Career Break Application

Consent for storing submitted data *

Yes, I give permission to store and process my data

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Name *

As given on your IPEM membership record

IPEM Membership Number *

Job Title *

Employer *

Department/Section *

Purpose of, or reasons for, the career break *

Proposed length of career break *

If you do not know the exact length please provide an estimate. If needed you may re-activate your membership early or apply to extend your career break.

Proposed start date of career break

If known

Proposed end date of career break

If known

Have you taken a career break on a previous occasion? *

Yes