Professional Reference Evaluation

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Professional Reference

Applicant

Brian Kinney

Tualatin, Oregon

Brian Kinney has requested the NCEES to compile a complete dossier on his/her professional record that will be used to support applicants for licensure. This process depends, among other considerations, on the verification of the extent, diversity, and quality of his/her practical training and experience. We therefore request your assistance, as an employer, supervisor, peer, or client, in filling out this form with sincere and conscientious consideration of the need for accurate data and for objective appraisal of the applicant's ability and/or potential to practice engineering/surveying.

Your Information

Your first and last names are required for this person to continue with his or her Record.

First Name

Middle Name

Last Name

Phone number

Employer

Position

What is/was your relationship to the applicant?

How long have you known this applicant?

Are you related to this applicant by blood, marriage, or adoption?

Yes

Are you a Licensed Engineer in the US?

Yes

Initial License Board

Initial License Number

What is the date you were first licensed? (mm/dd/yyyy)

Discipline of Exam Taken

Are you a Licensed Surveyor in the US?

Yes

Initial License Board

Initial License Number

What is the date you were first licensed? (mm/dd/yyyy)

Personal Experience With Applicant

From personal knowledge, I verify that the applicant has appropriate experience in the following areas (select all that apply)

Technical competency and engineering judgment

Integrity and ethics

Independent decision making

Project management / communications

Would you entrust this applicant with responsibility for an important engineering/surveying project involving the health, safety, and welfare of the public?

Would you recommend this applicant for licensure as a Professional Engineer/Surveyor?

Comments

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