| Instructions: | Instructions for Application Form A
1. General Information
a. Date the application.
b. Comity/Endorsement is only for individuals who already have a valid license in another jurisdiction. Individuals desiring to take one of the
Principles & Practices examinations should return to the Board’s web site and download the correct application.
c. Provide your social security number for required background check.
d. Provide first, middle and last name; if you do not have a middle name, please indicate so.
e. Provide your name as you sign drawings, etc. If you do not use a middle initial, please indicate so. If you desire to use your full name,
indicate “same”.
f. Provide the address you want the Board to use to correspond with you and provide an email address.
g. Provide your place and date of birth.
h. Provide your email address.
i. Indicate what discipline you feel qualified to practice in. Your education and experience record must support your answer.
j. Please print application on single sided paper only.
2. Company Information
All businesses except sole proprietors who are not operating under a trade name must have a Certificate of Commercial Practice issued by the
Board of Registration prior to practicing or offering to practice engineering in North Dakota. Application forms and instructions for a Certificate of
Commercial Practice are on our web site at www.ndpelsboard.org .
a. Provide the full name of the company you work for.
b. Provide the mailing address for the company.
c. Provide the Certificate of Commercial Practice number issued to your company by the North Dakota State Board of Registration for
Professional Engineers and Land Surveyors. If you are not sure if your company has been issued such a number, please call the Board
office at (701) 258-0786. If your company is in the process of applying for a Certificate of Commercial Practice, check the “Pending” box.
d. If your employer is a sole practitioner who is using a trade name, a Certificate of Commercial Practice is required.
Sole Practitioners
If you are a sole practitioner operating under your own name, put that information in the spaces provided in for company information.
Clearly indicate your name that you will be operating under and write the words “Sole Practitioner” next to your name. Anything other
than your personal name is considered a Trade Name and requires a Certificate of Commercial Practice.
This section may not be left blank. Failure to provide this information results in an incomplete application and will not be considered by
the Board.
3. References
a. Provide the name, registration number, address, position, and telephone number of five individuals you wish to provide reference letters
in support of your application.
b. At least 3 of the 5 references must be professionals licensed in the profession you are applying for who can verify at least a portion of
your experience. The remaining two references may be personal.
c. If you will be submitting an NCEES record, you must list the individuals who provided references. Do not leave this section blank or
reference the NCEES record. Reference letters must be dated within the past five years. If, for example, three of your reference letters
are more than five years old, you must request updated reference letters from three individuals. In this example, the three outdated
reference letters in your NCEES record would not be accepted. It is your responsibility to contact NCEES and have your council record
sent to North Dakota.
d. Refer to the instructions for completing the Reference Letter Form B.
4. Education
a. Provide, in chronological order, the name and location of each school you have attended.
b. Indicate the duration of time you spent in each school.
c. If you graduated from the school, provide the date of your graduation.
d. List any degrees received from each school.
e. Official transcripts of all courses and grades of colleges, universities, or technical schools attended are required. The transcript must be
sent to the Board office directly from the issuing university or arrive in a sealed envelope with the university registrar’s seal or signature.
f. If you are using an NCEES record, the transcripts from that record will suffice provided that they show the date of graduation and what
degree was conferred. You must list the schools you attended in this section. Do not leave it blank or reference the NCEES record.
5. Previous Registrations
a. Provide the names of any other jurisdictions in which you hold or have held a valid registration. Please list the jurisdiction of your original
registration first. . You must list your other registrations in this section. Do not leave it blank or reference the NCEES record.
b. Indicate the year of first registration for each jurisdiction.
c. “How registered” means whether you were registered by taking the Principles & Practice examination, comity, reciprocity, endorsement,
etc, or if a grandfather clause was in effect. If an oral examination was conducted by the Board as part of your registration in that
jurisdiction, please indicate so.
d. Indicate whether your license in that jurisdiction is active or lapsed.
e. If you have taken the Fundamentals examination, please provide the date and the state in which it was taken.
6. Technical and Other Examinations
a. If you have taken any technical examinations for trade certification, please list.
b. If you have taken any state specific examinations as part of the registration process in that jurisdiction, please list.
7. Experience Record
If you are applying for both a PE and PLS license or if you already have a license and are applying for a second one, you must use the “Dual
Registrant” experience record form located on our web site.
a. Beginning with the date you received your university degree, list each work engagement you have had. Show the title of position, name
of employer, and character of each engagement. This must be a detailed statement as to the duties performed, degree of responsibility,
and character of work. If necessary, attach additional sheets. Inadequate experience descriptions are a frequent cause for deferral of
applications.
b. Provide name, title, address, telephone number, state of professional engineering registration, and registration number of the supervisor
for each engagement.
c. When calculating time in columns 1 – 5, follow the instruction on Form A carefully.
d. All time must be accounted for and be current to the date of the application! Make certain that there are no time gaps in your
experience record even if that time is a period of non-professional work, unemployment, or even a short time gap during the transition
period from one place of employment to another.
e. If you are using an NCEES record, type, “Refer to NCEES record” in engagement A. If the experience record contained in your NCEES
Record is not current to the date of the application, you must complete the experience record in the application to bring your record up
to date. For example, if the last date entry in your NCEES Experience Record is “June 2007”, you must complete the experience record in
the application from “June 2007” to present. The annual renewal forms, “Update” forms and the “Engineering and Related Experience”
forms used by NCEES to update your experience in the NCEES record are not acceptable to the North Dakota Board without a current
Experience Record form.
8. Code of Ethics
a. Your professional practice in North Dakota is bound not only by statutes and rules, but also by the Code of Ethics. The Code of Ethics is
located in North Dakota Administrative Code § 28-03.1-01-01. Read the Code of Ethics carefully. When you have read the Code of Ethics,
sign your name on the line provided.
9. Affidavit
a. Answer yes or no. If you have had any form of sanction in any jurisdiction, please attach a statement giving full details and include any
correspondence from the jurisdiction that imposed the sanction.
b. Answer yes or no. If you answer yes, you must include a statement that explains the details of the conviction. Include all
criminal convictions including DUI’s. Also include non-felony convictions such as Minor in Consumption, open container, petty theft,
possession, etc.
c. When you are satisfied that all information in your application is true and accurate, sign your name to the application in the presence of a
notary public. Be sure the notary seals the affidavit.
d. All signatures must be original and in blue or black ink.
e. If you are using an NCEES record, you must still sign the application and have it notarized
Instructions for Reference Letter Form B
1. On the first blank line on page 1 of Form B, type your name and the profession (Professional Engineer or Professional Land Surveyor) in
which you are seeking registration. The remainder of page 1 is to be completed by your references.
2. On the reverse side of the form, enter your name on the top line. Complete the remainder of the form giving a detailed description of
each term of employment with the beginning and ending month and year. The experience must include all of the information you
furnished on Form A in Section 7 “Experience Record”. If the experience record submitted on Form A is of such length that the record
cannot be typed on the back of Reference Letter Form B, use additional sheets.
3. Each professional reference must initial that part of your experience record with which the reference has personal knowledge. Failure of
the reference to initial that portion of the experience listed with which the reference has personal knowledge will result in voiding the
opinion of that reference. Be sure to tell your references to initial the form. Reference letters that are not initialed is a frequent cause
for deferral of applications.
4. All time must be accounted for to the date of the application! Make certain that there are no time gaps in your experience record even
if that time is a period of non-professional work, unemployment, or even a short time gap during the transition period from one place of
employment to another.
5. Make five (5) copies of the completed Reference Letter Form B.
6. Send the forms directly to the references listed on Form A, Section 3 along with a stamped envelope addressed to the Board. The
references are to return the completed Reference Letter Form B directly to the Board office.
Instructions for Verification of Registration Form C
The North Dakota Board requires verification of your successful completion of the NCEES or state licensure examinations. Only the state in which
you took the examinations can make this verification. Follow the instructions below to complete the Verification of Registration form, send it to
the verifying state, and have the verification form sent to the North Dakota Board. Your application is not complete and will not be sent to the
Board for review without the appropriate verification form(s). If you are submitting an NCEES record, you do not need to complete Form C; it is
contained within your council record. Many states are now participating in an electronic verification system. Log in to your “My NCEES” account
at ncees.org to initiate an electronic verification request. If you request verification electronically, you do not need to complete form C.
1. In the upper right hand corner, fill in your name, address, and date of birth.
2. If you took the Fundamentals exam and the Principles and Practice exam in different states, make a copy of the form and prepare a
separate verification form for each state.
3. On the left side under “From:”, fill in the name and address of the state board(s) from which you are requesting verification of your
examinations.
4. Under “I.”, check the appropriate lines for the type of registration you hold in that state.
5. Contact the board(s) from which you are requesting verification to find out if they charge a fee for completing verification forms. Send
the form to the board per their instructions with the correct fee, if required. It is your responsibility to pay any required fees and
complete the process to request verification.
6. Request that the completed verification be sent to the North Dakota Board of Registration. The North Dakota Board will not accept a
verification form from an individual. The verification must be mailed directly from the state that is making the verification.
7. The North Dakota Board office will add the verification form to your application file.
8. If you took any NCEES examination in North Dakota, mark it in Section 5 on Form A. You do not need to send Form D to the North
Dakota board office. |
