LEA7 - Legionella Certification Application Form v1.0

General Details

The information you provide will be used to register you with Stroma's Legionella Certification Scheme. Please make sure that you complete all of the relevant sections.

Personal Details

Declaration

By ticking this box below, I declare that the all information provided within this document is true to the best of my knowledge. I confirm that I have read and understood all policies, terms and documentation provided within the Legionella Certification Scheme Members Pack. I promise to abide by all rules and ensure that all terms, conditions and standards currently defined within these polices, terms and documentation will be fully adhered to. I also accept that this Application Form (and all other policies, terms and documentations within the Legionella Certification Scheme Members Pack) may be altered in the future by Stroma Certification (Stroma Certification will notify the applicant of any changes made) and agree to abide by all subsequent changes made. The information on this form supersedes all previous versions.

Certification Checklist for Submission

To complete your application, please arrange for the following documents to be uploaded or confirm that paper copies will be posted to Stroma Certification.

Basic Disclosure

Individuals wishing to join a scheme shall provide a basic disclosure certificate.

The certificate should be no more than one year old at the time the application is received and will be retained by Stroma Certification until such a time that either the member wishes to leave the scheme or the certificate is no longer valid.

Upload: Colour Copy - CRB Certificate

Scheme Insurance

Persons wishing to join a scheme should hold the relevant Professional Indemnity (PI) and Public Liability (PL) Insurance as per the scheme requirements.

Stroma Certification provides a 'Per Click' policy which covers the above requirements. To see the Stroma 'Per Click' insurance policy please click here

If you have chosen to take advantage of Stroma Certification's 'Per Click' insurance, please upload a signed copy of the applicable proposal form(s) which you can download using the link below;

Download Per Click Proposal Form

Alternatively, please upload a copy of your company insurance cover documents covering both Professional Indemnity and Public Liability as applicable.

Identification Checks

Where it is not possible to provide the above documents, we are able to accept a copy of your birth certificate and two recent utility bills.

Please note that where this is the case, a professional interview will be conducted with prospective candidates and a declaration will be required to be signed during the interview stating you have neither a valid passport or valid driving license available at time of application.

Code of Conduct Declaration

To complete your membership you are required to read the Stroma Certification Code of Conduct, then sign and return the Code of Conduct Declaration Agreement Form.

Please ensure the document you submit has an inked signature and you confirm below how this is to be submitted.

Download Code of Conduct Declaration Agreement

Photo ID

You are required to provide a colour passport photograph in order for you to be issued with a Stroma Certification ID card.

Training Course / Qualification Certificate

Please upload a colour copy of your training and /or qualification certificate which you currently hold. At present we are able to accept certificates issued from ABBE, City & Guilds and BPEC. Certificates from other sources will also be considered.

Direct Debit Mandate

Provided below is a copy of the direct debit mandate in Microsoft word document format (.doc) for you to download, complete and upload if you don't have a digital scanner to scan your mandate.

Download Direct Debit Mandate Form

1. Please ensure you have included a direct debit mandate with a full hand signed signature.
2. Please can you arrange for a hard copy of the mandate to be posted to Stroma within 14 days.

Unable to Upload Key Documents

If you don't have all the required documents available for uploading please note you will have to post them, with a letter noting your online application reference which you will receive upon submission of this form.

Please post the documents to:

FAO Customer Services Dept
Stroma Certification Ltd
4, Pioneer Way
Castleford
West Yorkshire
WF10 5QU

Please note that any items sent to Stroma Certification will be retained and unable to be returned. As this is the case we ask that applicants make copies of their documents before submitting them. Ideally all items should be sent via recorded delivery to ensure they can be tracked in case of loss.