Membership Application

1Name/Email

2Contact

3Employment

4Experience/Education

5Referees

6Other

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Salesforce ID

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Your current AIOH Membership:

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rand

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Today_Date

YOU ARE APPLYING FOR

Current Membership Status

You cannot apply for this grade given your current AIOH member status. Please go to the MY AIOH Members Portal and MY DASHBOARD to pay Renewal OR contact the AIOH.

Title

Name(Required)

First Name Last Name

Email Address(Required)

Enter Email Confirm Email

Consent(Required)

PLEASE TICK TO ACKNOWLEDGE

That you have read the comprehensive guide to applying for AIOH Membership and accept the terms & conditions of membership (download). You also agree to have your application details saved on the AIOH database.

Mobile Number(Required)

Gender

Date of Birth(Required)

Your current home address

If you are overseas, please select your country first.

Home Street Address(Required)

Suburb(Required)

State(Required)

Postcode(Required)

Country(Required)

Current Employment Details

If you work overseas, please select your work country first.

Employer Name(Required)

Department/Section

Title or Role(Required)

Work Address Street(Required)

Suburb(Required)

State(Required)

Postcode(Required)

Country

Work Phone(Required)

In this Role FROM(Required)

In this Role TO(Required)

Please enter today's date if this is your current role.

How many years have you been in this role?(Required)

Please enter a number from 0 to 100.

Percentage of time spent on OH work(Required)

Please enter a number from 0 to 100.

What percentage of your time spent are you engaged in occupational hygiene work at this employer?

Previous Work Details 1 (previous to your current position)

Employer

Position Title/Role

In this Role FROM

In this Role TO

Years in this role

Percentage of time spent on OH work

Please enter a number from 0 to 100.

Previous Work Details 2 (previous to Work Details 1)

Employer

Position Title/Role

Years in this role

In this Role FROM

In this Role TO

Percentage of time spent on OH work

Please enter a number from 0 to 100.

REFEREE DETAILS

Please ensure your references follow the Reference Template provided. Download the Referee Templates.

Referee 1

Full Name(Required)

Phone Number(Required)

Position(Required)

Company Name(Required)

Is Referee 1 an AIOH Member?(Required)

Either a MAIOH / FAIOH (AIOH Full Member / AIOH Fellow Member).

Referee 2

Full Name(Required)

Phone Number(Required)

Position(Required)

Company Name(Required)

Is Referee 2 an AIOH Member?(Required)

Either a MAIOH / FAIOH (AIOH Full Member / AIOH Fellow Member).

UPLOAD YOUR SUPPORTING DOCUMENTS

Written reference for REFEREE 1 (2 files max)(Required)

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 2 MB, Max. files: 2.

Upload your documents as a PDF, JPEG or JPG format only (2MB maximum size per file). If your document is over 5MB, please compress your file prior to upload.

Written reference for REFEREE 2 (2 files max)(Required)

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 2 MB, Max. files: 2.

Upload your documents as a PDF, JPEG or JPG format only (2MB maximum size per file).

Please upload ONE Report

A report is required if one of your References are not a MAIOH / FAIOH (AIOH Full / Fellow Member). Upload your documents as a PDF, JPEG or JPG format only (5MB maximum size per file).

Please upload ONE Report

A report is required if one of your References are not a MAIOH / FAIOH (AIOH Full / Fellow Member). Upload your documents as a PDF, JPEG or JPG format only (5MB maximum size per file).

Please upload TWO Reports

Two reports are required if both your References are not a MAIOH / FAIOH (AIOH Full / Fellow Member). Upload your documents as a PDF, JPEG or JPG format only (5MB maximum size per file).

Membership Application

Your current home address

Current Employment Details

Previous Work Details 1 (previous to your current position)

Previous Work Details 2 (previous to Work Details 1)

Please list all qualifications held here. If you hold more than three, please enter additional qualifications under Other Studies. If you are currently studying, please enter the anticipated date of completion.

Highest qualification attained

Second qualification attained

Third qualification attained

Other studies completed

UPLOAD YOUR SUPPORTING DOCUMENTS

REFEREE DETAILS

Referee 1

Referee 2

UPLOAD YOUR SUPPORTING DOCUMENTS

Please upload ONE Report

Please upload ONE Report

Please upload TWO Reports

Please wait after your submission for your record to be created and documents to be uploaded.