Contact: Jennifer Graham, MBA, PMP, PR2

 

 JGraham@jggconsulting.ca  

 

a gLOBAL ENTERPRISE

www.jggconsulting.ca

Associate Application
 

Any changes to Form will automatically disqualify application

 

Applicant Information

 

WORD Document

* Preferred Salutation:         Mr. Miss. Ms. Mrs. Dr. Other

* Gender:                             Male Female

* Surname:                                         * Given Names:  

* Country:                                          * Title:                

* Business Address:                           * City:                 

* Province:                                         * Postal Code:   

* Business Telephone:           ext

Alternate Telephone:             eg.999-999-9999 or +2.22.22.22.22.22

 

# of CMC/PRINCE2/PMP/CBAP/ITIL/ITSM
Certified in your firm:             1 2 -10 11 - 25 26 - 50 51+

 

 

* E-mail address #1:                                                                

E-mail address #2:                         

Website Address:                             http://www.domain.com

* Address Correspondence to:    Residence   Business

Residence Information

* Residence Address:                                                                     

* City:                                                

* Province/Township/Country:                             

* Postal Code:                                  

* Residence Telephone:                           eg.999-999-9999      

Mobile Telephone:                             

Areas of Preferred Practice

 

Select the areas of business management in which you have professional interest and experience.

Operations Management      Human Resource Management               Strategic Management

PMO                                  Information Management                         Project Management

Organizational Change Management    ITIL - Please specify:         

Other - Please specify:        

Certification Requirements

Degree(s) Conferred

 

By submitting this application, I acknowledge my commitment to pursue the JG&G Consulting Services Inc.’ Certification

 

* I have an undergraduate or graduate degree or CA, CGA, CMA, (or International Equivalent) CMC, CBAP, PgMP, PMP, ITIL Expert, PRINCE2, or a PhD.

Yes No

 

Please attach university/degree transcripts or proof of designation.                            

 

 

 

Institute                                    Degree/Designations          From: Month/Year    To: Month/Year

1.             12 11 10 9 8 7 6 5 4 3 2 12010<2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959    12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

2.             12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959    12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

3.             12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959    12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

 

Transcript File – If you have more, please include in e-mail.
(PDF and DOC extensions accepted, maximum 2MB)

Designations(s) and other Memberships

Association/Institute                  Designation Earned             From: Month/Year    To: Month/Year

                12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959     12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

                12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959     12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

                12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959     12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

Consulting and Other Business Experience

 

Please attach a current Curriculum Vitae (CV) and resume.

 

Name and Address           Nature of                        Position                    From: Month/Year   To: Month/Year

of Employer                      Business

        12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959    12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

        12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959    12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

        12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959    12 11 10 9 8 7 6 5 4 3 2 12010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

 

 

Curriculum Vitae (Maximum 2MB)   Please attach in e-mail to JGGConsulting@jggconsulting.ca

 

Resume (Maximum 2MB)      Please attach in e-mail to JGGConsulting@jggconsulting.ca

 

Applicants with 10 years or more relevant consulting and/or project management and/or ITIL experience

may be qualified for the Experienced Path.

 

* I would like to be considered for this Path                                   Yes No

 

 

Date consulting since:                                                              12 11 10 9 8 7 6 5 4 3 2 11 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 312010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959     

 

References 

References must be individuals you have reported to directly and can vouch for the caliber of your work and your expertise. They attest to the accuracy of the information on the application form and implicitly recommend acceptance of the applicant as a member of JG&G Consulting Services Inc.

 

Name:                                                          

 

Phone:                                                          
eg.999-999-9999                                              

 

Email:                                                           

 

Business Address:                                        

 

Knowledge of Applicant:                             Professional Other Years: 

Name:                                                                                                                                   

Phone:                                                          
eg.999-999-9999                                              

 

Email:                                                           

Business Address:                                        

 

Knowledge of Applicant:                             Professional Other Years: 

Privacy

 

Pursuant to PIPEDA (Personal Information and Electronic Documents Act), JG&G Consulting Services Inc. collects the personal information contained in this form solely for administrative purposes related to this application and at no time discloses information to unauthorized parties.

 

Your contact information will remain on a secure internal database. From time to time JG&G Consulting Services Inc. offers a number of services to members, some of which require your explicit permission. If you do not wish your personal information used for the following purposes, please check the appropriate boxes:

 

     I do not wish to have my contact information listed on the searchable website.

 

     I do not wish to receive information from JG&G Consulting Services Inc. service partners (i.e. information on new services and discounted services)

 

     I do not wish to receive information from JG&G Consulting Services Inc. (includes event notification)

           

 

Please note, you may change this at any time by contacting JG&G Consulting Services Inc. directly. Questions, concerns or complaints regarding the collection of personal information should be directed to the Privacy Officer, JG&G Consulting Services Inc., 15 Maitland Place, Suite 1006, Toronto, ON M4Y 2X3 or JGGConsulting@jggconsulting.ca.

 

Declaration

 

I, , hereby declare that I have been working as a management consultant and/or project manager since , and during that time I have devoted at least two-thirds of my working time solely to the professional practice of management consulting and project management. I have read JG&G Consulting Services Inc.'s Code of Professional Conduct, understand it, and agree to abide by it. I have reviewed JG&G's Privacy Policy and have marked the appropriate boxes to ensure JG&G Consulting Services Inc. is aware of any concerns with privacy.

I have read the above statement and declare that all information is accurate to the best of my ability.

Membership Fees and Fee Schedule

 

 Level 1 Membership fees are $39.95 USD a month, or $399 USD (+ GST - Canadians only) per year (includes the last 2 months free). If you have attended the mandatory orientation session, you receive a $150 USD Discount after the first year towards the following year’s membership dues (12 months of paid dues).  If you attend the orientation session within 6 months of membership, the discount will apply. 

Purchase Your Association Membership

Level 1 $399.00 Level 2 $299.00 Level 3 $199.00

 

 

 Level 2 Membership fees are $29.95 USD a month, or $299 USD (+ GST - Canadians only) per year (includes the last 2 months free). If you have attended the mandatory orientation session, you receive a $100 USD Discount after the first year towards the following year’s membership dues (12 months of paid dues).  If you attend the orientation session within 6 months of membership, the discount will apply. 

Purchase Your Association Membership

Level 1 $399.00 Level 2 $299.00 Level 3 $199.00

 

 

 Level 3 Membership fees are $19.95 USD a month, or $199 USD  (+GST – Canadians only) per year (includes the last 2 months). If you have attended the orientation session, you receive a $50 USD Discount after the first year towards the following year’s membership dues (12 months of paid dues).  If you attend the orientation session within 6 months of membership, the discount will apply.

 

Purchase Your Association Membership

Level 1 $399.00 Level 2 $299.00 Level 3 $199.00

 

 

You must pay on-line with PayPal. Your credit card or bank account will be charged upon submitting this application. You will receive a receipt and copy of your application via e-mail. You will be notified once your application has been processed. Membership dues can be invoiced, and will only begin once payment has been received and processed. GST# 83882 9547 RT

©2009- 2010 JG&G Consulting Services Inc. All rights reserved.                   

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