REFERENCE QUESTIONNAIRE:
REGISTERED PROFESSIONAL TECHNOLOGIST (ENGINEERING)
SAMPLE
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:
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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.
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| 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
registration? Yes
No
Does
the applicant understand and properly apply the principles of the Code
of
Ethics? Yes
No
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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
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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
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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
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8. Management To what degree has the applicant been responsible for people, project or technology management and been exposed to the organization’s overall business environment?
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9. Societal
Implications Has the applicant become aware of the societal implications
of his/her work?
Yes
No
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I
recommend that registration as a Registered Professional Technologist
(Engineering) in APEGGA within the Defined Scope of Practice be: Approved
Deferred
Withheld
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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