{0000ASEAN ASSOCIATE SEANENGINEER _// ENGINEERING APPLICATION FORM AND GUIDELINES FOR APPLICANTS (/() REGISTER (Allenties must be computer printed or typewritten) * FORM 1: APPLICANT'S CHECKLIST [i seruicavrs terteR oF iwTeNr ADDRESSED TO THE PTC PRESIDENT PROFESSIONAL ORGANIZATION'S (EPO) ENDORSEMENT SIGNED BY THE NATIONAL PRESIDENT 4 CERTIFICATE OF GOOD STANDING FROM THE ACCREDITED NATIONAL APO & MEMBER OF PTC CERTIFICATE OF REGISTRATION VALID PROFESSIONAL IDENTIFICATION CARD COPY OF DIPLOMA (UNDERGRADUATE AND GRADUATE ENG'G) - CERTIFIED TRUE COPY ‘CURRICULUM VITAE PERSONAL DETAILS (FORM 2) PROFESSIONAL EXPERIENCE (FORM 3) Optional ‘SIGNIFICANT ENGINEERING WORK (FORM 4) Optional CONTINUING PROFESSIONAL DEVELOPMENT (FORM 5) [PF] cone oF etHics (FORM 6) APPLICANT'S DECLARATION (NOTARIZED) (FORM 7) FOR PTC USE ONLY. "APPLICANT NAME: "APPLICANT WO, SUBMITTED BY: APPLICATION FEE LIFE REGISTRATION FEE DATE ASH ASHE RECEIVED BY es ces DATE DEPOSIT: DEPOSIT Actions ‘OR NUMBER: OR NUMBER: DATE: DATE: DATE: Instructions: 1... Submit tree (3) ses of hard copies of al he competed applction documents listed in Form 1 using A& siz whe bond paper of not less than ‘substance (80 gs) thickness, Photoopis of lrge documents shal be reduced accoréingly, Each sot shal be subited using @ BLUE CLEAR ‘BOOK FOLDER, COMPLETE WITH TABLE OF CONTENTS AND TABS. 2. Submitasotcopy ofalthecomgleedapplcatondecumantsin tom 1 above and al supporing documents. Include an nox feof al document 5. Al pages of he apeeaton must be signed and dated bythe applicant an shall be delered or maled ta: Philippine Technologeal Counel, Inc, (PTC) Rooms 406-406 Natal Eninating Canter, Aledo Jiro Hal, Osmeta Ave, come: F. Agocilo St, Univarity of tha Philapnes, Dian, Quezon Cy Philipines 110. Te¥Faxno: (0682 926-586, 4, EMail Appleatons or Computer Generated Sqnaures on the Applcaion Fors Wl Nol Be Accepld, 5, _Applcation mst be suomsted togsther wih nr-tendsole Application Fae of P 50000, NAME: SIGNATURE: APOIDATE: 1 | Page 11 Ver16.0{0000ASEAN ec ASSOCIATE SEAN ENGINEER —_/)"( ENGINEERING [APPLICATION FORM AND GUIDELINES FOR APPLICANTS ‘(REGISTER (Allenties must be computer printed or typewritten} FORM 2: lease pastelcomputer print PERSONAL DETAILS ‘event (6 mes) passport size (60mm x Somm) colores picture with white background LJ asean encineer ATTRE 41. PERSONAL DETAILS Male —coaT TE FEMALE - CORPORATE twe: or Cor Oe On Os Ons Sumame L_ Given Names (nfl) Middle Name Date of Bith Name of Employer Private Address ( [Preferred mailing address): Business Address (EZ) Preferred maiing address): Postal Code: Country Postal Code County TelNo.( Fax) TelNo.( Fax( Ema Mobile No: 2, EDUCATIONALIPROFESSIONAL QUALIFICATIONS (Use additional sheets ifnecessary) ‘Academic Level Degree/Title Conferred University/College/Address Dates Attended: Undergraduate Graduate - Masteral (Graduate - Doctoral Post-Doctoral Professional Qualifications Registration Date of Registration Registration Body Adesso Region | Profesional Disipine [ 3. FIELD (s) OF SPECIALIZATION a) b) ° gd NAME: SIGNATURE: APOIDATE 2 | Page 11 Verl6.0{0000ASEAN ASSOCIATE SEANENGINEER _// ENGINEERING APPLICATION FORM AND GUIDELINES FOR APPLICANTS | REGISTER {Al enties must be computer printed or ypewrten) 2 4, MEMBERSHIP Please tick the accresited professional organization where you are a member. Oo Society of Aerospace Engineers ofthe Philipines (SAEP) Philippine Society of Agricultural Engineers (PSAE) 1 Philippine Institute of Civil Engineers (PICE) Philippine institute of Chemical Engineers (PIChE) 1 Institute of integrated Electrical Engineers (IEE) Institute of Electronics Engineers ofthe Philippines (IECEP) (1. Geodetic Engineers ofthe Philippines (GEP) 1 Phiippine Society of Mechanical Engineers (PSME) [Society of Metallurgical Engineers ofthe Philippines (SMEP) E Philippine Society of Mining Engineers (PSEM) [Society of Naval Architects and Marine Engineers (SONAME) [1 Philippine Society of Sanitary Engineers (PSSE) A Philippine institute of Industrial Engineers (PIE) 5, PROFESSIONAL TRAININGS/SEMINARS ATTENDED Name/Address of Role (eg. Dates Program Description/Ttle Provider Speake) Units Earned Attended ‘Gubrit Sotcopy of Supporting Docurens suchas Ceroaes, ec, Use adaTonal shee W necessary] 6. AWARDSICITATION RECEIVED (Please attach sotteopy of awards/citation) Date Received Name of Citation NamofAddress of Awarding Organi (Submit Sotcopy of Supporting Documents suchas the Citation, Cetiicaes, etc. Use additonal shoes ifrecossary) 7. AFFILIATION IN BUSINESS/PROFESSIONALICIVIC ORGANIZATIONS Tnelusive Date Name/Address of Organization Positions Hold ‘Bubrit Satcopy of Supporing Documents such as Membership Ceriicates, cards, ete, Use addional shee necessary) NAME: SIGNATURE: APOIDATE: 3 | Page 11 Ver16.0{0000ASEAN ASSOCIATE SEANENGINEER _// ENGINEERING APPLICATION FORM AND GUIDELINES FoR apPuicaNTs (00 REGISTER , (Al envi must be computer printed or typewritten) FORM 3: OPTIONAL PROFESSIONAL EXPERIENCE 8, SEVEN (7) YEARS PROFESSIONAL EXPERIENCE (See ANNEX A. Use separate sheets foreach company) Name of Company/Project Owner: Address of Company: Work | Starting Ending Project T Position No, | Date | Date | NamelDescription | Leeation | Nature of Work | “ saig (Submit Soficopy of Supporting Documents such as Cerificates, Appointment papers, etc.) CERTIFYING ORGANIZATION AND ATTESTER Certifying Organization ‘Address Attested by (Name and Signature) Attestor’s Relationship to Apy Telephone Email Notes: 1) Nature of Work = should indude a description of engineering and management activities which the applicant performed andlor which the applicant is directly responsible for. ) _Attester should be the immediate supervisor of the applicant ©) Cerificate of employment must accompany this form (This form is good only for one office/company) NAME: SIGNATURE: APOIDATE: 4 | Page 11 Verl6.0{0000ASEAN ASSOCIATE SEAN ENGINEER _/ ENGINEERING APPLICATION FORM AND GUIDELINES FoR apPuicanrs (REGISTER , (Al envies must be computer printed or typewritten) FORM 4: OPTIONAL SIGNIFICANT ENGINEERING WORKS 9, TWO (2) YEARS RESPONSIBLE CHARGE OF SIGNIFICANT ENGINEERING WORK (Please soe ANNEX A. Please use separate sheets foreach company.) Staring | Ending Specific Engineering wee Month Month Poet Pete” Works/Responsibility/ (Montmeeks) | cum) | amiyyy ‘Accomplishments (Submit Sofcapy of Supporing Documents suchas Cevthicales, Appointment papers, etc. Use additonal sheets necessary) CERTIFYING ORGANIZATION AND ATTESTER Certifying Organization Address ‘Attested by (Name and Signature) Attester's Relationship to Applicant Telephone Email Notes: a) Minimum Two (2) Years of Significant Engineering Works for which the Applicant held Responsible Charge, Describe the folowing for each ofthe Project cited 1. Personal engine andlor management contributions and responsib 2. Problems faced during the projectlactvity duration 3. Solutions formulateffound and implemented 4, Description of Engineering judgements made ies 5. Impact(s) generated by the above solutions and judgements 1) Alfester shouldbe the immediate supervisor ofthe applicant ©) Certficate of employment must aocompany this form (This form is good only for one ofice/comany) NAME: SIGNATURE: APOIDATE: 5 | Page 11 Ver16.0ASSOCIATE SEAN ENGINEER ‘APPLICATION FORM AND GUIDELINES FOR APPLICANTS ‘i (Allenties must be computer printed or typewritten} 90 (ASEAN (ENGINEERING YREGISTER ¢ g @ q q * FORM 5: CONTINUING PROFESSIONAL DEVELOPMENT 10. CONTINUING PROFESSIONAL DEVELOPMENT (Please provide supporting documents in softcopy format.) REF DATE TRE (PD Activity THerTopic Description Name & Addross of Provider ‘Actual Factor hours Tt @ 8 6 6 7 w 20 a B B % 7 2 3 Total CPD activities (Goal of 150 hours within the 3-year period) NAME: [USE ADDITIONAL SHEETS IF NECESSARY) SIGNATURE: APOIDATE: 6 | Page 11 Ver16.02000)ASEAN ASSOCIATE SEAN ENGINEER 2727 ENGINEERING APPLICATION FORM AND GUIDELINES FOR APPLICANTS ‘i.!(’), REGISTER. (Al envies must be computer printed or typewritten) * FORM 6: CODE OF ETHICS THE PTC CODE OF ETHICS PREAMBLE It isa solemn responsibilty ofa PTC member, after admission inthe practice of a particular profession to adhere tothe fundamental principles of his profession guided by the norm of conduct consistent wit this Code of Ethics ARTICLE 1 DECLARATION OF PRINCIPLES Rule 1. The practice of a particular aied Technological Profession is a privilege granted by the state. The privilege requites high degree of knowledge, efficiency, responsibilty, and moray. The dignty and honor of the profession ‘must at all mes be kept unblemished Rule2. The PTC Member shall, in the practice of his profession, be governed by the Golden Rule, and the ideals of services to man and his environment Rule 3. The duly constituted authorities shall be recognized and obeyed in the practice of his profession. ARTICLE I RESPONSIBILITIES TO THE STATE Rule 1. The PTC member shall maintain allegiance to the Republic ofthe Philippines, support the Constitution and obey all laws duly promulgated and approved by the duly constitute authorities Rule 2. He shall strive for the common good and shall contioute his expertise for the success of national projects, programs or policies, Rule 3. He shall alvays be ready and wiling to render professional service, even without compensation, in cases of accidents, emergencies or calamities. ARTICLE I RESPONSIBLITIES TO THE COMMUNITY Rule 1. The PTC Member should be aware ofthe safety and welare ofthe people, in the pursuit of his profession, Rule 2, He shall be well informed of the latest technological progress in his own line of work, He shall encourage, and require the use or application of standard equipment, machinery, or process for safety, economy and eficiency. Rule 3, He shall update and enhance constantly his professional knowledge and stil through assiduous research and study, and meaningful paticipation in continuing education programs and seminars conducted by the different Technological Associations or Educational institutions supervised by the stat. Rule 4. He shall avoid and discourage sensational, exaggerated and unwarranted statements that might induce participation in unsound enterprises. NAME: SIGNATURE: APOIDATE: 7 | Page 11 Ver16.09000 ASSOCIATE SEAN ENGINEER GQI09 [APPLICATION FORM AND GUIDELINES FOR APPLICANTS (/( (Allens must be compute printed or typewritten} ASEAN ENGINEERING REGISTER Rules. Rule 1. Rule 2. Rule 3, Rule 4. Rules. Rule 6. Rule 7. Rule 8. Rule 1. Rule 2. Rule 3, Rule 4. Rule t NAME: When he discovers faulty or unsafe devices, equipment, or machinery in any place, work or plant, he shall without delay, give notice thereof to the proper authority, public or private, forts immediate and effectve correction ARTICLE IV RESPONSIBILITIES TO EMPLOYER AND CLIENTS The PTC Member must faithfully use his knowledge and skis on performing his tasks to his cents or employer. He shall protect with utmost professional attention the interests of his employer or client He shall not advance or promote any interest of his client or employer which is contrary to law, public or professional obligations and ethics. Whenever his obligations to his employer or clents are in confict with his professional obligations or ethics, he should endeavour to resolve the confict in accordance with the law public policy, and the provision of this code, \When the confit beyond reconciiaton, he should sere his professional engagement He shal nt divulge any information given in confidence during his employment, neither shall be attempt to prof therefrom nor shall he use, direcly or indirect, such information to the prejudice of his employer and other contracting parties shall be fatfuly determined and discharged He shall nat engage or offer to engage, his professional services to those with confcting and adverse interests He shall act as tustee of nis dent or employer in the preparation of contracts and similar documents, He shall be impartial in the interpretation of such documents so that the rights and obligations of his clients or employer and other contacting partes shall be faithfully determined and cischarged. He must refer his cient or employer, whenever necessary, to serve the interests of the late, to experts or consultants. He must not aocept any favour or compensation whatsoever for the referral to such experts or consultants. ARTICLE V RESPONSIBILITY TO EMPLOYEES Tne PTC Member, as employer, shal at ll imes be concemed with the welfare of his employees whose rights as workers are quaranlsed under the Constitution and protected by laws He shall be wiling to share the substantial profs from his enterprise wit the employees responsible thereof, He must observe and obey all laws, rules and regulations on labor, particularly those affecting labor relations, hours of work, wages and terms and conditions of work He shall at all times strive to improve the knowledge and skils of his employees, provide safety measures for his men, and maintain the operations effciency of his machines or equipment. ARTICLE VI RESPONSIBILITIES TO COLLEAGUES "To thine oneself be true and thou cannot be false to any man “expresses the duly which a PTC Member owes to himself and to others. SIGNATURE: APOIDATE: 8 | Page 11 Verl6.09000 ASSOCIATE SEAN ENGINEER GQI09 APPLICATION FORM AND GUIDELINES FOR APPLICANTS {Allenies must be computer printed or typewriter} ASEAN ENGINEERING REGISTER , Rule 2. Rule 3, Rule 4 Rule 6. Rule 6, Rule 7. Rule 8, Rule 9. He shall use only fair means to gain professional advancement. In tbe pursuit thereof, he shall not injure the work employment opportunites of others, or use any improper or questionable method of soliciting employment of dlientele He shall no fratorize with those engaged in unethical practices. He must duly acknowledge the professional work of his colleagues and subordinates and give fll recognition thereto He shall dane clearly the line ofauthory and the scope of esponsibility of his associates and assistants, orders or the recall there, shal be fsued trough proper channels He must always encourage and promote the professional advancement of his colleagues, especially when he ‘occupies a position of authority, He shall exert efforts to assist in the development of the Knowledge and skils of his colleagues. He shall receptive fo new ideas and suggestions from others, and ready to recognize, encourage, and accredit the authors thereof He shall use tact and discretion in dealing with his colleagues and associates, but not atthe sacrifice frmness. He shall work out dificulty problems with courage and serenity He shall actively support the duly accredited association with the end in view of enhancing the practice of the profession and discharging his public responsiilties as a professional PENAL PROVISIONS Violation of any provision of this code shall constitute unethical or unprofessional conduct and shall be dealt with under the provisions ofthe pertimont section ofthe particular Architecture, Engineering or Allied Profession's Law. In addition to the PTC code of ethics, each ofthe professional disciplines has its own Cade of Ethics, which the professional is expected to observe and be bound with NAME: DECLARE TO OBEY AND BE BOUND BY THE ABOVE CODE OF ETHICS ‘SIGNATURE ABOVE PRINTED NAME Date SIGNATURE: APOIDATE: 9 | Page 11 Ver16.09, (ASEAN rt @ ASI ENGINEERING REGISTER i ASSOCIATE SEAN ENGINEER i [APPLICATION FORM AND GUIDELINES FOR APPLICANTS |) (Allenties must be computer printed or typewriter} vi ey Wi FORMT: APPLICANT'S DECLARATION 11. APPLICANT'S DECLARATION, | cetiy under penalty of perjury andlor falsification of public documents that al he documents submited in suppart of this application ‘are Lue copes ofthe authentic eriginal documents and that | am prepared to submit theses original documents if and when required | hereby declare that all statements of facts in my Application form and Engineering Practce Report are tue and correct and I have made claims of acquired competences in god fath. The reprtis my own work, | confi that | have road and that | understand the PTC Code of Ethics and the Codes of Ethics of my profession. | agree thal, it admited as an Advanced Level Engineer, | wil abservaand will be bound by these Codes of Etice, | understand that | have an obligation to inform PTC and my APO of any mater that may affect my finess for admission to and continued inclusion inthe Advanced Level Engineer Register. In support of my application for registration onthe Advanced Level Engineer Register, | ‘¢ certify that | nave been engaged in independent practice or have worked as an employee under the general drecton of a professional or have been eralled ina formal postgraduate training program in my area of expertise for atleast he equivalent cof one ful year during the past three years; '¢ cert that over that period | have maintained my continuing professional development (CPD) by involvement inact related to my particular aea of expertse; ‘¢ acknowledge that, on renewal of my APO membership, by paying my registration fee forthe coming year, | wil be indicating to ‘he counell my clear ntation to abide bythe undertakings | have made in applying for regisraton, and wil be confirming that my ‘rcumstances have not placed me outside the minimum practice requirements ‘+ acknowledge that my compliance with these CPO requirements during the period in which | remain registered may be auited at any ime; and ‘¢ Consent to my business contact detals being publshed in any form associated with my registration as Advanced Level Engineer. '¢ Stand ready for professional interview and respond to any reasonable request ofthe Philippine Technological Counc (PTC) for ‘explanations and further information i elation to my application Signature: Date: (Signature of Deciarant Declared at this, (Place) Gate} Before me (notarized) Residing at (Name, profession and address in BLOCK LETTERS, of person authorized to cerily the declaration. Please sign above name.) Date NAME: SIGNATURE: APOIDATE: 10 | Page 11 Ver16.09000 ASSOCIATE SEAN ENGINEER GQI09 [APPLICATION FORM AND GUIDELINES FOR APPLICANTS (/( {Allens must be computer printed or typewriter} ASEAN ENGINEERING REGISTER ANNEX A. Requirements for Registration NOTE1 1. The applicant should have attended and completed an accredited or recognized engineering program by the appropriate authority in the country. 2. Been Assessed as eligible for independent practice 2.4 The Assessment maybe undertaken by the Monitoring Committee, by a competent Professional Association andior by an authority with responsibilty for registration or icensing of professional engineers, 3. Gained a minimum of seven years (7) of professional experience after registration. 3.1. The works in question should be clearly relevant to the fields of engineering in which the applicant claims experience. 32 Should have paticipated in a range of roles and activilles appropriate to these fields of engineering NOTE2 1. Spent atleast two (2) years in responsible charge of significant Engineering Work 1.1 The Work should have required the exercise of independent engineering judgement, the project concerned should have been substantial in duration, cost and complexity and the applicant should be personally accountable forthe success or failure of the project, 4.2 In general, an applicant may be taken to have been in responsible charge of significant engineering work when they have a. Planned, designed, coordinated & executed a small project; or . Undertaken part of a larger project based on an understanding of the whole project; or . Undertaken novel, complex and/or multi -disciplnary work 2. Maintained t ir continuing professional development ata satisfactory level 3. Bound by the established Code of Professional Conductor Ethics, NAME: SIGNATURE: APOIDATE: 11 | Page 11 Vert60ASEAN ENGINEERING REGISTER ¢ g @ 900 ASSOCIATE SEAN ENGINEER q ei [APPLICATION FORM AND GUIDELINES FOR APPLICANTS ‘i. {Al envies must be computer printed or typewrten) * “F,_ Held individually accountable Tor their actions as a professional engineer NAME: SIGNATURE: APOIDATE: 12 | Page 11 Ver16.0