Your name has been given by ________________________________________________________
who is seeking registration with APEGGA as a Registered Professional Technologist (Engineering) with a Defined Scope of Practice described as:

1. How long have you known the applicant? _____________ Years

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 _______________________________________________________

Supervisor _________________________________________________________________

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.


Note: 1 A-Non technical training or orientation
B-Formal technical training
C-At a technician, technologist or technical support level
D-At a level where the application of engineering principles within the Defined Scope of practice was evident
Note: 2 We are looking for not only the general responsibilities that can be found in a job description but, also the specific assignments, values, successes, degress of independence and initiative needed as well as evidence of an increasing level of responsibility.

4. Character Does the applicant exhibit the required character for professional
Yes No

Does the applicant understand and properly apply the principles of the Code of
Yes No

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

7. Communication Has the applicant demonstrated an acceptable working knowledge of English?
Yes No

Has the applicant made written and oral presentations inside and outside his/her organization?
Yes No

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?

9. Societal Implications Has the applicant become aware of the societal implications of his/her work?
Yes No

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)

in the Province, State, or Country of: ____________________________

Revised January 10, 2000

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