Fillable Printable Professional Land Surveyor Registration Application

Professional Land Surveyor Registration Application

Questions: call (360) 664-1575

Professional Land Surveyor

Registration Application

To become a professional land surveyor either by exam or by comity

(interstate registration):

• Youmusthaveaminimumof8yearsapprovedlandsurveyingexperience.

Amaximumof4yearseducationmaybecreditedtowardsexperience.

• YoumustsuccessfullycompletetheFundamentalsofLandSurveying(FLS)

andthePrincipleandPracticeofLandSurveyingexams.

• YoumusttakeandpasstheWashingtonLawandEthicsexamand

successfullycompletea2-hourstatespecicexam.

• Ifapplyingbycomity,youmustbecurrentlylicensedinanotherstate.

To apply:

1. CompletethisformandsendthesignedapplicationandtheExperienceRecordSummary(pages1-3)*withacheckor

moneyorderfor$140,payabletotheDepartmentofLicensing,to:

Board of Registration for Professional Engineers and Land Surveyors

Department of Licensing

PO Box 35001

Seattle, WA 98124-3401

*Applicantsapplyingbycomity:IfyouarehavinganNCEESlandsurveyingrecordsent,completeonlypages1and

2andsendtous.(TheNCEESsurveyingrecordisaserviceprovidedbyNCEESthatcontainsarecordofeducation,

experience,references,examresults,andlicense.)

2. CompletetheExperienceDescriptionandVericationsection(pages4-6)andsendtotheperson(s)verifyingyourwork

experience.Thepersonverifyingwillsendthecompletedformdirectlytoourofce.

3. Gotohttps://verify.ncees.organdfollowtheinstructionsonrequestingalicense/examverication.Ifyouhavetaken

andpassedtheFLSexaminWashingtonState,thisstepisnotnecessary.

4. Ifyouwantanyeducationconsideredtowardstherequirements,requestanofcialtranscriptbesentto:

Board of Registration for Professional Engineers and Land Surveyors, Department of Licensing, PO Box 9025,

Olympia, WA 98507.Photocopiesarenotacceptable.

5. YouwillreceiveanemailwithinformationtoaccesstheLawandEthicsexamthatmustbetakenandpassedbefore

youcanbeapprovedfortheexam.

6. Onceyouhavebeenapprovedfortheexam,youwillreceiveanemailwithinformationtoscheduleyourexam.

Applicant

Applicationtype:(checkone) By exam – $140 By comity – $140

PRINT or TYPEName(Last, First, Middle – will appear in the proper order on your wall certiﬁcate) Maidenname (If any – will not appear on certiﬁcate)

SocialSecuritynumberrequired* Dateofbirth Gender

Male Female

Mailingaddress

City State ZIPcode County

Presentposition Businessname

Businesslocationaddress

City State ZIPcode County

(Areacode)Businesstelephonenumber (Areacode)Residencetelephonenumber Email

*AllapplicantsarerequiredbyfederalandstatelawtoprovidetheirSocialSecuritynumber(SSN)foruseinchildsupportenforcementprograms(42U.S.C.

666(a)(13)andRCW74.20A.320).Itmayalsobeusedforeducationloanrepaymentprogramsandidenticationofrecordswithsimilarnames.Submission

ofyourSSNismandatory;failuretosubmititmayresultindenialofyourapplication.

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Click here to START or CLEAR, then hit the TAB button

Applicantname

Applicant – continued

Answerthefollowing

1. Hasanycourtorlicensingjurisdictiontakenactionagainstyouforyourpracticeinengineering

orlandsurveying? Yes No

Ifyes,pleaseattachanexplanationonadditionalsheet.

2. Haveyoueverbeenconvictedoforenteredapleaofguiltyornolo contendretoamisdemeanor,

grossmisdemeanor,orfelony?  Yes No

Ifyes,pleaseattachanexplanationonadditionalsheet.

3. AreyouhavinganNCEESexperiencerecordsent?  Yes No

Nameandlocationofcolleges,universities,

technicalschoolsattended

Datesofattendance

From    To Curriculum Degree/Date

Previous and current registration

Answerthefollowing

Haveyouledanapplicationwiththisofcewithinthelastveyears?  Yes No

Ifyes,dateapplied Certicatenumber

Applicationtype: Engineer-in-Training ProfessionalEngineer ProfessionalLandSurveyor

 WrittenLSITexaminstateof

 WrittenPLSexaminstateof

Number(s)anddate(s)oforiginalcerticate(s):

LSITnumber State Issuedate

PLSnumber State Issuedate

Iscerticatenowinforceinoriginalstate?  Yes No

Ifnot,why?

Ifyouareregisteredwithotherstates,pleaselist:

Comityapplicants:Stateofmostrecentresidenceandpractice:

Land surveyor references

Givenamesandaddressesofvereferences(notrelatives)whoareresponsiblelandsurveyors,atleastthreeofwhich

areregisteredprofessionallandsurveyors,havingpersonalknowledgeofyourcharacterandprofessionalreputation.

Name Position Emailaddress

(Areacode)Telephonenumber

Certicatenumber/State

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

Dateandplacesigned Applicantsignature

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When you have completed this form, please print it out and sign here.

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Applicantname

Experience record summary

Pleaselistallofyouremployersbelowbeginningwiththemostrecent.Thislististoincludetheentiretimefromleaving

college(ifapplicable)orbeginningyourlandsurveyingcareertothepresenttime.Thoseperiodswhileinschool,

unemployed,ornon-landsurveyingworkmustalsobeincluded.Ifnotverifying,indicate“No”.Anyexperiencenotveried

willnotbecountedtowardstheexperiencerequirement.

Verication

number

Timeperiod(begin with most recent)

From(month-year) To (month-year) Employer

Tobeveried?

(yes or no)

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Professional Land Surveying

Experience and Veriﬁcation

Applicant experience veriﬁcation

• Experienceisgainedunderthedirectsupervisionofalicensedprofessionallandsurveyor(PLS).

• Ifemployedbythefederalgovernment,youarenotrequiredtogainexperienceunderaprofessionallandsurveyor.Your

directsupervisormustverifyyourexperience.

Instructions for applicant

Sendthecompletedworkexperiencedescriptionsandvericationform(pages4-6)tothepersonverifyingyourwork

experience.Additionalsheetsmaybeattachedifneeded,butpleaseidentifythecategoriesyouaredescribing.Youmay

makephotocopiesofthisformforadditionalevents.

Work experience information – applicantcompletethissection

Applicantname Vericationnumber (from page 3)

Employedby

Jobtitle Datesofemployment (From, To) Averagehoursperweek

Supervisor/Veriernameandtitle (Areacode)Telephonenumber

Supervisor/Verierbusinessaddress

City State ZIPcode

Work experience descriptions – applicantcompletethissection

Thisexperienceisbrokendownintosixcategories(A-F)foreachevent.Describeexperience(onelineisnotsufcient),

detailingtheworkyoupersonallyperformed.Thisworkshouldbeprogressiveindifcultyandmagnitude,demonstrate

sufcientbreadthandscope,andreecttheacquiredabilitytoapplylandsurveyingprinciplestodemonstratethatyour

judgmentmaybetrustedonprojectsinvolvingpublichealthandsafety.

Describeyourexperience

A.Applyingstate,federal,andcaselaw.

B.Exercisingsoundjudgmentwhenmakingindependentdecisionsregardingcomplexboundary,topographic,

horizontalandverticalcontrol,andmappingissues.

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Applicantname  Vericationnumber

Work experience descriptions – continued

Describeyourexperience

C.Fieldidenticationandevaluationofboundaryevidence,includingmonumentationandtheabilitytousethat

evidenceforboundarydetermination.

D.Conductingresearch.

E.Preparingandanalyzingcomplexpropertydescriptions.

F.InteractingwithclientsandthepublicinconformancewithChapter196-27AWAC.

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Applicantname Vericationnumber

Veriﬁcation instructions

Aftercompletingyourverication,pleasereturnthisformandtheattachedworkexperiencedescriptions(pages3-5)to:

Board of Registration for Professional Engineers and Land Surveyors, Department of Licensing, PO Box 9025,

Olympia, WA 98507.

Work experience veriﬁcation – supervisor/veriercompletethissection.Allsectionsmustbecompleted.

1. Ifyouarenottheapplicant’ssupervisorforthisevent,pleaseexplainyourworkingrelationshiptotheapplicantand

howyouareabletoprovidethisverication:

2. Ifyouarenotalicensedlandsurveyor,underwhatauthorityareyouverifyingexperience?(federal agency, county

engineer, etc.)  Yearsoflandsurveyingexperienceyouhave

3. Describeyourlevelofsupervisionoverthisapplicant.

4. Stateyouropinionregardingtheaccuracyoftheapplicant’semploymenttime,hoursworked,anddescriptionsof

experience(categoriesA-F),includingthescopeandcomplexityoftheworkdescribed.

5. Duringthistimeofemployment,howlonghastheapplicantbeeninapositionofmakingindependentjudgmentsand

decisions? years/months.Giveabriefdescriptionofatypicalprojectforwhichtheapplicantmade

independentjudgmentsanddecisions,andthecharacterofthedutiesrequiredbytheproject.

6. Explainwhyyouthinkthisindividualissuitedforlicensure.

7. RCW18.43.040statesthatnopersonshallbeeligibleforregistrationasalandsurveyorwhoisnotofgoodcharacterand

reputation.Commentontheapplicant’scharacter,personalandprofessionalreputation:

8. Wereyouregisteredasaprofessionallandsurveyoratthetimeyousupervisedtheapplicant?..........

Yes No

I hereby certify that the statements and answers contained in this veriﬁcation regarding the person named as applicant are true

and correct to the best of my knowledge.

PRINT Yourname Yourtitle

Address City State ZIPcode

Emailaddress Licensenumber State Issuedate Expirationdate

Dateandplacesigned Supervisor/Veriersignature

(Sealorstamp)

Please afﬁx your stamp or seal in the space provided. Ifnosealorstampisavailable,you

mayattachacopyofyourcurrentlicense.

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When you have completed this form, please print it out and sign here.