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ES-201 Examination Securit}' Agreement Form ES-201-3

1. Pre-Examination

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 7-11--11 'lo 7-).:i..lls of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facil ity management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination

m To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during N the week(s) of . From the date that I entered into this security agreement until the completion of examination administration, I did not ~ instruct. evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted ~ below and authorized by the NRC. ru

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JOB TITLE I RESPONSIBILITY

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SIGNATURE (1)

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DATE SIGNATURE (2) DATE NOTE

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ES-201 Examination Security_Agreement Form ES-201-3

1. Pre-Examination

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 7-11-J I 1o 7-l2. Ifs of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the

• facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination

8j To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during N the week(s) of . From the date that I entered into this security agreement until the completion of examination administration, I did not ~ instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted ~ below and authorized by the NRC. Ql co CD N

PRINTED NAME

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NOTES:

JOB TITLE I RESPONSIBILITY

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SIGNATURE (1)

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DATE SIGNATURE (2) DATE NOTE

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ES-201 Examinaticm Security Agreement Form ES-201-3

1. Pre-Examination

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 7-1!-/ i '?& 7,'J"2-ff of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g. , acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facil ity licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facil ity licensee. I will immediately report to facil ity management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination

ill To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during N the week(s) of . From the date that I entered into this security agreement until the completion of examination administration, I did not ~ instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted ~ below and authorized by the NRC. Q)

~ PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE N -....J 0 -N co

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ES-201 Examination Security Agreement Form ES-201-3

1. Pre-Examination

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 7-1!-/ / 16 7,.~"2.-tf of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g. , acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect f~edback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination

~ To the best of my knowledge, I did not.divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during N the week(s) of . From the date that I entered into this security agreement until the completion of examination administration, I did not ~ instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted ~ below and authorized by the NRC. Ql cc (1)

N -.J 0 -N CX>

PRINTED NAME

NOTES:

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JOB TITLE I RESPONSIBILITY

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DATE SIGNATURE (2)

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DATE NOTE

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ES-201 Examination SecuritY.Ag_reement Form ES-201-3

1. Pre-Examination

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 7-Jl-/ C '/P 7.:. )1--'s of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g. , acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback) . Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination

m To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during N the week(s) of . From the date that I entered into this security agreement until the completion of examination administration, I did not ~ instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted ~ below and authorized by the NRC. Q) (Q Cl> I\.) ...... 0 ...... I\.) (X)

PRINTED NAME

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NOTES:

JOB TITLE I RESPONSIBILITY

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DATE SIGNATURE (2) '''" w s-h/rv - __, ..

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DATE NOTE

7·l1"f'- --Ut.~ftc. __

7 ·?7·/J _ _

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?1'3

ES-201 Examination Security Agreement Form ES-201-3

1. Pre-Examination

J acknowledge that l have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 7-Jt-/C 70 7.:..;12~/t's of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that! am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRG (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, ram aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. r will immediately report to facility management or the NRG chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination

8j To the best of my knowledge, I did not divulge td any unauthorized persons any information concerning the NRC licensing examinations administered during ~ the week(s) of . From the date that r entered into this security agreement until the compJef1on of examination administration, I d'1d not ~ instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted ~ below ~nd authorized by the NRC. w

"' <D PRINTED NAME

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JOB TITLE I RESPONSIBILITY

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SIGNATURE (1)

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DATE SIGNATURE (2) DATE NOTE

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ES-201 Examination Securi!Y_Ag_reement Form ES-201-3

1. Pre-Examination 1-,.,.11

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 7- t /~I' f" 7- as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination

ill To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during N the week(s) of . From the date that I entered into this security agreement until the completion of examination administration, I did not ~ instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted ·-o below and authorized by the NRC. Q)

co CD N -....J 0 -N co

PRINTED NAME JOB TITLE I RESPONSIBILITY

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4. ~a: ~ -~~fy~ 71Gtif.l,k§' S"'µA lli lOi(, 5. __ '"C _M__ Tl4~11l%WIZ. 6. Me; c.r :Gt,,sirvchr

~·?! ;t!?- e·'~? 9.~~~ ~-~~ 10 .. _ ___ _ 11 .. _ ____ _ 12 .. _____ _ 13. _____ _ 14. _____ _ 15. _____ _

NOTES:

DATE DATE NOTE

7i.11J.J/J.B 7 ~ ~z 'l,_--·1/;1/tt. 7/zn, --

7=1!ffe ~/:/{& ~ , i-11- It.. J.)5../l. __ 7-lt-J/. 2/t![/JI. --7-tt-tll ~IL_ 7-Lt-1 ?:=:l::D!. - -

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