PEB Application Form

8/9/2019 PEB Application Form

http://slidepdf.com/reader/full/peb-application-form 1/11

Name of Applicant

PROFESSIONAL ENGINEERS BOARD

COMMONWEALTH OF THE BAHAMAS

APPLICATION FOR REGISTRATION AS A PROFESSIONALENGINEER

Applicants are required to read the Professional Enineers Act !""# asamended$ These documents are a%aila&le on the PE' (e&site )

www.pebahamas.org

Form PE')* and supportin documentation to &e su&mitted in triplicate

P+OTO ,Please sin &ac- of photo.

Attach cop/ of I0 paesof passport

NA1E OF APPLICANT2Last First 1iddle

FORM PEB-1: To be completed by all persons applying or registration as a ProessionalEngineer.

3indl/ tic- (hether /ou are appl/in under !ection "#$%#a% & "#$%#d% of the Act or

!ection 1' thereof respectin temporar/ reistration and su&mit the required documents for

the rele%ant parts as pro%ided for hereunder$

P(RT-1 )(TE*OR+E! OF E,*+,EER+,* (, *E,ER( +,FORM(T+O,:

Please indicate the discipline,s. of enineerin in (hich /ou are see-in reistration ascateori4ed in the First Schedule of the Professional Enineers Act$

Ci%il Structural 1echanical Electrical Chemical

Aricultural Aeronautical 'uildin Ser%ices Geotechnical

Industrial 1arine En%ironmental

Nationalit/ 0ate of 'irthPassport No$ NI'5National Identification No$/ome (ddress: 'o657ip Cit/2 Island5State5Pro%inceCountr/ Telephone2 1o&ile2B0siness (ddress:

P$O$ 'o6 Cit/2 Island5State5Pro%inceCountr/ Telephone2 Fa62Email Address2

+a%e /ou e%er chaned /our name throuh marriae8 deed poll or court action9 :es No

If /es list maiden or pre%ious name and date of chane &elo( and attach rele%ant documents asnecessar/$

+a%e /ou pre%iousl/ made application to this 'oard for Reistration9 :es No

If /es list last date2

Please indicate an/ special testin requirements due to disa&ilit/ or reliious conflicts$

Form PEB-1 (pplicants +nitials 22222222 Page1

FORM PEB-1



Name of Applicant

P(RT- 5 6 PROFE!!+O,( E7PER+E,)E

From To Name of Orani4ation andParticulars of Trainin

#$* =erif/inIntitials1onth :ear 1onth :ear

#$* Applicants under Section >,!.,a. of the Act are required to pro%ide %erif/in initials

#$! Applicants under Sections >,!.,a. are to attach a ?or- E6perience +istor/ Report of at least *8""" (ords of the applicant@s (or- e6perience (hich (ould demonstrateproficienc/ in the desin and e6ecution of enineerin (or-s aainst (hich the Applicant (ill&e e6amined$

#$ Applicants under Section >,!.,a. of the Act are required to ha%e a minimum of #)/earsrele%ant post raduate e6perience$

$




Name of Applicant

P(RT-8: ET(+! OF PROFE!!+O,( E,*+,EER+,* RE*+!TR(T+O,

,Oriinal or notari4ed cop/ of certificates must &e presented for %erification.$ Applicantsappl/in under Section >,!.,d. are to pro%ide proof of current reistration$

Name Of Reisterin

Orani4ation5'oard

Reistration

Num&er

0ate

Reistered

0iscipline

E6amined

Status

Acti%e5Inacti%e

+a%e /ou e%er had an/ disciplinar/ action &rouht aainst /ou resultin in a fine8reprimand or re%ocation of enineerin license in an/ Burisdiction9

:es No

+a%e /ou e%er &een con%icted of an/ criminal offence in The 'ahamas or else(here9

:es No

+a%e /ou e%er &een denied the riht to ta-e an enineerin e6amination in an/countr/9

:es No

+a%e /ou ever &een refused an Enineerin license or the rene(al thereof9

:es No

,If an/ of these questions are ans(ered in the affirmati%e please pro%ide completedetails on a separate sheet.




Name of Applicant

P(RT-9: MEMBER!/+P +, E,*+,EER+,* OR*(,+(T+O,;(!!O)+(T+O,,Oriinal or notari4ed cop/ of certificates must &e presented for %erification.

Name of Enineerin

Orani4ation5Association

Class of

1em&ership

0ate of

Election

Professional Papers

Presented

Status

Acti%e5Inacti%e

P(RT 6 < 6 E,*+,EER+,* REFERE,)E!$* Applicants under Section >,!.,a. are required to indicate the names and addresses of at

least three ,. enineerin references ,all of (hom must &e currentl/ reistered &/ a leall/

empo(ered enineerin authorit/ reconi4ed &/ the 'oard.$

Name of Referee Name of Professional Affiliation

1em&ershipNum&er

0esination,e$$ PE8CEn8 PEn.




Name of Applicant

,OTE: T/+! O)3ME,T M3!T BE ,OT(R+E

The undersined here&/ ma-es application for Professional EnineerinReistration and affirms that he has read the Professional Enineers Act asamended8 the Reulations8 the Code of Professional ConductD and that all

statements and ans(ers contained herein are true and correct$ An/ (illfulfalsification of an/ information contained in this application or attacheddocuments are rounds for disqualification$

Applicant@s Sinature2$$

0ate$$

Ac-no(leded 'efore 1e

This 0a/ Of8 !

1/ Commission E6pires

Num&er




Name of Applicant

PROFESSIONAL ENGINEERS 'OAR0P$O$ 'o6 N)*

N a s s a u 8 ' a h a m a s

P a r t - = : E n g i n e e r i n g R e e r e n c e R e p l y F o r m

(PP+)(,T +,FORM(T+O,

Name of Applicant2Last First 1iddle

0ate of 'irth

Address of Applicant2

Street

Cit/

Island5State5Pro%ince

Countr/

P$O$ 'o65Postal Code

Telephone2

Email2

REFERE,)E +,FORM(T+O,

Name of Reference2Last First 1iddle

Address of Reference2

Street

Cit/

Island5State5Pro%ince

Countr/

P$O$ 'o65Postal Code

Telephone2

Email2

Indicate date document (as for(arded to reference2HNOTE2 0O NOT INITIATE REFERENCE 0OC;1ENTS ;NTIL FILING APPLICATIONI ha%e i%en /our name as reference and ha%e su&mitted to the Professional Enineers 'oard asined Certification of Release Statement authori4in Jan/ indi%idual8 compan/ or institution (ith(hom I ha%e &een associated (ith8 to furnish the Professional Enineers 'oard (ith an/ informationconcernin m/ qualifications for professional reistration in the 'ahamas (hich the/ ha%e on record or other(ise8 and do here&/ release the indi%idual8 compan/ or institution and all indi%iduals connectedthere(ith from all lia&ilit/ for an/ damae (hatsoe%er incurred &/ me as a result of their furnishin such

information$J ?ill /ou -indl/ furnish from /our compan/ records8 the information requested &elo(and for(ard the completed document directl/ to the Professional EnineerKs 'oard$

Applicant@s Sinature

0ate this Engineering Reerence Reply Form for(arded to Reference




Name of Applicant

Reerence +nitials: >>>>>>>>>

TO BE )OMPETE B? REFERE,)E

*$The a&o%e noted applicant is or (as emplo/ed (ith this compan/ from

to

!$ The applicant has (or-ed (ith me5for me from to

$

$ From m/ personal -no(lede the applicant has &een enaed in

enineerin for/ears$

#$ From m/ personal -no(lede the applicant has &een in an increasin

le%el of responsi&ilit/ in enineerin for /ears$

$ Please comment on the applicantKs enineerin (or- as indicated in Nos$ and # a&o%e for the stated times$

A$ E6perience2

'$ A&il i t/2

C$ Competenc/2

0$ Character2




Name of Applicant

Reerence +nitials: >>>>>>>>>

To the &est of m/ -no(lede8 the a&o%e is true and correct$ Please indicate/our status &elo($

Name of Reference Sinature Initials

Title5Position

Professional 0esination

Reistration ,Location.

0ate

Seal2




Name of Applicant

Application Chec-list

1. Form PE')* and all attachments are to &e su&mitted in triplicate

$. Form PE')! to also &e completed &/ persons appl/in for temporar/

reistration$ The Form and all attachments are to &e su&mitted intriplicate

4. Read the Professional Enineers Act !""# and the !""> Amendment

5. Forms PE')* and PE')! ma/ &e completed electronicall/ then printedfor sinature and notari4ation

8. Chec- &o6 to indicate appropriate Section of Act under (hichapplication is su&mitted

9. Chec- the discipline,s. for (hich the applicant is see-in reistration

<. Attach a cop/ of information paes in passport and NI' Card8 &rinoriinals (ith /ou (hen su&mittin the application

=. +a%e copies of all certificates M deree5diplomas8 professionalmem&ership certificates notari4ed or &rin the oriinals (ith /ou (hensu&mittin the application$

". Applicants under Sections >,!.,a. must include the names and address of at least three ,. enineerin references ,all of (hom must &e currentl/

reistered &/ a leall/ empo(ered enineerin authorit/ reconi4ed &/ the'oard.$

1'. Applicants under Sections >,!.,a. are to attach a ?or- E6perience+istor/ Report of at least *8""" (ords of the applicant@s (or-e6perience (hich (ould demonstrate proficienc/ in the desin ande6ecution of enineerin (or-s$

11. Forms PE')* and PE')! and attachments to &e notari4ed &/ a notar/pu&lic in the Common(ealth of the 'ahamas

1$. All fees are to &e paid &/ cheque ,cash will not be accepted%$ Feesare to &e paid in Bahamian ollars and are non-re0ndable. Onl/ therele%ant application fee is to &e su&mitted (ith Forms PE')* and PE')!$

Applicants (ill &e ad%ised at the appropriate time for the pa/ment of other fees M e6amination reistration$




Name of Applicant

(PP+)(BE FEE!

Application Fee2 '!""$""

NCEES E6amination Fee2 '$""

Reistration Fee First 0iscipline2 '!""$""

Reistration Fee second andall su&sequent disciplines2 '*""$"" for each discipline

Temporar/ Application Fee2 '"$""

Temporar/ Reistration Fee2 '"$""

Temporar/ Reistration Fee second And all su&sequent disciplines2 '$""

Annual Reistration Rene(al Fee '!""$""

0uplicate Certificate2 '*""$""

0elinquenc/ Fee2 '!"" for each delinquent /ear

F PEB 1 ( li t + iti l P 11

PEB Application Form

Documents

Transcript of PEB Application Form