Practitioner Membership Renewal

I give my permission to AP to approach other organisations as necessary to establish facts and circumstances should an allegation arise that might result in the breach of AP’s Standards of Conduct and Ethics

Declaration

All applicants must answer each of the questions below. Please note that deliberately false statements will result in non acceptance/cancellation of your membership. If you answer ’yes’ to any questions below please provide additional information. Please note that answering yes to questions in the declaration does not mean you will not be accepted for membership.

THIS FORM IS FOR EVENTS THAT HAVE OCCURED SINCE YOU LAST COMPLETED A DECLARATION. IF YOU HAVE ALREADY DECLARED SOMETHING TO US, YOU DO NOT NEED TO DECLARE IT AGAIN

Conviction

1. Do you have a conviction which is not spent under the Rehabilitation of Offenders Act 1974 in the UK, or a conviction in another country which might prejudice the public’s trust in you, your profession or AP if accurately informed about the details?*

Yes

Additional Statement

3. Have you ever been refused/ expelled from membership of any other professional body/register on the grounds of professional misconduct or other professional related offence?*

Yes

Additional Statement: Please provide brief history including time and outcome

Can you explain in more detail the circumstances/situation which led to the offence/s?*

Has there been a change in your circumstances that is relevant to the conviction, since the offence/s?

How do you feel about the offence/s?

Is there a probation officer assigned to you?*

Is there anything else we would need to consider/you wish to draw to our attention?*

Disciplinary

5. Are you currently/likely to be the subject of any criminal, civil, investigatory or disciplinary proceedings or enquiries?*

Yes

Additional Statement: Please provide brief history including time and outcome

6. Have you ever been, or are you likely to be involved in a situation or incident likely to result in disciplinary action against you as a member of AP?*

Yes

Additional Statement: Please provide brief history including time and outcome

Can you explain in more detail the circumstances/situation which led to the disciplinary action including the outcome and how long ago it was?*

What steps have you put in place to prevent further disciplinary action?

Is there anything else we would need to consider /you wish to draw to our attention?*

By submitting this form, you agree with the Addiction Professionals Terms and Conditions and Privacy Policy .

Once you have submitted this form, you will be taken to the payment options page. Payment must be made for your application to be processed.

If you application is successful, we will email you with your membership certificate and details of how to access your complimentary CPD Membership.

If your application is unsuccessful you will receive a full refund.

Please note: In the course of your application for membership and for qualifications we may ask for provision of references and reports from your workplace manager and/or supervisor. We may also ask for evidence of qualifications and membership of other professional bodies and organisations during your membership with AP.

Practitioner Membership Renewal

Membership Type

Your details

Declaration

Conviction

Disciplinary