AppNewMbr

1APPLICANT INFO

2EMPLOYERS

3EDUCATION

4NCIDQ

5CEU

6WORK EXPERIENCE

7INSURANCE

8OTHER MEMBERSHIPS

9REFERENCES

10SIGN APPLICATION

11WEBSITE ENTRY

APPLICANT INFORMATION

Refer to IDNS Regulations for the qualifications for each category. Please note that IDNS, NSAA or APENS membership is a requirement to practice Interior Design within the province of Nova Scotia.

Which membership category are you applying for? *

Registered
Non-Resident Registered
Intern
Student
Allied

Applicant Name: *

First

Last

Applicant Phone Details

Work / Home Phone:

Cell / Mobile Phone:

Applicant Email: *

Applicant Home Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

EMPLOYMENT

Please provide employment details for the past FIVE years:

Current Employer / Company Name *

Full Time / Part Time? *

Full-Time Employment
Part-Time Employment

Current Employer / Company Phone # *

Current Employer / Company Email: *

Current Employer / Company Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Start Date of Employment: *

Current Job Role / Position: *

Current Employer Reference: *

First

Last

PREVIOUS EMPLOYMENT

If current employment is less than FIVE years, please provide previous employment history:

Previous Employer / Company Name

#2 Full Time / Part Time?

Full-Time Employment
Part-Time Employment

Previous Employer / Company Phone #

Previous Employer / Company Email:

Previous Employer / Company Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Previous Employer Start & End Dates

Start Date

End Date

Previous Employer : Job Role / Position:

Previous Employer : Reference:

First

Last

Previous Employer / Company Name:

#3 Full Time / Part Time?

Full-Time Employment
Part-Time Employment

Previous Employer / Company Phone #

Previous Employer / Company Email:

Previous Employer / Company Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Previous Employer Start & End Dates:

Start Date

End Date

Previous Employer : Job Role / Position:

Previous Employer : Reference:

First

Last

EDUCATION

For application approval, the Association requires OFFICIAL transcripts of education records.

Institute & Program Names:

Institution Name: *

Program Name: *

Institution Address: *

Address Line 1

City

State / Province / Region

Postal Code

Country

Program1 GradDates+Yrs

# of Program Years: *

Program Start Date: *

Graduation Date: *

CIDA Accreditation: *

Additional Institutions:

First

Last

Institution #2 Address:

Address Line 1

City

State / Province / Region

Postal Code

Country

Program #2 GradDates+Yrs

# of Program Years:

Program Start Date:

Graduation Date:

CIDA Accreditation:

Additional Institutions:

First

Last

Institution #3 Address:

Address Line 1

City

State / Province / Region

Postal Code

Country

Program #3 GradDates+Yrs

# of Program Years:

Program Start Date:

Graduation Date:

CIDA Accreditation:

Additional Institutions:

First

Last

Institution #4 Address:

Address Line 1

City

State / Province / Region

Postal Code

Country

Program4 GradDates+Yrs

# of Program Years:

Program Start Date:

Graduation Date:

CIDA Accreditation:

NCIDQ #

NCIDQ CERTIFICATION:

Date Certified

If you are applying for either a Registered or Non-Resident Registered membership you are required to upload here your NCIDQ certificate.

NCIDQ Upload

If you are not providing certifications, please explain why here:

CONTINUING EDUCATION UNITS:

Applicants acknowledge that Registered, Non-Resident Registered and Intern members are required to satisfy the continuing education (CEU) requirements specified by the International Design Continuing Education Council (IDCEC) and IDNS to qualify for annual renewal of their IDNS membership registration as described in the IDNS By-Laws.

Reporting cycles are three years and IDCEC transcripts must be submitted annually.

CEU *

I confirm acceptance and agreement to the continuing education requirements as specified by the IDCEC and described by the IDNS By-Laws.
Not applicable to this application.

SUPERVISED WORK EXPERIENCE:

Required for INTERN only membership application.

Tick here which is applicable to this application: *

Supervised Work Experience : Not applicable.
Supervised Work Experience : Applicable - complete fields below:

Supervisor Name & Job Position:

First

Last

Supervised Contract # and Hours Completed:

First

Last

PROFESSIONAL LIABILITY INSURANCE:

PI Ins

Registered and Non-Resident Registered members are required to have liability insurance as outlined in the Regulations, Section 37 & 38. If applicant does not have insurance at the time of application, any accepatnce into the Association will be pending proof of insurance.

Please upload a copy of Insurance Certificate here.

PI Certificate: *

Click or drag files to this area to upload. You can upload up to 5 files.

Full Insurance Provider Name: *

Insurance Policy Details:

Policy # *

Policy Starting Date: *

Policy Expiry Date: *

Insurer's Contact Details:

Insurer Contact Name: *

Insurer Phone #: *

Insurer Email:

OTHER MEMBERSHIPS/ORGANISATIONS:

(Please provide details of other Professional Memberships or Organisations)

OTHER MEMBERSHIPS / ORGANISATIONS

Name of Membership #1:

Date of Membership #1

Membership Category #1:

Currently a Member:

OTHER MEMBERSHIPS / ORGANISATIONS #2

Name of Membership #2:

Date of Membership #2:

Membership Category #2:

Currently a Member #2:

OTHER MEMBERSHIPS / ORGANISATIONS #3

Name of Membership #3:

Date of Membership #3:

Membership Category #3:

Currently a Member #3:

Have you had any disciplinary action taken against you or had your licence revoked in the last two years? *

Do you have any open complaints/actions being taken against you? *

PROFESSIONAL REFERENCES:

(Please provide two professional referrals for your application; preferably a Member of IDNS or NSAA)

Referral #1 Full Name: *

Referral #1 Phone&Email:

Referral #1 : Phone: *

Referral #1 : Email: *

Referral #2 Full Name: *

Referral #2 Phone&Email:

Referral #2 : Phone: *

Referral #2 : Email: *

APPLICATION AGREEMENT

I hereby make application for membership in the Association of Interior Designers of Nova Scotia (IDNS). If accepted, I agree to abide by the Act, Regulations and By-Laws of this Association and accept any decisions of the Board of Directors.

I hereby grant IDNS to request and obtain information related to my education, current and past employment and any association membership records and other information that is required for the purposes of applying to IDNS for membership.

I hereby authorize IDNS and its officers, directors, panel members, employees and agents (the above designated parties) to review my application and determine my eligibility to become a member of IDNS. I authorize the above designated parties to contact any state/provincial and fenderal authorities, employers and others to confirm the information contained in my application to become a member of IDNS.

I agree to cooperate promptly and fully in any review of my application; including submitting such documents and information deemed necessary to confirm the information in my application.

I hereby waive all claims against IDNS arising out of my application and my information in the membershp application, including (but not limited to) claims arising out of (a) any release of information to state/provincial and fenderal authorities, licensing boards, employers and others and (ii) any investigation and review of my application.

Applicant Signature *

Type in CAPITALS your full name as signature to this application's agreement.

Applicant Signature

ApplicantYesAgreement *

YES, I hereby agree and accept all stipulations as set out in this application's agreement.

Date of Signature *

WHAT HAPPENS NEXT?

Applications will be reviewed within 30 days of receipt of application fee, all required forms and documentations. Any information that is missing or not submitted could cause delays in the review. If an applicant is accepted, a letter will be issued along with an invoice for the annual membership dues. A list of the annual dues can be found on the IDNS website on the membership application page. Membership will commence upon receipt of paymnet of dues and proof of liability insurance.

If your membership is accepted, please confirm below, your consent to receive email communications from IDNS. These communications from IDNS include email notices of meetings, seminars, social functions and other association related events and issues. By agreeing to the consent below, you also agree that IDNS can list your name, address, phone number and email address on their website under the membeship listing.

Applicant To Authorize Email Communications: *

YES, I agree to receive email communications as part of my membership with IDNS.
NO, I do not agree to IDNS sending email communications (NB: IDNS sends meeting notices only by email!)

Please provide below the following information you wish to be entered on IDNS' website membership listing upon acceptance to the Association:

WEBSITE ENTRY DETAILS : How would you like for your entry to be shown on IDNS members listing website?

Type here how you would like for your name to be shown on IDNS website members listing.

CompanyName+Web

Company Name

Website

Address

Address Line 1

City

State / Province / Region

Postal Code