Bangladesh Professional Engineers Registration Board

Transcription

1 Bangladesh Professional Engineers Registration Board APPLICATION FORM (Format 1) BPERB/PEng/01 ( for office use only) Ref No:. Applicants are requested to carefully read the Guidance for applicants given in Appendix 2, before filling up this form. BRANCH OF ENGINEERING / DISCIPLINE Please indicate the branch of engineering/discipline to be placed on the register of Professional Engineers of Bangladesh. PERSONAL INFORMATION (Please use Capital Letters) PART 1: PERSONAL PARTICULARS Last name Other names Mailing address: Nationality: Gender: Date of Birth: IEB Membership No: Membership Grade: National ID no. Telephone: Membership of other Professional Institutions: (if applicable) PEng Bangladesh Application Form Page 1 of 16

2 PART 2: ACADEMIC QUALIFICATIONS Undergraduate degree in engineering (certificates are to be attached) Name of University Full title of degree With discipline Program duration Mode of delivery Full Time Part Time Others If other, please specify Date of graduation (mm/yyyy) Postgraduate degree in engineering (if applicable) -1 (certificates are to be attached) Name of University Full title of degree With Discipline Program duration Mode of delivery Full Time Part Time Others If other, please specify Date of graduation (mm/yyyy) Page 2 of 16

3 Postgraduate degree in engineering (if applicable) -2 (certificates are to be attached) Name of University Full title of degree With Discipline Program duration Mode of delivery Full Time Part Time Others If other, please specify Date of graduation (mm/yyyy) Other engineering qualifications (if applicable) (certificates are to be attached) All certificates are to be attested. Page 3 of 16

4 PART 3: PROFESSIONAL QUALIFICATION (if applicable) PART 4 : BRIEF SUMMARY OF CURRENT AND PAST WORK EXPERIENCE 1) Please provide a brief summary of your past experience and roles. Details of your level of professional competences acquired through your work experience will be elaborated in Section B of this Application Form. 2) Each section should be verified by one of your senior supervisor/ Sponsor/referee who is/was familiar with you and your Professional experience, and who is a Fellow of IEB, preferably a registered Professional Engineer. Page 4 of 16

5 PART-4: SUMMARY OF CURRENT AND PAST WORK EXPERIENCE Period (mm/yy) Name of Organisation Position or Title; Nature of project, its significance, your functions/responsibilities, achievements This is a true account of the candidate s work experience and professional competence. Name who verified Contact Number Address IEB Membership no. Current Job Title Relationship to candidate Signature Date of verification: Page 5 of 16

6 PART-4: SUMMARY OF CURRENT AND PAST WORK EXPERIENCE Period (mm/yy) Name of Organisation Position or Title; Nature of project, its significance, your functions/responsibilities, achievements This is a true account of the candidate s work experience and professional competence. Name who verified Contact Number Address IEB Membership no. Current Job Title Relationship to candidate Signature Date of verification: Page 6 of 16

7 PART-4: SUMMARY OF CURRENT AND PAST WORK EXPERIENCE Period (mm/yy) Name of Organisation Position or Title; Nature of project, its significance, your functions/responsibilities, achievements This is a true account of the candidate s work experience and professional competence. Name who verified Contact Number Address IEB Membership no. Current Job Title Relationship to candidate Signature Date of verification: Page 7 of 16

8 PART-4: SUMMARY OF CURRENT AND PAST WORK EXPERIENCE Period (mm/yy) Name of Organisation Position or Title; Nature of project, its significance, your functions/responsibilities, achievements This is a true account of the candidate s work experience and professional competence. Name who verified Contact Number Address IEB Membership no. Current Job Title Relationship to candidate Signature Date of verification: Page 8 of 16

9 PART-4: SUMMARY OF CURRENT AND PAST WORK EXPERIENCE Period (mm/yy) Name of Organisation Position or Title; Nature of project, its significance, your functions/responsibilities, achievements This is a true account of the candidate s work experience and professional competence. Name who verified Contact Number Address IEB Membership no. Current Job Title Relationship to candidate Signature Date of verification: Page 9 of 16

10 PART 5: SPONSORS /REFEREES NAMES AND ADDRESS The application must have three sponsors/referees who can confirm the candidate s conduct and suitability for advancement to registration as Professional Engineer. Each must fill in a Sponsor s Confidential Report Form (Format-2) and seal it in an envelope addressed to the Registrar, BPERB. Name (in Block Capitals) & Address of Sponsors 1. IEB Membership No PART 6: DECLARATION BY APPLICANT I confirm that all statements on this application form are true and correct and I have made claims of competence in good faith. I agree that in the event of my registration as a Professional Engineer of Bangladesh, I will be governed by the IEB s Rules for Professional conduct and ethics expected of Professional Engineers of Bangladesh. I understand that I have an obligation to inform the Bangladesh Professional Engineers Registration Board of any matter that may affect my fitness for registration. I give consent to my business contact details being published in any form associated with my registration as a Professional Engineer of Bangladesh by BPERB. I will also undertake the required number of Continuing Professional Development [CPD] training each year that may be prescribed by the BPERB and to submit CPD record to the BPERB prior to renewal of my registration. Signature Date Page 10 of 16

11 SECTION B Competence and Commitment Report PART 7: Achievement of competence and Commitment in Profession Section B is to provide evidence that you have attained the required level of professional competences (with reference to Appendix 1) to support your application for registration of Professional Engineer in Bangladesh. Word limit for this SECTION B is words. Before filling this section go through carefully Core Competence Standards in Appendix 1. Give your achievement in profession against each element of competence. Competence i: Evidence of your general and specialist knowledge and understanding to optimize the application of existing and emerging technology for solving problems Page 11 of 16

12 SECTION B Competence and Commitment Report PART 7: Achievement of Competence and Commitment in profession Competence ii: Evidence of your application of theoretical and practical knowledge to the analysis and solution of engineering problems Page 12 of 16

13 SECTION B Competence and Commitment Report PART 7: Achievement of Competence and Commitment in profession Competence iii: Evidence of your Technical, commercial and managerial leadership Skills with sound understanding of economic and procurement policies Page 13 of 16

14 SECTION B Competence and Commitment Report PART 7: Achievement of Competence and Commitment in profession Competence iv: Evidence of your effective communication and interpersonal skills with professional commitment Page 14 of 16

15 SECTION B Competence and Commitment Report PART 7: Achievement of Competence and Commitment in profession Competence v: Evidence of your professional conduct, commitment to society, health and safety, environment and regulation. Page 15 of 16

16 SECTION B PART 8: DECLARATION BY APPLICANT The professional competence and commitment report presents a true account of my achieved evidences of professional work competences. Signature Date Page 16 of 16