APPLICATION FOR REGISTRATION
FOR GEOSCIENTISTS REGISTERED ELSEWHERE IN CANADA
2. POST SECONDARY EDUCATION
Attach a resume. For each position include dates, (month/year), technical responsibilities & accomplishments, management responsibilities, communications skills required and an understanding of the societal implications of your work.
Have you ever been found guilty of, or is there an outstanding judgement against you for:
a) unprofessional or unskilled practice by a professional regulatory organization or agency? Yes No
b) an offence under the Engineering, Geological and Geophysical Professions Act or Regulations or equivalent legislation in other jurisdictions? Yes No
c) any criminal offence? Yes No
d) negligence due to unskilled practice of the professions
in any civil actions made against you? Yes
6. KNOWLEDGE OF PROFESSIONAL LAW & ETHICS
I will pass the National Professional Practice Examination to fulfill
the registration requirements.
7. ENGLISH LANGUAGE COMPETENCY
English is my native language.
I have previously proven that I am competent in the use of the English
language by virtue of
8. PROFESSIONAL STATUS
I am/was registered in ______________________________Province(s) or States(s) (Include Years Registered).
I previously applied for registration with APEGGA in and__________________Year and
was assessed examinations and/or experience which has not been completed.
was previously registered as a # from to .
am presently an MIT #___________________ .
I previously applied for registration with _____________________________________________Other Province(s)/State(s)/Country(ies) and
the application was refused/rejected
* I declare that all the above statements are complete and correct to the best of my knowledge and belief. I agree to file additional information if the response to any question changes between now and the date of my registration. I understand that a false statement or misrepresentation may disqualify me for registration.
* I grant permission to APEGGA to obtain such additional information as it may deem appropriate from such additional sources as it may deem necessary to the progression of my application.
* I will conform to the requirements of the Engineering, Geological and Geophysical Professions Act of the province of Alberta, the Regulations including the Code of Ethics, and the By-Laws of the Association if granted membership in APEGGA.
* I declare
that I do not have any alcohol or drug dependency or suffer from any
medical condition that renders me incapable of fulfilling the requirements
of a professional engineer, geologist or geophysicist.
Date _____________________________ Signature_______________________________________________
REVISED JULY 2001