Chartered Institute of Legal Executives Membership Reinstatement

Chartered Institute of Legal Executives
Membership Reinstatement Form
Please complete in block capitals in black or blue ink (handwriting),
or type using upper and lower cases.
My application is for reinstatement as a CILEx ■ Associate ■ Graduate Member
Office use only: Reg. no.
■ Fellow
1. Personal Details
Title:
Mr
■
Mrs
■
Miss
■
Ms
■
Other
Family Name:
Forenames:
Address:
Town:
County:
Postcode:
Daytime Tel:
Fax:
Email:
Date of Birth:
Day
■■
Month
■■
Year 19
■■
Age
■■
Gender (M/F)
■
2. Name of Current Employer
Name:
Address:
Town:
County:
Postcode:
Tel:
DX No:
Town:
Email:
Address for communication:
Home
Preferred means of contact:
Post
■
■
Work
Email
■
■
Telephone
■
3. Name of Previous Employer(s)
Employer:
From:
To:
Employer:
From:
To:
Employer:
From:
To:
Data Protection Act: The information requested in this form has been solicited solely to enable CILEx, IPS and ITC to provide you with the
membership assessment services for which you have applied, and to meet our obligations as a professional educational and regulatory body.
It will be updated regularly through our contact with you. CILEx has a variety of Membership Benefit products that are sourced from
approved suppliers. From time to time they may wish to send you relevant information. If you do not wish to receive such information,
please write to: CILEx Membership Department, Chartered Institute of Legal Executives, Kempston Manor, Kempston, Bedford, MK42 7AB.
4. Fees
Non-refundable £40 registration fee + the current annual subscription fee
Note: any previous outstanding fees will also need to be paid.
Payment method (please tick appropriate box):
*To be made payable to the Institute of Legal Executives
Personal cheque*
Invoice employer
Firm’s cheque*
Postal order*
Credit/charge card
(We accept Visa, Mastercard and Switch. Please delete as appropriate)
Card No:
Exp
Signed:
Security
Date:
5. Specialist Categories of Practice (Please tick the appropriate box(es)
Sub categories:
Personal injury
Housing
General litigation
Debt recovery
Employment
Defence
Prosecution
Family
Conveyancing
Local authority
Welfare benefits
Government
Immigration
Finance
Probate / wills
Company
Commercial
Practice management
Costs / accounts
Non legal work
Associate Prosecutor
6. Categories of Employment (Please tick the appropriate box)
Solicitors’ firm (0-20 partners)
Government department
Solicitors’ firm (20+ partners)
Law Centre / CAB
Licensed conveyancers firm
Self employed
Commercial company
Other legal organisation
Local authority
Non legal organisation
7. Nature of Duties (Please tick the appropriate box)
Fee earner
Legal accounts
Practice management
Other legal work
Legal secretary
Non legal work
Continued overleaf
8. Previous CILEx Membership
Date enrolled as an Associate/Graduate Member/Fellow (delete as appropriate:
Previous CILEx registration number:
Date previous CILEx registration ceased:
Please specify details of why registration ceased:
9. Pro Bono
Please indicate if you personally undertake Pro Bono work:
■ Yes
■
■ Yes
■ No
No
10. Police
Please indicate if you have police station accreditation:
11. Equality Act 2010
CILEx is asked to monitor and provide statistical reports to the Ministry of Justice in keeping with equality and
diversity. Additionally’ CILEx is under a statutory duty to publish an Equality and Diversity Scheme; the Scheme
includes monitoring the diversity of CILEx members.
WHITE
■ British
MIXED HERITAGE
■ White and Black Caribbean
■ White and Asian
ASIAN or ASIAN BRITISH ■ Indian
■ Pakistani
BLACK or BLACK BRITISH ■ Caribbean
12. DDA
CHINESE or OTHER ETHNIC GROUP
■ Chinese
■ Irish
■ Other White background
■ White and Black African
■ Other Mixed background
■ Other Asian background
■ Bangladeshi
■ Other Black background
■ African
■ Other ethnic group ■ NOT STATED (prefer not to say)
The definition of disability is a physical or mental impairment which has a substantial and long-term adverse effect
on a person’s ability to carry out normal day-to-day activities. Do you consider yourself to be disabled within this
definition?
■ Yes
■ No
If yes, what reasonable adjustment do you need to use our services?
Continued overleaf
12. Prior Conduct (Please answer ALL questions by ticking Yes or No)
Name:
1. Has any decision ever been made against you (whether currently under appeal or not) excluding
or expelling any professional body?
Yes
■
No ■
2. Have any proceedings been taken against you under the Solicitors’ Act 1974, including under
section 43 which provides for control of the employment for solicitors’ staff?
Yes
■
No ■
3. Has a declaration of bankruptcy been made against you or have you made any arrangement
with your creditors?
Yes
■
No ■
4. Are there any outstanding judgments or orders of the Court against you?
Yes
■
No ■
5. Has a caution or conviction been recorded against you in the UK or elsewhere (other than a
motoring offence not resulting in disqualification)? (This declaration is subject to the provisions of
the Rehabilitation of Offenders Act 1974. Fellows are an exempt category under the Act; Fellows
and applicants Fellowship must include details of spent convictions.)
Yes
■
No ■
6. Has any order been made against you by the Legal Ombudsman?
Yes
■
No ■
7. Have any clients made a complaint about your work and/or conduct to you or your employer in
the last 12 months? (This question is to enable IPS to collect information about the types and
numbers of complaint made against CILEx members).
Yes
■
No ■
If the answer to any of the above questions is ‘YES’, please give further details below. (If you have answered ‘YES’ to
question 5 please provide details of the offences and any convictions; a copy of any memorandum of conviction; and
confirmation whether you have paid any fine or complied with any other order imposed on you)
14. Declaration
I declare that the information given in this form is correct. I understand that once registered as a member of CILEx
I shall be bound by the provisions of the Memorandum and Articles of Association, the bye-laws and all other
regulations of CILEx for the time being in force, including the Code of Conduct and supporting guides to good practice.
Signed:
16. Marketing
Date:
Chartered Institute of Legal Executives, Kempston Manor, Kempston, Bedford, MK42 7AB.
tel: +44 (0)1234 845777
web: www.cilex.org.uk
email: [email protected]