2447 Cap Exam Application Form Page 2
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3B. VERIFICATION OF EMPLOYMENT IN POSITION OF RESPONSIBLE CHARGE
(This form is completed only if your eligibility for CAP was based on ten (10) years work experience in automation without a
four year technical degree).
A Verification of Employment in Position of Responsible Charge form should be completed by your current and/or former supervisor(s) if
you are documenting ten (10) years of automation experience of which at least two (2) years must be in a position of responsible charge.
Two (2) references from individuals who can attest that you have had at least two (2) years experience in a position of responsible charge
should be submitted using this form. Duplicate this form as necessary to document your work experience. Provide original, signed forms
as faxed, photocopied, or electronic signatures do not qualify. Responsible charge relates to the span or degree of control an
automation professional has to maintain while exercising independent control and direction of professional automation work, and to the
level of decisions being made. Responsible charge does not refer to management control or administrative functions such as accounting,
labor relations, or marketing. The span of control necessary to be considered in a position of responsible charge includes:
• Personally makes critical automation project decisions, or reviews and approves proposed decisions prior to implementation,
including consideration of alternatives
OR
• Judges the quality of other technical specialists and the validity and applicability of their recommendations before such
recommendations are incorporated in the work
______________________________________________________________________________________ was employed as a(n)
name of candidate
________________________________________________________________________________________________________
title of candidate while employed
in _____________________________________________________ at _____________________________________________
name of company/organization
location
from ____________________
____________________ to ____________________
____________________.
month
year
month
year
The candidate was directly involved in a position of responsible charge including the following activities during the above period
of employment:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
I, _________________________________________________________________________________________________________, attest to this
name of supervisor/co-worker
as the _________________________________________________________________________________________________________________
title of supervisor/co-worker
on this the ___________ day of _____________________________.
date
month year
_________________________________________________
____________________________________
_____________________________
signature of supervisor/co-worker
e-mail
telephone
Return this form to:
ISA
CAP Program Audit
PO Box 12277
Research Triangle Park, NC 27709 USA
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