Land Surveyor Work Verification Form 1999 Page 2
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2STATE OF ALASKA
DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
BOARD OF REGISTRATION FOR ARCHITECTS, ENGINEERS AND LAND SURVEYORS
P.O. BOX 110806
JUNEAU, ALASKA 99811-0806
(907) 465-2540
E-mail: license@dced.state.ak.us
LAND SURVEYOR WORK VERIFICATION
SOCIAL SECURITY NO. (Optional):
NAME:
COMPANY:
(Applicant)
(Employer)
(NOTE: If you have a work verification file open with the board, identify your Applicant File Number
______. If you need information regarding opening a file, contact the division at the above address.)
SUPERVISOR:
DATES OF EXPERIENCE:
(Calendar Dates)
WORK EXPERIENCE (in Months)
(To be completed by applicant)
Date(s)
Date(s)
FIELD
From/To
OFFICE
From/To
Control or Geodetic Surveys
Boundary Computations
Topographic Surveys
Field Note Reduction
Staking Property Boundaries
Subdivision Design & Property
(Location & Monumentation)
Description Preparation
Construction Layout
Survey Project Administration
(including Building Trades experience)
(as Project Manager)
Professional Judgment Decisions
Plat & Deed Research
Regarding Placement of Lines or
(Title Research)
Corners
Other (Explain Below):
Other (Explain Below):
EXPLANATION of "Other" Field or Office Experience (Use a separate page if necessary)
4
4
4
4
Supervision of Field Party:
Yes
No
Supervision of Office Personnel:
Yes
No
Estimated Percentage of Time Supervising:
Field Party:
Office:
APPLICANT
NOTE: No more than 12 months education or experience may be counted in any 12-month period. If you went to school
full-time for a school year, you may count that time as a full year for education, but no summer experience may be
counted toward "work experience."
It is recommended that surveying employees have this sheet completed approximately every year, thus limiting the
research time required to verify experience. Employees may request that a copy of the completed form be placed in their
employer's personnel file in case a backup copy is needed in the future. Original work verifications should be
submitted directly to the Alaska Board of Registration for Architects, Engineers and Land Surveyors (AELS) by
the Supervisor or Professional Licensee certifying the work experience.
08-4412a (New 11/99)
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