Applicant Form for Professional Licensure – Transfer Applicant - PEGNL - Professional Engineers and Geoscientists Newfoundland and Labrador

Application Form for Professional Licensure – Mobility Applicant

Notice to Applicants
• Requirements for registration are defined in PEGNL's Registration Policy.
• Submission of the online form requires payment by credit card. If you are not able to pay by credit card, please contact the PEGNL office.
• Please complete ALL sections.
• Please ensure ALL necessary supporting documents are supplied to PEGNL in the required manner.
• Applicants applying to PEGNL via mobility with another Canadian jurisdiction must be currently registered in good standing with at least one other regulator in the country. Applicants must identify ALL regulators with which they are currently registered. As per PEGNL by-laws, they still need to demonstrate good character, as noted in this application.

APPLICANT INFORMATION

First Name(Required)

Last Name(Required)

Middle Name

Citizenship(Required)

Canadian

Permanent Resident

Non-Canadian

Date of Birth(Required)

Gender(Required)

Male

Female

Prefer Not to Say

Other

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone(Required)

Preferred Email(Required)

COMMUNICATION PREFERENCES

PEGNL is required to send information to members in relation to regulatory matters. As a result, you will receive communications from us on the following: Discipline, enforcement, renewal (dues payment, professional Development requirements, etc.), elections to the Board of Directors, Annual General Meeting information and registration, regulatory amendments (such as changes to the Act, Regulations, Guidelines and Bylaws), declaration of new members and other information as applicable. This information will largely be delivered by individual emails and dispersed in our regulatory publication illuminate.

Member Announcements

PEGNL also sends out a regular Member Announcements that includes information on professional development offerings, events, volunteer opportunities, publications, careers and other information that our members may find interesting or useful that aren’t directly related to the regulation of the professions. If you would like to subscribe to these emails please check the box below:

Member Announcements Subscription

Yes, please send me the Member Announcements as described above.

Third Party Offerings

PEGNL Members are eligible for several special programs and benefits from third-party suppliers (such as vehicle, home, & health insurance discounts). On occasion, PEGNL will supply limited contact information to these third-parties from members who have consented to release of same. If you would like to receive information on these promotions as they arise, please complete the Consent Release Information section below. Otherwise, please leave blank.

Consent Release

By checking the box and signing below I note my agreement to the use and sharing of limited contact information, as described in the PEGNL Privacy Policy, for the purpose of receiving PEGNL member-specific third-party communications.

Consent Release

Yes, I consent to providing the necessary information to receive third-party communications.

Consent Release Signature

Signature

Consent Release Date

Date

By signing this form you hereby consent and agree that entering your information through use of your key pad, mouse or device constitutes your signature, acceptance and agreement as if actually signed by you in writing and has the same force and effect as a signature affixed by hand. Further, you agree that the lack of certification authority or other third party verification will not in any way affect the validity or enforceability of your signature or any resulting contract. Please ensure that you have reviewed the application before applying your electronic signature.

Category Applying For(Required)

Professional Engineer

Professional Geoscientist

EMPLOYMENT INFORMATION

(If unemployed, please leave blank)

Employer Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Field of Practice(Required)

UNDERGRADUATE EDUCATION INFORMATION

Undergraduate Education(Required)

Degree / Diploma (e.g., B. Eng., B. Sc., B.Tech., etc.)

Discipline (e.g., Civil, Geology, Mechanical, etc.)

Institution

City and Country

Start Date (Month and Year)

End Date (Month and Year)

GRADUATE EDUCATION INFORMATION

Graduate Education

Degree / Diploma (e.g., M. Eng., M. Sc., M. A. Sc., etc.)

Discipline (e.g., Civil, Geology, Mechanical, etc.)

Institution

City and Country

Start Date (Month and Year)

End Date (Month and Year)

GOOD CHARACTER STATUS

PEGNL members are bound by a Code of Ethics and applicants must demonstrate good character to be deemed suitable for membership. The following questions are part of the character review process. If you answer “yes” to any of these, please provide more details (in email or pdf form).

GC Question 1(Required)

Have you ever pleaded guilty or been found guilty of any offence under any statute whether in Canada or elsewhere?

Yes

GC Question 1 More Information(Required)