APPLICATION FOR REGISTRATION:
REGISTERED PROFESSIONAL TECHNOLOGIST (ENGINEERING)

Please read the accompanying instructions carefully before you fill out the form.

I wish to apply for registration as a Registered Professional Technologist (Engineering).

  
For Office Use Only
Member Number:
Employer Number:
Comp Entry:
Receipt Number:
Amount:
  1. PERSONAL INFORMATION
    2.

Legal Name
Mr. Ms. Dr.


Surname


Given Names in Full (NO Initials)

Preferred Name


Surname
Common Names and/or Initials

Home Address



City

  Province


Postal Code

    Telephone
Fax 		 
 

 


E -Mail

 

Business Address



City

  Province
Postal Code

 

Telephone  
Fax
   
E -Mail

Company Name

 


Preferred Address


Home Business Other (attached)


Citizenship Canadian Citizen Admitted to Canada for permanent residence in 19
Date of Birth Month/Day/Year Place of Birth
       
2. DEFINED SCOPE OF PRACTICE

Please describe the Defined Scope of Practice of engineering in which you wish to engage and to become registered as a Registered Professional Technologist (Engineering). It is recommended that the Defined Scope of Practice be as specific and concise as possible.








 

3. EXPERIENCE

Please attach a current resume in reverse chronological order (present position first) to your application outlining the following:

*Company names and locations
*Employment dates
*Names of Supervisors
*Positions titles

For each position include technical responsibilities & accomplishments, management responsibilities, communications skills required and an understanding of the societal implications of your work.

4. REFERENCES

These individuals must be familiar with the significant time elements of your experience and preferably all three of them should be Professional Engineers. At least one of these individuals must be a Professional Engineer under whose supervision and control you worked in your Defined Scope of Practice for two years or more.

 

 

Name

Relationship

Professional Status

Address

1

       

2

       

3

       

5. CHARACTER

Have you ever been found guilty of, or is there an outstanding judgement against you for:

a) unprofessional conduct 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 No

e) unprofessional conduct or unskilled practice by the Alberta Society of Engineering Technologists or equivalent organization from another Province? Yes No

 

6. KNOWLEDGE OF PROFESSIONAL LAW & ETHICS

I have passed the Professional Practice Examination for the________________(Province) Professional Engineering Association.

I will pass the Professional Practice Examination to fulfill the registration requirements.

7. REGISTERED ENGINEERING TECHNOLOGIST STATUS

I am a Registered Engineering Technologist registered with ASET Yes No

8. COMMENTS



 
  • 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 ASET and APEGGA to obtain such additional information as they may deem appropriate from such additional sources as they 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 Registered Professional Technologist (Engineering).

Enclosed is my cheque for $ made payable to ASET or

Visa Master Card AMEX # Expiry Date:

 

I understand that this Application forms part of my application for registration as a Registered Professional Technologist (Engineering) and agree that if I am nominated by ASET this Application can be forwarded by ASET to APEGGA Registration Department for use by APEGGA.

 

Date____________________ Signature __________________________________________________

MAIL TO: ASET, 2100 Canada Trust Tower, 10104 - 103 Ave. NW, Edmonton, AB T5J 0H8
 

HAVE YOU INCLUDED:

Completed Application Form
ASET Nomination Fee

PLEASE NOTE:

Do not submit the APEGGA application fee at this time. If you are nominated for registration by ASET, you will be invoiced for the APEGGA application fee following the ASET Nomination.

 

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