Fillable Printable Structural Engineer Registration Application

Structural Engineer Registration Application

Structural Engineer

Registration Application

Use this application to apply for a structural license by comity or exam.

Emailed applications will not be accepted. Make checks payable to

Department of Licensing. Submit this checklist, form, supporting documents,

and fees to:

Board of Registration for Professional Engineers and Land Surveyors

Department of Licensing

PO Box 35001

Seattle, WA 98124-3401

Your attention to these details will help us process your application quicker. See experience veriﬁcation form for

qualifying experience requirements.

To be licensed in Washington State as a structural engineer, all applicants must:

• BecurrentlylicensedasaWashingtonStateProfessionalEngineer(PE).

• Demonstratetwoyearsofprogressivestructuraldesignexperienceinadditiontothe8yearsofexperiencerequiredfor

registrationasaprofessionalengineerinWashingtonState.

• Providecompleteexplanationstodescribethetimespentonprojectswhereyoudevelopedtheknowledge,skills,

and abilities in the tasks typically performed in structural designs of signiﬁcant structures or the structural systems

integrated within signiﬁcant structures. RCW18.43.020(11)

Special note to EXAM applicants:

YoumustsubmityourapplicationbyJanuary15fortheAprilexam;orJuly31fortheOctoberexamadministration.

Special note to COMITY applicants:

• SomeUSjurisdictionsmayissueastructuralengineeringlicenseunderconditionsthatarelessstringentthanthe

requirementsofWashingtonState.

• Comitylicensurewillnotbeconsideredunlessvericationofpassingoneofthefollowingexaminationscanbe

obtained:

– TheNCEES16-hourstructuralengineeringexamination(verticalandlateral);or

– TheWesternStates16-hourStructuralExaminationasadministeredbefore1998;or

– AcombinationofNCEESSEIIwithWashingtonStateSEIIIorwithCaliforniaSEIII

• YoucanobtainvericationsforexaminationsandlicensurebyvisitingtheNCEESwebsite:https://verify.ncees.org

• NCEES Council records are not accepted for Structural Engineering Applications.

Instruction checklist

Initialeachitemtoacknowledgeitascompleted.

Structural Engineer Registration ApplicationAllsectionsmustbecompletelylledoutanditmustbesigned

and dated.

Application fee $65non-refundablefeeforexamor$110non-refundablefeeforcomity.

SubmitacompletedStructuralEngineerRegistrationApplicationwithacheckormoneyorder,payabletothe

Department of Licensing.

Structural Engineering Experience and Veriﬁcation You must complete your section of the Experience form

andsendittoyourverier/supervisor.Theveriermustcompletetheirportionandreturnittoyouinasealed

envelopesignedacrosstheap.ThevericationmustbesubmittedwithyourApplication.

I certify that I have read this Instruction checklist and have initialed each item above to acknowledge its completeness.

PRINT or TYPE Name

Date and place signed Signature

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Structural Engineer

Registration Application

Type (check one):

NCEES16-hourStructuralExam–$65

Comity – $110

Applicant

PRINT or TYPE Name (As shown on your PE license) WashingtonPElicensenumber

Mailing address

City State ZIPcode

Date of birth (mm/dd/yyyy) SocialSecuritynumberrequired*

Presentposition Businessname

Businesslocationaddress

City State ZIPcode County

(Areacode)Business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(47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.

Current registration (for comity applicants only)

StatewhereSEexamwastaken SEnumber Issuedate Expirationdate

Experience record summary

Pleaselistthestructuralexperienceyouareverifying.

Project

number

Time period (begin with most recent)

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

Nameofpersonverifyingyourwork

Legal

Answerthefollowing

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

orlandsurveying? .................................................................. Yes No

2. Haveyoueverbeenconvictedoforenteredapleaofnolocontendretoanycriminaloffense? ....... Yes No

IfyouansweredYestoanyoftheabove,pleaseattachanexplanationonanadditionalsheet.

3. Doyouauthorizeanybusinessassociates(pastandpresent)andanygovernmentalagencies

(local,state,orfederal)toreleaseanyinformation,les,orrecordswhichmayberequiredfora

backgroundinvestigation,totheDepartmentofLicensing? .................................. Yes No

4. Do you understand that any false information in this application may constitute cause for the denial,

suspension,orrevocationofyourlicensetopracticeinthestateofWashington? ................. Yes No

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

Signature

Date and place

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Structural Engineer

Experience and Veriﬁcation

Instructions for applicant

Providecompleteexplanationstodescribethetimespentonprojectswhereyoudevelopedtheknowledge,skillsand

abilities in the tasks typically performed in structural designs of signiﬁcant structures or the structural systems

integrated within signiﬁcant structures. RCW18.43.020(11).

• One sentence descriptions are not acceptable.

• Theworkshouldbeprogressiveindifcultyandmagnitude;demonstratingsufcientbreadthandscope,andbe

reectiveofyourabilitytodesignandapplyengineeringprincipleswhereyourjudgmentsanddecisionsaretrustedand

relied upon.

• Theworkexperienceshouldshowthreeofthefourcommonmaterialsused(steel,concrete,wood,andmasonry).

• Describeyourstructuraldesignexperienceofsignicantstructuresbylistingaminimum of three projects in either of

the following categories where you had full or partial responsibility:

– Buildingstructureornon-buildingstructuredesignedinSeismicDesignCategoryDorabove;and/or

– Bridgewithatotalspan(endtoend)of200feet.

– Qualifying experience consists of structural design experience in:

1. Determinationoflateral/gravityforces—seismicand/orwind

2. Selectionofframingsystems

3. Selectionoffoundationsystems

4. Applicationofcoderequirements

5. Multi-storybuildingsorequivalentmulti-levelstructures

Sendthecompletedworkexperiencedescriptionsandvericationform(pages3-8)totheperson(s)verifyingyour

engineering experience. Each project must be veriﬁed. Ifyoursupervisor/verieristhesameformorethanone

project,thatpersoncanchoosetocompletetheirportionofthevericationformonce.Theverier(s)mustcompletetheir

portion and return it to you in a sealed envelope signed across the ﬂap.Thevericationmustbesubmittedwithyour

application.

• Experiencemustbegainedunderthedirectsupervisionofalicensedstructuralengineer,oralicensedprofessional

engineerwiththeauthoritytopracticestructuralengineeringintheirjurisdiction.

• Forworkexperiencetobeacceptedassatisfactory,eachengagementmustbeseparateanddistinct—dualcreditwill

notbeallowedforoverlappingengagements.

Missinginformationorpoorexplanationsofstructuralexperiencewilldelaythereviewandcouldresultinadenialof

yourapplication.Donotassumethatthereisauniversalunderstandingbyreviewersonhowyourexperiencesatises

WashingtonStaterequirements.Do not use jargon or acronyms.

NOTE: All items must be completed for each project listed. Each engagement must be summarized on the forms

provided (“See Attached” is not acceptable). Additional sheets may be added, but not substituted for the form.

Work experience information – applicant complete this section

Applicantname

Employed by

Jobtitle Datesofemployment Averagehoursperweek

From To

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

Veriﬁer business address

City State ZIPcode

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Applicantname

Work experience descriptions – applicant complete this section

Project 1: One sentence descriptions are not acceptable

Project description. Location,type,size,anddenehowthisisasignicantstructure.

General construction type/ project description.ExplainhowyourprojectmeetsIBCSeismicDesignCategoryD.

Primary gravity force resisting system.Usingcommonconstructionmaterials(steel,concrete,wood,andmasonry)

Primary lateral force resisting system.Usingcommonconstructionmaterials(steel,concrete,wood,andmasonry)

Scope of analysis and design responsibilities

Explainyourspecicresponsibilitiesinthegravityandlateralforcesresistingsystemslistedabove

Structural documentation

Explain responsibilities for drawing/speciﬁcation preparation

Construction phase responsibilities

Explainanystructuralconstructionrelatedactivities

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Applicantname

Work experience descriptions – applicant complete this section

Project 2: One sentence descriptions are not acceptable

Project description. Location,type,size,anddenehowthisisasignicantstructure.

General construction type/ project description.ExplainhowyourprojectmeetsIBCSeismicDesignCategoryD.

Primary gravity force resisting system.Usingcommonconstructionmaterials(steel,concrete,wood,andmasonry)

Primary lateral force resisting system.Usingcommonconstructionmaterials(steel,concrete,wood,andmasonry)

Scope of analysis and design responsibilities

Explainyourspecicresponsibilitiesinthegravityandlateralforcesresistingsystemslistedabove

Structural documentation

Explain responsibilities for drawing/speciﬁcation preparation

Construction phase responsibilities

Explainanystructuralconstructionrelatedactivities

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Applicantname

Work experience descriptions – applicant complete this section

Project 3: One sentence descriptions are not acceptable

Project description. Location,type,size,anddenehowthisisasignicantstructure.

General construction type/ project description.ExplainhowyourprojectmeetsIBCSeismicDesignCategoryD.

Primary gravity force resisting system.Usingcommonconstructionmaterials(steel,concrete,wood,andmasonry)

Primary lateral force resisting system.Usingcommonconstructionmaterials(steel,concrete,wood,andmasonry)

Scope of analysis and design responsibilities

Explainyourspecicresponsibilitiesinthegravityandlateralforcesresistingsystemslistedabove

Structural documentation

Explain responsibilities for drawing/speciﬁcation preparation

Construction phase responsibilities

Explainanystructuralconstructionrelatedactivities

LS-651-014(R/4/16)WAPage6of8 (continued on next page)

Applicantname

Instructions to person verifying work experience of applicant

Theapplicantshouldhavesentyoudescriptionsfor1to3projects.Pleaserefertothesedescriptionsfortheverication

below.Aftercompletingyourverication,pleasereturnallpagestotheapplicantinasealedenvelopesignedacrossthe

ap.

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

PRINT or TYPENameofpersoncompletingthisverication Title

Address

City State ZIPcode

(Areacode)Telephonenumber Emailaddress Projectnumbersbeingveried

Professionalregistrationnumber Expirationdate State Branchofengineering

Describeyourlevelofsupervisionovertheapplicant’swork.Ifyouarenottheapplicant’ssupervisor,pleaseexplain

yourworkingrelationshiptotheapplicantandhowyouareabletoprovidethisverication.

IfyouarenotlicensedasastructuralengineerinWashingtonState,pleasedescribeyoursubstantialstructural

experienceandthejurisdictionswhereyouhavelawfullypracticed.

Howdoestheapplicant’sdescriptionsofexperience,includingthescopeandcomplexityoftheworkmatchyourevaluation.

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Applicantname

During this time of employment, how long has the applicant been in a position

ofmakingstructuralengineeringjudgmentsanddecisions? .................... years/months

Provideexamplesofengineeringjudgmentordecisionsmadebytheapplicantintheprojectsyouareverifying.

Provideanyadditionalinformationthatwillassistinthedeterminationofthisapplicant’seligibilityforlicensureasa

structural engineer:

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 and the statements given regarding myself are true and correct.

Date and place Signature

Please afx your stamp or seal in the space below. If no stamp or seal is available, attach a copy of your current

license. If the stamp/license cannot be provided, please give a detailed explanation.

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