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Home
About Us
Membership
Resources & Links
- FAQ
- 2023 ASHSP Annual General Meeting
Contact Us

Membership Application

Member Application

1.0 Profile

Email *

Password *

Confirm Password *

Name *

Name

First

First

Last

Last

Phone *

Organization

1.1 Home Address

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

1.2 Mailing Address

Same as Home Address

Yes

No

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

2.0 Designations

CRSP #

CSP #

ROH #

ROHT #

CMIOSH #

CFIOSH #

CIH #

CHSC #

CRST #

CPE #

Other #

Other (2) #

2.1 Designations

NCSO #

QSR #

HSA #

MSO #

CHSMSA #

2.2 Designations - Certifying Auditor

Certifying Partner

Certification #

I intend to or am currently working towards a designation listed in section 2.0. *

Yes

No

Designation being sought *

List all that apply

Projected completion date *

If nothing was selected from Sections 2.1 or 2.2, then use the space below to describe your interest in joining the ASHSP, as well involvement in and-or contributions to the field of occupational health and safety.

3.0 Education

Institution *

Completed?

Yes

No

Course/Program *

Level Achieved Or Underway *

Completion Date *

Actual Or Anticipated

4.0 Employment

Employer Name *

Employment Start Date *

Employment End Date

Position(s) Held *

Past Employer Name

Past Employment Start Date

Past Employment End Date

Past Position(s) Held

5.0 Declarations

Are you a resident of Alberta? *

Yes

No

Have you ever had a finding of unprofessional conduct or similar finding made against you by any professional organization? *

Yes

No

If yes, please provide further information.

Do you have any outstanding complaints or discipline matters with any professional organization with which you have been registered? *

Yes

No

If yes, please provide further information.

Have you even been convicted of a criminal offence in any country? *

Yes

No

If yes, please provide further information.

Have you even been found guilty of a breach of a university or similar code of conduct, or an academic infraction of any post-secondary education institution? *

Yes

No

If yes, please provide further information.

Please enter further information for the question(s) above.

This information is collected in accordance with the Personal Information Protection Act (Alberta). I consent to this information being used by the ASHSP for the purposes of evaluating my application for membership and for ongoing purposes related to my membership, obligations, and entitlements. *

No Yes

I hereby declare that the information on this membership application is complete and accurate. I understand that making a false or misleading statements or withholding information may disqualify me for registration or lead to cancellation of membership. *

No Yes

I grant the Alberta Society of Health and Safety Professionals permission to verify information I have disclosed, and to obtain additional information as may be required to process my application for registration. *

No Yes

I hereby consent to have the following contact information publicly posted on the ASHSP website, check all that apply (membership number and category will be displayed with applicable selections below): *

No public information

Phone number

Email address

Home address

Mailing Address

Current employer name

Name (include designatory letters with name)

Designatory Letters:

If you are human, leave this field blank.

info@ashsp.ca

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