APPLICATION TO REINSTATE PERMIT TO PRACTICE AS A PARTNER, CORPORATION OR OTHER ENTITY
 apegga_full.jpg (9015 bytes)
Name of Organization
Mailing Address
 
Postal Code 
Telephone Number 
E-Mail 
Fax 

The above named organization hereby applies to APEGGA to reinstate its Permit to Practice.
We previously held #P   

Selection of fields of practice listed under the professions of engineering, geology and geophysics is not intended to be restrictive but is requested for statistical purposes only. However, members are reminded they are required by the Code of Ethics to practice only in their areas of competence as determined by their qualifications and experience.

Engineering
Aerospace   Chemical Geological Electrical & Electronics
Biosystems  Civil  Mechanical Manufacturing/Industrial
Computer/Software Environmental Mining   Metallurgical & Materials
Petroleum Other Engineering Specialties
Geology
General  Geochemistry Hydrology Engineering
Economic Palaeontology Soil Science
Geophysics
General  Environmental Remote Sensing
Petroleum Mining
Other Occupations, Please Specify
Industry of Professional Practice
 Consulting       Non-Consulting 
 
Description of Company's or Organization's principal activities:
 
 
Company has been inactive
Company has been active (please give details below on dates (from and to/year) and nature of work performed.)



Branch Offices are located at:
   

The annual permit dues are $335.00 (GST exempt).

A Permit Holder is eligible for a 50% reduction of $167.50 annual permit dues if:

  • the Permit Holder has only one professional Engineer, Professional Geologist, Professional Geophysicist, or Registered professional Technologists as a full time employee or a member of the firm,

and

  • the gross revenues of the firm did not exceed $250,000.00 in the last 12 months.

 

Declaration by Chief Operating Officer or his Authorized Designate

___________________Member # (if applicable)

I ____________________________ , Member No (if applicable) ______________________occupy the position of _____________________________________________in the applicant's organization and in that position have authority and undertake to maintain an organization in which the practice of the professions indicated above can be conducted in accordance with requirements described in The Engineering, Geological and Geophysical Professions Act with specific reference to Part 1 & 4 of the Act and Part 7 of the Regulations.

I further undertake:

(a) To notify the Registrar in writing forthwith if the professional members or licensees of APEGGA who have assumed responsibility for the professional practice cease to be full time employees or shareholders of the applicant.

(b) To surrender permit stamps and certificates to the Registrar in circumstances where there are not members or licensees of APEGGA assuming responsibility for the professional practice of the applicant.

(c) To report on an annual basis the names of

(i) Chief Operating Officer or his designate taking corporate responsibility for the applicant.

(ii) APEGGA members or licensees assuming responsibility for direction of the professional practice of the applicant.
_________________________________________ _______________________
(Signature)
(Date)
   

Declaration by Members or Licensees Assuming Responsibility for the Professional Practice

I, the undersigned, am a professional member or licensee of APEGGA and as a full time employee or member of the firm* undertake to provide responsible direction and personal supervision to that portion of the applicant's professional practice performed by the organizational unit described below.

I have read the relevant sections of The Engineering, Geological and Geophysical Professions Act and the Regulations reproduced on the reverse side hereof and I agree to conduct the professional practice for which I have assumed responsibility in strict accordance with the requirements of relevant legislation and regulations.

I further specifically undertake to notify the Registrar of APEGGA in writing if I cease to accept the responsibility indicated below and advise reasons for relinquishing that responsibility.

 

NAME AND PROFESSIONAL
DESIGNATION		 MEMBER # OFFICE ORGANIZATIONAL GROUP
(Discipline or Operation)
 
 
 
 
 

Signature

 
 
 
 
 

Signature

 
 
 
 
 

Signature

 
 
 
 
 

Signature

 
 
 
 

 

Signature

*Reference in the Act on a full time employee or member of the firm is interpreted to mean that the relationship between the APEGGA member and the firm is an ongoing and continuous one as distinguished from one that does not have the depth or responsibility normally associated with a full time employee relationship.
 

Permit Holder: (Company Name)___________________________(Permit No.)_________________

I, ____________________________________________________________occupy the position of

____________________________________________ in the Permit Holder firm. In that position I have authority and undertake to maintain an organization in which the practice of the profession (s) for which the above Permit Holder is authorized to practice, can be conducted in accordance with The Engineering, Geological and Geophysical Professions Act and Regulations.

I hereby apply for a 50% reduction of the annual permit dues payable by the Permit Holder for the invoiced billing year and declare:

  • The Permit Holder has only one Professional Engineer, Professional Geologist, Professional Geophysicist or Registered Professional Technologist as a full time employee or member of the firm, and
  • The gross revenues of the firm did not exceed $250,000.00 in the last 12 months.

I declare the above statements to be true, complete and accurate to the best of my knowledge and have enclosed a payment of 50% of the Permit to Practice dues.
 
(Signature) (Date)

 

Payment

Enclosed is my cheque made payable to APEGGA or credit payment in the sum of $_______________

 Visa    MasterCard  AMEX       #

  Expiry Date

Note: If the Permit to Practice was cancelled by APEGGA a $110.00 reinstatement fee is required in addition to any other outstanding dues.

For Office Use Only

Permit No._________________   Fee: $______________   Approved______________________________

#__________________

 

Revised December 2002