Application Form ASEAN Chartered Professional Engineer (ACPE) 1. Personal Information (as shown on passport)

Transcription

1 Reg. No. Please Affix Recent Photo Application Form ASEAN Chartered Professional Engineer (ACPE) 1. Personal Information (as shown on passport) First Name Middle Name Last Name Gender Male Female Nationality Date of Birth (DD/MM/YYYY) Citizen ID Passport No. Passport expiry date Contact Address Province Postcode Mobile No. Tel: Fax: 2. Professional Information Associate Engineer License No. (Discipline) Issued date Expiry date Current PE License No. (Discipline) Issued date Expiry date Present Company Name Company Address Province Postcode Tel: Fax: 3. Engineering Education Undergraduate Degree University/Institute Year of graduation Discipline of Engineering Post Graduate Degree University/Institute Year of graduation Discipline of Engineering 4. Discipline for ACPE Regulation (Please mark only one discipline which you desire to register as an ACPE) Civil Mechanical Industrial Environmental Mining Electrical Chemical Other 5. Responsible Charge/ Expertise (Can be more than one if applicable) Consultancy Project Planning Investigation Operation and Maintenance Analysis and Design Engineering Supervision I, the undersigned, apply for the registration as ASEAN Chartered Professional Engineer through the Thailand Monitoring Committee and declare as follows; (a) I declare that I have not submitted any other application to the Monitoring Committees of any other ASEAN Member State for registration as ACPE. (b) I confirm that all the information I have given in ACPE application form and the enclosed certificates are true. (c) I shall be bound by the Professional Engineer Act and the Professional Engineer (Code of Professional Conduct and Ethics) Rules established and enforced by the Council of Engineers, Thailand. (d) I shall be bound by ASEAN Mutual Recognition Arrangement (MRA) on Engineering Services and other relevant commitments in the future. Date Signature of Applicant

2 Professional Experience Detailed Description of Engineering Work (Please describe the contents and significance of the work, the applicant s role, and the degree of the applicant's responsibilities about 50 words.) Work Starting Date- Position and Project Owners/ No. Ending Date Name of Clients (months) Organizations Details of Engineering Work Sum of Experience Note: The professional experience should be referred to professional practices record Years Months

3 Professional Practices Record Engineering Work Experience (Please describe in retrospective order, beginning with the most recent one.) Work Name of No. Organizations (Position/Title) Project Owners/ Clients Starting Date Ending Date (months) Professional Practices Sum of Experience in responsible Charge of Significant Engineering work Note: Attesting Witnesses Column Duty/ Scope of Work Outcome/ Performance Signature Years Remark Months 1. The applicant has spent 2 years in responsible charge of significant engineering works. 2. The signor(s) above shall be, in principle, the applicant s direct supervisor(s) or any professional engineer/senior engineer under the applicant has executed his engineering works.

4 Continuing Professional Development (CPD) ASEAN Chartered Professional Engineer Registration Continuing Professional Development (CPD) Every practicing professional engineer must submit his CPD record together with his application as an ACPE with the Council of Engineers, Thailand. (Please describe the continuing professional development activities and enclose certified copies of certificates, documents etc.) NO. Date (DD/MM/YYYY) Activity and Details of Activity Total Weighted PDU Organized by Weight

5 Monitoring Committee Summary ASEAN Chartered Professional Engineer Registration Name of Applicant PE License/Certificate No. Issued by Council of Engineers Issued date (DD/MM/YYYY) Expiry date (DD/MM/YYYY) Thailand Registered Engineer Registration No. Issued date Thailand Registered Engineer s Discipline ASEAN Chartered Professional Engineer Register (ACPER) Discipline Certified Compliance with ASEAN Chartered Professional Engineer Criteria Completed an accredited or recognised engineering program, or assessed recognized equivalent Been assessed within their own country as eligible for independent practice Gained a minimum of seven years practical experience since graduation Spent at least two years in responsible charge of significant engineering work Complied with the Continuing Professional Development (CPD) policy of the Country of Origin at the satisfactory level Confirmed signature on statement of compliance with codes of ethics Signed ( ) Delegated Monitoring Committee (Thailand) Date ( ) Chairman Monitoring Committee (Thailand) Date