role (choose one)
1 Director: Top-level with overall responsibility for
own function with board membership or equivalent,
including MD, CEO or Chairman.
2 Senior executive/group role: Top executive with
overall responsibility but without board membership or
equivalent.
3 Senior business partner: Individual with responsibility
for an activity within the overall function – may be a
senior HR specialist or in a broader HR role. Makes a
significant contribution to policy formulation.
4 Business partner: Individual in senior position
with strong professional role – may have
supervisory responsibilities for departmental
work and/or manage a small team.
5 Manager: An experienced professional with first
level of responsibility and more than two years’
experience at this level.
6 Adviser/Assistant: A professional starting out
on their HR/L&D car
eer withunder two years’
experience in function.
7 In-house consultant: Individual working
within an organisation on a programme/
project, possibly working cross-functionally.
8 Independent consultant: Individual
providing consultancy services to
organisations on a freelance/contractual
basis.
9 Lecturer/Academic
10 Consultant in HR/Management
Consultancy
Your details If you work from home tick this box
5 What is your employment status? (choose one from each section)
1 Full-time
Section A
Section B
2 Part-time/job share 3 Retired from full-time employment
4 Not in paid employment
9 Not applicable 6 Permanent 7 Temporary/fixed term/interim
5 Full-time student
8 Self-employed
Name ..........................................................................................................
16 How likely is it that you would recommend the CIPD to a friend/colleague?
14 Is your membership subscription reimbursed by your employer? (choose one)
1 Yes
2 No
3 I am self-employed and my business pays
6 Which geographic area(s) are you responsible for/have influence over? (choose one or more)
1 UK and Ireland
2 Western Europe
3 Central and Eastern Europe
4 Middle East
5 Africa
6 North America
7 Latin America
8 Asia-Pacific
9 South East Asia
15 Please indicate if you purchase or have influence in the purchase of the following products/services? (choose one or more)
1 In-house training/development programmes
2 Courses (open)/conferences
3 Training DVDs/packages
Extremely unlikely
0 – 1 – 2 – 3 – 4 – 5 – 6 – 7 – 8 – 9 – 10
Extremely likely
4 Development of HR capability
5 HR consultancy services
6 Online HR/employment law
information services
7 Recruitment advertising/services
8 HR software systems
9 Qualification-based programmes
for HR/L&D employees
10 How many people are there in the HR/L&D department you work in? (choose one)
1 1–2
2 3–5
3 6–9
4 10–19
5 20–49
6 50–99
7 100–499
8 500+
11 How many years’ experience in HR/L&D/other specialism do you have? (choose one)
1 1–3 years
1 1–3 years
2 4–9 years
2 4–9 years
3 10–19 years
3 10–19 years
4 20+ years
4 20+ years
12 How many years, in total, have you been in employment? (choose one)
8 How many people work for your organisation in the country where you’re based? (choose one)
1 1–9
2 10–49
3 50–99
4 100–249
5 250–499
6 500–999
7 1,000–4,999
8 5,000–9,999
9 10,000–19,999
10 20,000+
13 What is your annual salary (including bonuses)? (choose one)
1 Up to £14,999
2 £15,000–£19,999
3 £20,000–£29,999
4 £30,000–£44,999
5 £45,000–£69,999
6 £70,000–£99,999
7 £100,000–£129,999
8 £130,000–£149,999
9 £150,000+
10 Prefer not to say
9 How many people work for your organisation globally? (choose one)
1 1–9
2 10–49
3 50–99
4 100–249
5 250–499
6 500–999
7 1,000–4,999
8 5,000–9,999
9 10,000–19,999
10
20,000+
7 What is the main industry sector you work in? (choose one)
1 Agriculture, forestry and fishing
2 Mining and extraction
3 Manufacturing
4 Electricity, gas and water supply
5 Construction
6 Retail and wholesale
7 Hotels and restaurants
8 Transport, storage and communication
9 Finance, insurance and real estate
10 Professional/consultancy services
11 IT industry
12 Central government
13 Local government, including schools and fire
services
14 Defence – armed forces and police
15 Further and higher education – public sector
16 Further and higher education – private sector
17 Health and social care – public sector
18 Health and social care – private sector
19 Voluntary and not-for-profit
20 Other private sector services
21 Media
For your security and peace of mind, we will not supply your details to any
organisations for marketing purposes. By submitting your membership
questionnaire you agree that the CIPD and its subsidiaries may use your
details as explained in this questionnaire. Your participation helps us to
understand the characteristics of our membership and develop services that
meet your personal and professional needs. Please refer to our privacy policy
cipd.co.uk/absite/privacy or call +44 (0)20 8612 6208 for more details,
including how to let us know, if for any reason, you do not want to receive
marketing communications from us.
May 2015
Chartered I
nstitute of Personnel and Development
151 The Broadway London SW19 1JQ United Kingdom
T +44 (0)20 8612 6200 F +44 (0)20 8612 6201
E cipd@cipd.co.uk W cipd.co.uk
Incorporated by Royal Charter
Registered as a charity in England and Wales (1079797) and Scotland (SC045154)
Issued: December 2016 Reference: 7201ARF
© CIPD 2016