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Institut Geologi Malaysia: Institute of Geology Malaysia
Institut Geologi Malaysia: Institute of Geology Malaysia
________________________________________________________________ MALE
IDENTITY CARD NO: ______________________________ E-MAIL: ______________________________ PHONE [BUSINESS]: ______________________________ [HOME]: ______________________________ MOBILE: _______________________________________ FAX: ___________________________________ BUSINESS ADDRESS: HOME ADDRESS:
Business
Home
2. EDUCATIONAL BACKGROUND
Name of College/University/Institution Location Degree Year Major Subject(s)
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Regional Geology Mineral Exploration / Structural Geology / Sedimentology Mining Geology / Economic Geology Mineralogy / Petrology / Petrography Stratigraphy / Paleontology Petroleum Geology Engineering Geology / Hydrogeology Geophysics Environmental Geology Structural Geology / Sedimentology
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
No No No No No No No No No No No No No
6. EMPLOYMENT HISTORY
Employer From To Position Held Company Activities
Instructions:
Please attach: i) Payment with your application. All cheques (crossed), bank drafts, Money Orders or Postal Orders are to be made in favour of Institut Geologi Malaysia and must include sufficient clearing charges. ii) Certified copy/copies of Academic and Professional Qualifications. iii) Relevant document(s) to substantiate your field of expertise. iv) Short resume of yourself in not more than 150 words for inclusion in theDIRECTORY OF GEOLOGISTS.
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7. SPONSORS CERTIFICATION FOR ADMISSION We, the following, attest that to the best of our knowledge the details contained in this application form by __________________________________________ are true and honest. We further attest that we have known the said applicant in proximity for a number of years as per stated and consider him/her to be a fit person to be admitted as a member of the Institute Geology Malaysia.
I.
Membership No: ___________________ Tel No: __________________________ Known applicant for: ___________ (yrs)
_____________________________________________
Date: __________________________
Membership No: ___________________ Tel No: __________________________ Known applicant for: ___________ (yrs)
____________________________________________
Date: __________________________
SIGNATURE OF SECOND SPONSOR 8. DECLARATION Have you ever been: convicted of a crime? a defendant in a civil action arising out of the practice of geology? indicted for / convicted of felony or misdemeanor other than a traffic violation? subjected to an investigation, injunction or penalties concerning any alleged consumer, investor or securities fraud? Yes Yes Yes Yes No No No No
If you answered yes to any of the above questions, please provide an explanation of the charges and the final judgment and why these charges and judgments are not pertinent to your professional standing and should not be considered in this application. Attached additional sheets if necessary.
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In affixing my signature to this application, I declare that all statements made herein are true and accurate. I further agree to fully cooperate with IGM in the processing of my application and to furnish any additional information as so requested. I hereby grant IGM permission to contact the listed employers, sponsors and any others to verify information contained herein as well as to obtain any information that may be pertinent to this application.
Name: ___________________________________
Date: _____________________
Secretary/Membership Committee:
President:
____________________________ (Signature)
____________________________ (Signature)
Recognition: Fellows, Members and Licentiates are designated by the abbreviation F.I.G.M., M.I.G.M. and L.I.G.M. respectively. Graduate Members are not assigned any abbreviation. The abbreviation denotes the bearer as a geologist who observes and is bound by the Code of Ethics as laid down by IGM. The Council has the right to expel or suspend any member who is guilty or contravenes the IGM Code of Ethics or any laws introduced to govern the conduct of a geologist following procedures specified in the IGM Constitution.
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1. There are four classes of membership in IGM, namely Fellow, Member, Licenciate and Graduate Member. Fellows, Members and Licenciates are Corporate Members of the Institute. 2. All applications for membership must be proposed by two Corporate Members, one of whom must certify his/her personnel knowledge of the applicant. 3. A candidate for election to the class of Graduate Member must have a Bachelor's Degree with Honours in Geology recognized by the Government of Malaysia or equivalent qualification*.
4. A candidate for election to the class of Licenciate must not be less than twenty-one years of age and must posses the following qualifications: a) at least a Diploma in Geology or equivalent qualification b) experience in a branch of geology of at least five years duration c) passed the membership examinations, if any, athough the Council may exempt a candidate from whole or part of these examinations if he or she has passed other recognized external examinations approved by the Council, and d) be a fit and proper person to become a Licenciate 5. A candidate for election into the class of Member must not be less than twenty-one years of age and must posses the following qualifications: a) a Bachelor's degree with Honours in Geology from a University or Institution of Higher Learning recognized by the Government of Malaysia or equivalent qualification, b) professional experience in a branch of geology of at least three years duration which should include at least one year responsible work in geology, and c) be practising the profession at the time of application and be a fit and proper person to become a Member 6. A candidate for transfer or election into a class of Fellow shall posses the following qualifications: a) be a Member or have satisfied the conditions for admission to the class of Member b) at least fifteen years of professional experience in the geology profession of which at least five years should have been spent in responsible charge of important geological operations or should have been spent as a consultant or advisor in the branches of geology provided that the training and technical experience of the candidate engaged as a consultant or advisor justified such professional status, c) be practising at the time of application and satisfy the Council that he or she is a fit and proper person to become a Fellow 7. All applications must be made on a form prescribed by IGM.
* Equivalent Qualification: i) ii) iii) A minimum of 3 years course duration in an Institute of Higher Learning which offers a degree recognised by the Malaysian Government Public Service Department (JPA). The course must be examination based and must have at lease 50% credit hours in the basic principles of geology or any geoscience branches. A qualification accepted by the Board of Geologists for the purpose of registration as a Professional Geologist under the Geologists Act upon being gazetted.
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