Nevada State Board Of Professional Engineers And Land Surveyors Page 2
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26. Please comment on the applicant relating to the specific projects and experience listed above:
:__________________________________________________
Engineering knowledge and ability
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
:_____________________________________________
Ethics in dealing with clients and the public
__________________________________________________________________________
__________________________________________________________________________
____________________
State your opinion regarding accuracy of applicant’s descriptions of experience:
__________________________________________________________________________
__________________________________________________________________________
7. Do you or did you have supervision or review and approval responsibility over applicant’s work? Yes__ No__
If yes, how long? __________ Comments: _____________________________________________________
__________________________________________________________________________
8. The Board will appreciate any additional information you can share regarding this applicant’s appropriateness
______________________________________________
for licensing as a Professional Engineer.
___________________________________________________________________________
___________________________________________________________________________
I, the undersigned, certify that the reference given on this form is true and complete to the best of my knowledge.
I am currently licensed as a Professional Engineer in the State of __________________
(List only your primary state
if licensed in multiple states)
My license number in that State is ___________________and expires on ___/___/___.
I practice in the specific area of _____________________engineering.
Please Print the following:
Your Name:____________________________________________________________
Your Firm: ______________________________________________Your Title: _________________________
Address: __________________________________________________________________________________
City: ______________________________________________State:__________ Zip:______________________
Signed: ______________________________________________________ Date: ________________________
Email address: _________________________________
Please affix your wet stamp or seal in the
space provided to the right.
If necessary, other forms of Proof of Licensure may be
substituted (such as a photocopy of your current ID
Pocket Card ).
Thank you for your assistance.
11/98
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