ENGINEERING COUNCIL OF SOUTH AFRICA (03/04/2013) Form E1.1 Private Bag X 691 Waterview Corner, 1st Floor, BRUMA Tel: (011) 607-9500 Fax: (011) 622-9295 BRUMA Office Use Ref.: ______________________ Email: Website: 2198 A P P L I C A T I O N F O R M Application for Registration as: (Tick appropriate block ) Please consult the enclosed Information Sheet (Sheet E1.1 & 2) before completing this application. Candidate Engineer Please include a certified copy of your BSc Eng/B Eng Degree Candidate Engineering Technologist Please include certified copies of your National Diploma and B Tech Degree certificates and include certified copies of your statement of results for the N Dip and the B Tech Candidate Certificated Engineer Please include certified copies of your GCC Candidate Engineering Technician Please include a certified copy of your National Diploma Certificate 1. General Information: Surname: First Names: Date of birth: Identity No. Or Passport No: *Race Group: Please tick the applicable block Asian Black *Gender Group Please tick the applicable block Mr.______ Mrs._____Miss_____ Col.______ Ms. ______ Dr. ______Prof. _____ Hon.______ Coloured White Address: Country of normal residence: Home Tel. No.: (Include area codes) Cell no.: Residential Address: Work Tel. No.: Fax No.: E-mail: * Completion of this section is necessary in order to accurately reflect equity statistics in terms of Government Policy. 2. Examinations Passed: 2.1 Educational Institution Qualifications attained Date of final Examination month & year Office use Recognised Not recognised Part NB: Kindly initial this page in the presence of a Commissioner of Oaths / Justice of Peace. Commissioner of Oaths/ Applicant: ………………………………….. Justice of Peace: …………………………………… (03/04/2013) Form E1.2
Registration Number: ___________________________________________ Name & Surname: ______________________________________________ Disability is defined as: “Persons with disabilities including those who have long-term physical, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others”. Do you have any disability (Please tick): Yes No If yes, state nature of Disability: ____________________________________________________ NB: Completion of this form is necessary in order to accurately reflect disability statistics in terms of Government Policy.
ENGINEERING COUNCIL OF SOUTH AFRICA (2014-07-17) Form C1.1 Private Bag X 691 Waterview Corner, 1st Floor, BRUMA 2026 2 Ernest Oppenheimer Avenue Tel: (011) 607-9500 Bruma Lake Office Park Fax: (011) 622-9295 BRUMA Email: Johannesburg Office Use Ref.: Website: 2198 A P P L I C A T I O N F O R M REGISTRATION AS A PROFESSIONAL ENGINEERING TECHNICIAN NB: Please consult the Information Sheets (Sheets C1.1 & C1.2) before completing this Application. 1. General Information: Surname: First Names: PHOTOGRAPH (Passport-type. Please paste - do not staple) Alternatively, insert electronically in JPEG or similar format Date of Birth: Identity No: or *Gender *Race Group Asian: Black: Passport No. and Country: Country of normal residence: M: F: Coloured: White: Home Address: Postal Address: Name & Address of present Employer: Tel. No. (Home): Tel. No. (Work): (include area codes) Cell No.: E-mail: Title of Position held: Tel. No. (Employer): Fax No.: (include area codes) E-mail: *Completion of this section is necessary to accurately reflect equity statistics in terms of Government Policy. Please cross applicable blocks. 2. Qualifications: (All qualifications at tertiary level) (List of subjects to be provided on Form C1.3 AR) Educational Institution Qualification Attendance from to Date of final examination Office use NB: Kindly initial this page in the presence of a Commissioner of Oaths / Justice of Peace. Commissioner Of Oaths/ Applicant: …………………………. Justice Of Peace: ………………………………………
(2014-07-17) Form C3 ENGINEERING COUNCIL OF SOUTH AFRICA SUID-AFRIKAANSE RAAD VIR INGENIEURSWESE Private Bag X 691 BRUMA 2026 Tel: (011) 607-9500 Fax: (011) 622-9295 E-mail: engineer@ecsa.co.za Website: www.ecsa.co.za PROFESSIONAL ENGINEERING TECHNICIANS Name of Referee Date Address: Dear Sir/Madam I have applied to the Engineering Council of South Africa for Registration as a Professional Engineering Technician and hereby request you to provide the Council with your evaluation of my experience and capabilities, on the basis of your personal knowledge thereof. Please use the attached Form C4 and consult the guideline for referees (Sheet C4). In making this request to you I acknowledge that the information which will be supplied by you to ECSA is of a confidential nature and that I have no right thereto. Your co-operation and early despatch of the document direct to the Council would be appreciated, as it would expedite the processing of my application. Thank you in advance for your co-operation. Yours faithfully ………………………………………….. Signature of Applicant Name of Applicant (Please print) Address: Postal Code: Telephone No: Cell No:
Appendix B: Sources of Evidence against Outcomes Notes: 1. Well-defined is the level identifier defined for the Professional Technician category in document R-02-PN. Engineering Report claims are verified by the applicant’s supervisor. No Outcome Training and Experience Reports Engineering Report Incl claim to competency Referee Reports (3) IPD Report Discretionary Interview A1 Define, investigate and analyse engineering problems Factual/ Verified Factual/ Verified Evaluative Information to the left is considered in the Experience Appraisal Evaluative/ Verified All information is used by Interview Panel when making their recommendation to the Registration Committee A2 Design or develop solutions to engineering problems Factual/ Verified Factual/ Verified Evaluative Evaluative/ Verified A3 Comprehend and apply the knowledge embodied in established engineering practices and knowledge specific to the jurisdiction in which he/she practices Factual/ Verified Factual/ Verified Evaluative Factual: Knowledge Enhancement Evaluative/ Verified B4 Manage part or all of one or more engineering activities Factual/ Verified Factual/ Verified Evaluative Evaluative/ Verified B5 Communicate clearly with others in the course of his or her engineering activities Tests Concise Writing. Factual/ Verified Evaluative Evaluative/ Verified C6 Recognise and address the reasonably foreseeable … impacts of well-defined engineering activities. May not be covered Factual/ Verified Evaluative Evaluative/ Verified C7 Meet all legal and regulatory requirements and protect the health and safety of persons in the course of well-defined engineering activities. Factual/ Verified Factual/ Verified Evaluative Evaluative/ Verified D8 Conduct engineering activities ethically. May not be covered Factual/ Verified Evaluative Evaluative/ Verified D9 Exercise sound judgement in the course of well-defined engineering activities. May not be covered Factual/ Verified Evaluative Evaluative/ Verified D10 Be responsible for making decisions on part or all of well-defined engineering activities. Factual/ Verified Factual/ Verified Evaluative Evaluative/ Verified E11 Undertake professional development activities sufficient to maintain and extend his or her competence. Factual/ Verified Evaluative/ Verified (Commitment) Factual Evaluative/ Verified (Commitment)