Nevada State Board of Professional Engineers and Land Surveyors
1755 E. Plumb Lane, Suite 135
Reno, NV 89502
is seeking licensure as a (discipline) ___________________________ Engineer in Nevada and has sent you this
request for a professional reference. We understand that you are a Licensed Professional Engineer (license may
be in any state) and have personal knowledge of the applicant’s engineering work, character and ethics. Please
complete, sign, then stamp or seal this form. Place it in an envelope; seal and sign the envelope according to the
instructions, then return the envelope to the Board office. This Reference is confidential and will not be accepted
by the Board if not properly completed as instructed. THE NEVADA BOARD HAS ON FILE A NOTARIZED
AFFIDAVIT RELEASING ALL REFERENCES, EMPLOYERS AND FORMER EMPLOYERS, NAMED BY THE
APPLICANT, FROM ALL LIABILITY FOR ANY DAMAGE WHATSOEVER FOR GIVING INFORMATION AS
REQUIRED ON THIS FORM.
Applicant: Describe up to 3 projects you had full or partial responsibility for while working with this professional
engineer. Include dates, locations, and descriptive statements defining design work performed.
(Attach an additional sheet if more space is needed)
Please relate your responses about the applicant to the projects and time frame he/she has listed above.
1. How long have you personally known this applicant? ___yrs. ___mos. During what time frame?____________
What was or is the relationship? Co-worker _____ Business Associate _____Friend _____ Relative _____
2. Do you believe the applicant has had:
Four years of preparatory/sub-professional experience?
Formal education in Engineering?
Four years of responsible Engineering experience in the discipline he/she is applying for?
3. Please comment on the applicant’s character, personal, and professional reputation:
4. Would you recommend this applicant for licensure as a Professional Engineer?
5. Would you be willing to employ the applicant to do responsible Engineering work?
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