Application for Accreditation As An

EMANZ EnergyMasters Accreditation Scheme

Application for Accreditation as an

EnergyMasters FanSpecialist

Please refer to the EnergyMasters Fan Specialist Applicant’s Guidebefore completing this Application Form.

1.Applicant Details

Surname: ______First name:______

Address:______

______Post Code:______

Email address:______

Daytime telephone number(s):______

Company:______

Address:______

______Post Code:______

2.Qualifications

Please identify the courses completed according to the requirements outlined in the EnergyMasters Fan Specialist Applicant’s Guide

Qualification / Length of study (years) / Discipline / Education provider / Country / Year completed
e.g. NZCE / 2 / Mechanical / Wellington Polytechnic / New Zealand / 1991

Work History Summary

Organisation/ Employer / Position/Title / Dates (Month/Year) / Key activities, responsibilities, major achievements and details of projects undertaken

4.Memberships/Registrations/Licenses

Include below any:

membership of IPENZ at associate, technical or professional level, or
registration on a National Register of Current Competence, or
trade qualification.

Organisation / Class / Current
Y/N / Registration number / Year gained
e.g. IPENZ / TIPENZ / Y / 12345 / 1990

5.Referees

Please provide the names of two referees:

Referee 1: ______Email: ______

Referee 2: ______Email: ______

The two referees need to be sufficiently familiar with the applicant’s work to provide comment on the applicant’s competence with regard to refrigeration systems auditing.

Applicants must forward the Referee Form to the two nominated referees, along with a copy of the applicant’s completed Competency Self Assessment Form, for each referee to complete and then return directly to EMANZ.

6.Information for Accreditation Listing

A successful candidate for accreditation will have the details of their areas of expertise listed alongside their name and contact details on the EMANZ website. Potential clients often want to engage EnergyMasters with particular experience or industrial machinery backgrounds. To assist the appropriate promotion of auditors please provide the following information.

Please provide no more than 200 words to outline your Areas of Expertise and gives details of the following:

Practice Field - if you are an IPENZ member or listed on a National Register of Current Competence, identify your defined practice field(s) e.g. Electrical, Industrial, Mechanical.

Practice Area – Include details on your practice area(s), e.g. Boiler servicing, Industrial process energy auditing, pumps and fans engineering and installations.

Areas of Expertise
Work Areas
[Indicate here which geographical area of the country are you available to work in, for example, Lower North Island / National / South Island only].

7.Privacy

Any audits or information you send to EMANZ will remain confidential and only be used inhouse for the purpose of this assessment. Any hard copies will be returned to you at the end of the assessment.

Application Checklist

Please ensure that you have included the following documents as part of your application / No. of copies / Applicant Check / Admin Check
1 / Completed Application Checklist (this page) / 1
2 / Application Form(this form) / 1
3 / Competency Self Assessment Form / 1
5 / FanSystems Audit Report (refer to the FanSpecialistApplicant’s Guide) / 1
6 / Proof of existing qualifications / 1
8 / Completed Referees Forms–from 2 nominated Referees (note: when completed, these are to be sent from each Referee directly to EMANZ) / 2
7 / Other information that you wish to have considered. / 1
8 / Cheque for application and assessment fee / 1

9.Processing this Application

Send the completed forms and payment to EMANZ for processing.
Postal address:
EnergyMasters Accreditation
C/o EMANZ
PO Box 19-261
Courtenay Place
Wellington 6149
Phone: 04 385 2839
Email:
Website:

EnergyMasters Fan Specialist Application FormUpdated October2013