Part A
Personal Details
All applicants must complete Part A and only those applying for the Associate Fellow of (or) Fellow qualification are required to complete Part B. For further details CLICK HERE |
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Family Name
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Given Name
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E-mail
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Phone
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Preferred Name
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Title
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Home address
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Post Code
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Please specify your currently held professional qualification: |
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Non-classified
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ANZIM
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MNZIM
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AFNZIM
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Please specify the qualification you are making an application for: |
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ANZIM
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MNZIM
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AFNZIM
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FNZIM
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Employment Information
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Position/Title
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Date Appointed
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Organisation
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Type of Business
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Business Address
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E-mail
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Phone
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Fax
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Address for Correspondence
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Employment Summary
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1. Years (From-To)
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1. Position
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1. Organisation
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1. No. of employees (& No. reporting directly to you)
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1. Total turnover & assets
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2. Years (From-To)
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2. Position
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2. Organisation
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2. No. of employees (& No. reporting directly to you)
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2. Total turnover & assets
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3. Years (From-To)
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3. Position
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3. Organisation
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3. No. of employees (& No. reporting directly to you)
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3. Total turnover & assets
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Supporting Documendation
- You may wish to attach a letter in support of your application from your manager or chief executive or if you are the head of the organisation, a business associate would be appreciated.
- A copy of your current job description
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Educational Qualifications
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1. Degrees, Diploma, Certificates awarded
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1. Where Obtained
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1. Year
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2. Degrees, Diploma, Certificates awarded
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2. Where Obtained
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2. Year
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3. Degrees, Diploma, Certificates awarded
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3. Where Obtained
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3. Year
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4. Degrees, Diploma, Certificates awarded
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4. Where Obtained
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4. Year
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PART B: This section to be completed by a associate Fellow and Fellow applicants only. |
Management Achievements
If you management experience / achievements indicate qualification of Associate Fellow or Fellow please list below outstanding managerial career achievements which have significantly influenced the organisation(s) you have been associated with:
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Other Current Interests and affiliations
Include entries relevant to your application as explained in the General Criteria:
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Referees
Please have your application signed by two persons, who will act as your referres any may be contacted by NIM to confirm that you meet the criteria. the first referee should be your CEO or, if you are the head of the organisation, a business associate would be appropriate.
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1. Name
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1. Home Address
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1. Phone (Daytime)
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2. Name
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2. Home Address
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2. Phone (Daytime)
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Supporting Documentation
To assist the Qualifications Committee to assess your professional qualifications, or qualification advancement please attach the following information. Failure to provide this information will delay the approval of your application.
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A copy of your organisation chart - showing your position clearly
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You may wish to attach a letter in support of your application from your manager of chief executive or if you are the head of the firm, a business associate would be appropriate
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A copy of your current job description plus any other relevant job description If you are an owner/manager, a copy of your current annual accounts would be helpful
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In accordance with the Privacy Act 1993 the information you provide will be used only for the purposes of membership registration, membership qualification and the provision of membership services. You are a member of the New Zealand Institute of Management Inc. but your personal information is held by a division and national office.
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Declaration
In support of my application I submit personal details and I understand that this information my be passed on to any NZIM Division Board, NZIM National Office, National Board and National Qualifications Committee, in order to determine my professional qualification. I also understand that various people may be asked for supporting references and that this information is provided on the understanding that it is evaluative material in terms of Section 29(1) and 29(3) of the Privacy Act 1993 and will not be disclosed to me. I hereby apply for membership of the New Zealand Institute Inc. I agree to be bound by the Rules of the Institute and to abide by the Code of Ethics and I declare that all the information supplied is accurate. I understand that if I wish to withdraw my membership from NZIM I will do so in writing and I will surrender my professional qualification certificate. If my membership lapses, my records will be destroyed and I will have to reapply for membership and professional qualification. |
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I accept this declaration
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