name has been given by ________________________________________________________
2. In what capacity? Employer Supervisor Mentor Colleague Friend Client
3. What position(s) has the applicant held? Most recent first. Repeat as necessary for each position on this form or attach additional sheets.
Dates Employed (month-year)______________ Position Title_________________________
Company and Location _______________________________________________________
Duration of Work Performed at each Level (see Note 1 below) A__ B__ C__ D__ months
Nature of Responsibilities (see Note 2 below) - Attach additional sheets if necessary.
Does the applicant exhibit the required character for professional
the applicant understand and properly apply the principles of the Code
5. Application of Theory Has the applicant demonstrated the knowledge of and ability to apply principles of engineering within the Defined Scope of Practice? I don't know Yes No
Does the applicant recognize and work within his/her own limitations? Yes No
6. Practical Experience Has the applicant had sufficient experience to practice the profession of engineering within the Defined Scope of Practice with sound judgement and the application of sound principles? Yes No
Has the applicant demonstrated an acceptable working knowledge of English?
the applicant made written and oral presentations inside and outside his/her
8. Management To what degree has the applicant been responsible for people, project or technology management and been exposed to the organizationís overall business environment?
Implications Has the applicant become aware of the societal implications
of his/her work?
I recommend that registration as a Registered Professional Technologist (Engineering) in APEGGA within the Defined Scope of Practice be: Approved Deferred Withheld
If registration is deferred or withheld, how much more experience is needed? ____ months.
Name:(Please Print)_____________________ Signature: __________________________
Position:_____________________________ Date: ______________________________
I am a registered Professional Engineer, or RPT (Eng)
Country of: ____________________________