Professional Engineering
Professional Engineering
Professional Engineering
Professional Engineer
Fundamentals of Engineering - Examination
Enrolled Engineer Intern - Acceptance of Examination
Principles and Practice - Examination
Licensure - Acceptance of Examination
Endorsement
Restoration
Do NOT Use This Application:
To apply for licensure as a strucural engineer OR
To take the Fundamentals of Engineering examination after graduating with a baccalaureate degree from an
ABET-EAC accredited engineering program OR
To take the Fundamentals of Engineering examination if you are in the final year of a baccalaureate degree program
from an ABET-EAC accredited engineering program OR
If your degree is a Technology degree. A degree in engineering technology does not meet the educational requirements
in Illinois.
Table of Contents
Page #
Additional application forms can be downloaded from the IDFPR Web site at www.idfpr.com.
DPR-I-PE -- Instructions Revised 9/14
baccalaureate degree from a non-approved engineering program or a related science curriculum and
have passed the Fundamentals of Engineering examination. OR
To apply for LICENSURE by acceptance of examination - ALL APPLICANTS who have satisfied the
education, experience, and examination requirements and are not licensed in another state or territory OR
To apply for LICENSURE by Endorsement (for those actively licensed in another state or territory) OR
To apply for RESTORATION of licensure.
GENERAL INFORMATION
To apply under the provisions of the Illinois Professional Engineering Practice Act of 1989, read and follow
each of the steps in the order they are listed. This will aid you in accurately completing your application and thus,
eliminate delays in processing. The application which you submit is valid for 3 years from date of receipt. If you are
issued a license, please be advised your license will expire on November 30 of each odd-numbered year and must
be renewed at that time.
Note: The Division licenses Professional Engineers in Illinois pursuant to the provisions of the Professional Engineering Practice Act of 1989 and Administrative Rules. The Division licenses Structural Engineers pursuant to
the provisions of the Structural Engineering Practice Act of 1989. The regulations are independent and unique, and
each requires a unique and separate application, supporting documents, and fee.
Applicants must complete the 4-page Application for Licensure/Examination and submit it with the supporting
documents required by the method under which application is being made.
Do not utilize this application if you are offering only structural services.
Professional Engineer - Page 2
Step I -
Part 1A - Application Category Information - Select method of application and complete Part 1A as indicated below:
Profession Name:
Professional Engineer OR Engineer Intern
Profession
Code
Licensure Method
Fee
Fundamentals of Engineering
061
Examination
$20 *
061
Acceptance of
Examination
062
Examination
$100 *
062
Examination
$100 *
Professional Engineer
062
Acceptance of
Examination
$100
Professional Engineer
062
Endorsement of License
$100
Professional Engineer
062
Restoration of License
$20
**
Part 1B - Check the box indicating the appropriate information regarding your application.
Part II - Applicant Identifying Information - Enter all applicable information requested. You must include your social
security number in Part II, box number three (3).
Part III - Education Information:
Numbers 1 through 5 - Enter all applicable information requested.
Number 6 - Indicate all post secondary education. Please indicate beginning and
ending dates by month/year.
Part IV - Record of Licensure Information - Enter all applicable information requested if you have ever held a license
as a professional engineer, engineer intern, or a related license.
Part V - Record of Examination - Enter dates (month/year) that you passed the Fundamentals and/or Principles
and Practice of Engineering examinations or any other licensing examination in Illinois or any other jurisdiction, indicate this in Part V (page
three) of the application.
Part VI - Personal History Information - Must be completed by all applicants.
Part VII - Examination Coding Information - DO NOT COMPLETE PART VII (page four) of the Application for Licensure and/or Examination.
Part VIII - Child Support & Student Loan Information - Must be completed by all applicants.
Part IX - Certifying Statement - Read the certifying statement then sign and date your application.
Evaluation or the Engineering Credentials Evaluation International (ECEI) or the American Association of
Collegiate Registrars and Admissions Officers (AACRAO). Official transcripts must be forwarded directly to
the NCEES or the AACRAO from the educational institution.
Note: The Board has only approved the NCEES Credentials Evaluation and the ECEI, a division of the Accreditation Board for Engineering and Technology (ABET) for evaluation of foreign engineering baccalaureate
degrees; AACRAO for related science or non-approved baccalaureate degrees.
Proof of completion of the Test of English as a Foreign Language internet Based Test (TOEFL-iBT) with a
minimum integrated score of 88 and a minimum score of 26 on the speaking module, or the Test of English
as a Foreign Language (TOEFL) with a score of 550 for the paper-based examination or 213 for the computer based test, AND the Test of Spoken English (TSE) with a score of 50 for all applicants who graduated
from an engineering program outside the United States or its territories and whose first language is not
English. In order to determine countries whose first language is English, the applicant shall submit
verification from the college or university that the engineering program from which the applicant graduated
was taught in English.
NCEES Credentials Evaluation www.ncees.org
Mailing Address: NCEES
P.O. Box 1686
Clemson, SC 29633
OR
The Engineering Credentials Evaluation International (ECEI).
Engineering Credentials Evaluation International
111 Market Place #1050
Baltimore, MD 21202
Ph (410) 347-7700; FAX (410) 625-2238;
E-mail: international-relations@abet.org;
Website: www.abet.org/ecei/
Although ECEI no longer accepts new applications for evaluations, if you previously obtained an ECEI evaluation,
you may contact them to request a duplicate evaluation to be submitted to:
The Department of Financial & Professional Regulation
320 West Washington Street, 3rd Fl /Design Unit
Springfield, IL 62786
To obtain an evaluation for a related science or a non-engineering baccalaureate degree contact American Association of Collegiate Registrars & Admissions Officers (AACRAO):
American Association of Collegiate Registrars & Admissions Officers
One DuPont Circle NW, Suite 520
Washington, DC 20036-1110
Telephone: 202-293-9161
Website: www.aacrao.org
Professional Engineer - Page 4
OR
The Department will ONLY accept TOEFL and TSE or TOEFL-iBT. Other services for a test of English are
not acceptable.
Step III - Fee - Payment must be in the form of a check or money order made payable to :
Illinois Department of Financial and Professional Regulation
Professional Engineer - Page 5
Step IV - Mail Application - Forward 4-page application, supplemental documents, and fee to:
Illinois Department of Financial and Professional Regulation
ATTN: Division of Professional Regulation, Design/PSS4
P.O. Box 7007
Springfield, Illinois 62791
For those in the categories above, apply directly to Continental Testing Services, Inc.
To qualify for the examination you must satisfy the education requirements PRIOR TO REVIEW BY THE BOARD.
In addition to the 4-page Application for Licensure/Examination mentioned in Step 1 and the fee amount as indicated
in STEP I PART 1A of the general information found on page 3, you must comply with one of the following to
substantiate your qualifications:
If you graduated with a baccalaureate degree in a non-approved engineering curriculum or a related science degree
curriculum, the following documents must accompany your application and fee;
An original official transcript indicating conferral of the baccalaureate degree and listing all course work
of Engineering exam, along with all pertinent examination information. The CT-ENG form may be submitted
with your application, or request the Agency/Board to mail the document directly to this Department.
2) Are a graduate of a non-approved engineering curriculum or a related science baccalaureate degree and
were approved by the Department to sit for the Fundamentals examination under Section 1380.240 of the
Rules and have completed 4 years of engineering experience subsequent to the conferral of baccalaureate
degree. The following documents must accompany your application:
An original official transcript indicating conferral of the degree and listing all coursework completed for your
and must document at least 4 years experience in engineering work subsequent to receipt of baccalaureate
degree. A separate VE-PNG must be submitted for each employer. This document must be filled out and
completed by your supervisor/employer and returned to the Department by the supervisor/employer or
returned to you in a sealed envelope and included with the application.
Supporting documentation of graduate study or co-op as set forth in Step II, page 5 of general instructions.
3) Are a foreign educated graduate (baccalaureate degree), and you have completed the 4 years of engineering
experience since the conferral of the baccalaureate degree. The following documents must accompany
your application and fee:
Evaluation of baccalaureate degree as stated in Step II, page 4.
Proof of TOEFL-iBT as stated in Step II, page 4.
Supporting Document VE-PNG must be completed to provide verification of your employment/experience
and must document at least 4 years experience in engineering work subsequent to receipt of baccalaureate
degree. A separate VE-PNG must be submitted for each employer. This document must be filled out and
completed by your supervisor/employer and returned to you in a sealed envelope and included with the
application.
Note: Applicants will be notified by the Department regarding examination eligibility after review by the Board.
To qualify for the examination you must satisfy the education requirements PRIOR TO REVIEW BY THE BOARD.
In addition to the four-page written application and fee, submit the following documentation:
Supporting document(s) for education You must comply with one of the following to substantiate your
engineering education qualifications:
You are a graduate with a baccalaureate degree from a non-approved engineering program or a related
science curriculum:
An original official transcript indicating conferral of the baccalaureate degree and listing all
course work completed for your degree with school seal affixed. It is suggested that you also
submit official transcripts of all post-baccalaureate level course work, since course work may be
applicable to substantiate your eligibility. OR
If you are a foreign-educated graduate (baccalaureate degree), the following documents must accompany
your application and fee:
A course by course evaluation as stated in Step II, page 4
TOEFL-iBT as stated in Step II, page 4.
Supporting document CT-ENG is required if you hold a certificate of enrollment as an Engineer
neering experience satisfies the requirements for licensure as described in Section 1380.230 (APPROVED
EXPERIENCE). Applicants who graduated from an ABET-EAC approved program with a baccalaureate
degree must provide four (4) years of engineering experience subsequent to the conferral of baccalaureate
degree. Applicants who graduated from a non-approved engineering program or a related science with a
baccalaureate degree must provide eight (8) years of engineering experience subsequent to the conferral of
baccalaureate degree. A separate VE-PNG form must be submitted for each employer. This document must
be completed by your supervisor/employer and returned to you in a sealed envelope and included with the
application.
Supporting documentation of graduate study or co-op as set forth is Step II, page 5 of general instructions.
Supporting document CT-ENG must be completed by the jurisdiction(s) where you passed the Fundamen-
tals of Engineering exam and the Principles and Practice exam, along with all pertinent examination information. The CT-ENG form may be submitted with your application, or request the agency/board to mail the
document directly to this Department. A CT-ENG must be submitted from each jurisdiction where an exam
was passed. (If you passed either or both the exams in Illinois, this is not required).
Fee in the form of a check or money order made payable to the Illinois Department of Financial and Profes-
ENDORSEMENT OF LICENSURE
ALL REQUIRED SUPPORTING DOCUMENTATION MUST BE SUBMITTED
with the required fee unless otherwise directed.
Illinois issues separate licenses for Professional Engineer and Structural Engineer. A structural engineer license is
required to practice structural engineering in Illinois. (Separate application and examination is required.)
Do not utilize this application if you are offering structural services.
To apply for licensure by endorsement, you MUST hold an ACTIVE license/registration as a Professional Engineer
in another U.S. jurisdiction and must have met Illinois requirements at the time of original or subsequent licensure.
The following documents must be submitted:
Properly completed 4-page Application for Licensure/Examination (See page 2). Do not state See NCEES
instructions.
Professional Engineer - Page 9
report of their foreign education credentials, and TOEFL-iBT as stated in Step II, page 4.
NCEES Council Record issued by and forwarded directly to the Department by the NCEES OR the
documents listed in (1) (2) and (3) below. (NOTE: If you submit an NCEES Council Record, you may be
required to submit additional documents).
1) You must comply with one of the following to substantiate your professional engineering education
qualifications:
You are a graduate with a baccalaureate degree from an ABET (EAC) approved engineering
program and have acquired a minimum of four (4) years of engineering experience ubsequent to the
conferral of baccalaureate degree; an official transcript indicating baccalaureate degree awarded and
conferral date with school seal affixed.
You are a graduate of a non-approved engineering program or related science curriculum and have
acquired a minimum of eight (8) years of engineering experience subsequent to the conferral of
baccalaureate degree; an official transcript indicating all course work completed for your baccalaure
ate degree from the college/university attended, with school seal affixed. It is suggested that
you also submit official transcripts of all post-baccalaureate level coursework, since this coursework
may be applicable to substantiate your eligibility.
You are a graduate of an institution located outside the United States and have acquired eight (8)
envelope to be submitted with your application. A separate VE-PNG form is required for each
employer.
3) Supporting Document CT-ENG is required if you hold a certificate of enrollment as an Engineer Intern or registration as a Professional Engineer or Structural Engineer in another state(s) or territory(ies) of
the United States.
The supporting document CT-ENG must be completed by the jurisdiction of original licensure and
the jurisdiction of current licensure where you predominately practice. If examinations were passed
in different jurisdictions, verification from each jurisdiction is required. If an examination was passed
in Illinois, a CT-ENG from Illinois is not required. You must indicate the same in Part IV of the
application. You are authorized to photocopy this document if necessary. The licensing Agency/
Board can return the completed document to you in a sealed envelope to be submitted with your
application or mail it directly to this Department.
Fee in the form of a check or money order made payable to the Illinois Department of Financial and Professional
Regulation. Fee amount is indicated on Reference Sheet - Non-examination.
RESTORATION
ALL REQUIRED SUPPORTING DOCUMENTATION MUST BE SUBMITTED
with the required fee unless otherwise directed.
To restore your Illinois Professional Engineer license which has expired more than five years, you must submit the
application, supporting documents and fee as listed below. Based on the Illinois State Board of Professional
Engineers evaluation of your application, you may be required to submit additional documentation or appear for
a personal interview.
The following documents must be submitted:
Properly completed 4-page Application for Licensure/Examination (see page 3).
Supporting Document RS must be completed. If this form was not included in the application packet, you
must obtain one by contacting the Department of Financial and Professional Regulation at 1-800-560-6420.
Supporting Document CT-ENG must be completed by the jurisdiction of current licensure where you have
most recently been practicing. You are authorized to photocopy this document, if necessary. The licensing
Agency/Board can return the completed document to you in a sealed envelope to be submitted with your
application or they may mail it directly to this Department.
Supporting Document VE-PNG must be completed to provide verification of your employment/professional
experience for at least the last 2 years, or other evidence of continued competency in professional engineering which may include:
a) Proof of passage of the Principles and Practice of Engineering examination within the last 5 years;
b) Lawfully practicing professional engineering as an employee of a governmental agency;
c) Teaching professional engineering in a college or university;
If restoring after active military service, submit a copy of DD214.
All applicants for restoration of a professional engineer license in Illinois must submit proof of having com-
pleted 30 professional development hours in accordance with Section 1380.325 of the Rules for Administration of the Professional Engineering Practice Act of 1989 within 24 months prior to restoration. This must
be verified by the submission of certificates of attendance provided by acceptable providers of structured
educational programs.
Fee in the form of a check or money order made payable to the Department of Financial and Professional
Regulation. Fee amount is indicated in the "Official Use Only" box of Supporting Document RS.
~ IMPORTANT NOTICE ~
These Restoration instructions apply only to those professional engineers whose licenses have been on inactive
status, or in not-renewed status, for five or more years.
If your license has been inactive, or in not-renewed status, for less than five years, you should contact the
Department of Financial and Professional Regulation at 1-800-560-6420 for detailed instructions on how to
restore it to active status.
This chart contains fee information for licensure by endorsement of a license issued in another jurisdiction and for restoration of a lapsed license. If you require information concerning the application fee for licensure by examination and the
final filing deadline date, contact the Department.
PROFESSION NAME
PROFESSION
CODE
LICENSURE
METHOD
APPLICATION
FEE
Professional Engineer
062
Endorsement
$100.00
Professional Engineer
062
Restoration
An application submitted without the application fee will be returned for resubmission with the appropriate fee.
If assistance is needed, direct your request to one of the following telephone numbers:
217/782-8556
Telecommunicative Device for the Deaf (TDD) - 217/524-6735
Please allow 3 weeks from mailing your application before making an inquiry concerning its status.
DPR-PE-NON 04/06
COMPLETED
Application Fee
SUPPORTING DOCUMENTS
SUBMITTED
APPLICATION FOR
LICENSURE AND/OR EXAMINATION
IMPORTANT NOTICE: Completion of this form is necessary for consideration for licensure
under 225 of the Illinois Compiled Statutes. Disclosure of this information is VOLUNTARY.
However, failure to comply may result in this form not being processed.
1.
4. FEE
$
B. CHECK BOX INDICATING THE APPROPRIATE INFORMATION REGARDING YOUR APPLICATION
Other:
PART II:
1. NAME
Applicant Identifying Information--You must notify the Department of Financial and Professional Regulation Division of Professional Regulation and/or Continental Testing Service in writing, of any address changes after you
file this application in order to receive any further information.
LAST
FIRST
5. BUSINESS ADDRESS
MIDDLE
STREET
STREET
CITY
STATE/COUNTRY
ZIP CODE
COUNTY
CITY
STATE/COUNTRY
ZIP CODE
COUNTY
CITY
STATE/COUNTRY
9. DATE OF BIRTH
Month
Day
10. AGE
Year
Work: ( __ __ __ ) __ __ __ __ __ __ __ __
Home: ( __ __ __ ) __ __ __ __ __ __ __ __
(Area Code)
Fax:
( __ __ __ ) __ __ __ __ __ __ __
(Area Code)
__
(Area Code)
Female
Male
Fax:
( __ __ __ ) __ __ __ __ __ __ __ __
(Area Code)
APPLICATION FOR LICENSURE AND/OR EXAMINATION - Page 1 of 4
Additional application forms can be downloaded from the IDFPR Web site at www.idfpr.com.
1. PRELIMINARY EDUCATION (Elementary and High School or G.E.D. Circle number of years completed)
1 2 3 4 5 6 7 8 9 10 11 12
2. NAME OF LAST PRELIMINARY SCHOOL
ATTENDED
Graduated
High School?
Yes
Received
OR G.E.D.?
No
Yes
No
4. DATE OF GRADUATION
Month
Year
1 2 3 4 5 6 7 8
6. COLLEGE OR UNIVERSITY NAME
(Undergraduate and Graduate)
Graduated?
Yes
LOCATION
(City and State or Country)
No
DATES OF ATTENDANCE
FROM
TO
Month/Year
Month/Year
7. SPECIALIZED TRAINING (Residency, Professional Training, Vocational Training, Practical or Clinical Training)
DATES OF ATTENDANCE
LOCATION
INSTITUTION NAME
(City and State or Country)
TO
FROM
Month/Year
IL486-1019
TYPE OF
DEGREE EARNED
Month/Year
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If you have ever been licensed to practice the profession for which you are now making application, or held a related license, complete
the information requested below. If you have ever held a temporary, trainee or apprenticeship license, or a permit, it must be listed here
also. In addition, the INSTRUCTION SHEET enclosed with this Application package may instruct you to have Certification(s) of Licensure in other state(s) prepared and submitted in support of your application (contact other state(s) regarding possible fee). You must
also list all other licenses held in Illinois, however, certification of licensure from Illinois is not required. Failure to disclose all licenses
held may result in denial of your application or other appropriate action.
STATE
PROFESSION NAME
LICENSE NUMBER
DATE OF
ISSUANCE
LICENSE STATUS
(Active, Lapsed, etc.)
STATE
MONTH/YEAR
EXAM RESULTS
(Passed, Failed, Absent)
YES NO
1. Have you been convicted of or pled guilty or nolo contendere to any criminal offense in any state or in federal court? Please do not give
details on minor traffic charges, but do include information relating to Driving While Intoxicated (DWI) charges. If yes, attach a certified
copy of the court records regarding your conviction, the nature of the offense and date of discharge, if applicable, as well as a statement
from the probation or parole office.
2. Have you been convicted of a felony?
3. If yes, have you been issued a Certificate of Relief from Disabilities by the Prisoner Review Board? If yes, attach a copy of the certificate.
4. Have you had or do you now have any disease or condition that interferes with your ability to perform the essential functions of your profession, including any disease or condition generally regarded as chronic by the medical community, i.e., (1) mental or emotional disease
or condition; (2) alcohol or other substance abuse; (3) physical disease or condition, that presently interferes with your ability to practice
your profession? If yes, attach a detailed statement, including an explanation whether or not you are currently under treatment.
5. Have you been denied a professional license or permit, or privilege of taking an examination, or had a professional license or permit
disciplined in any way by any licensing authority in Illinois or elsewhere? If yes, attach a detailed explanation.
6. Have you ever been discharged other than honorably from the armed service or from a city, county, state or federal position? If yes, attach
a detailed explanation.
PART VII: Examination Coding Information (This part is for examination applicants only)
Refer to the REFERENCE SHEET enclosed with this application package and complete the following:
a) CHART II -
b) CHART III -
Select the examination site you desire and enter Test Center Code:
c) CHART IV -
d) Record the number of times you have taken this exam in Illinois or any other state:
PART VIII: Child Support and/or Student Loan Information (Every applicant is required by law to respond to the
following questions)
1.
In accordance with 5 Illinois Compiled Statutes 100/10-65(c), applications for renewal of a license or a new license shall include the applicant's
Social Security number, and the licensee shall certify, under penalty of perjury, that he or she is not more than 30 days delinquent in complying
with a child support order. Failure to certify shall result in disciplinary action, and making a false statement may subject the licensee to
contempt of court.
Are you more than 30 days delinquent in complying with a child support order?
(NOTE: If you are not subject to a child support order, answer "no.")
2.
Yes
No
In accordance with 20 Illinois Compiled Statutes 2105/2105-(5), "The Department shall deny any license or renewal authorized by the Civil
Administrative Code of Illinois to any person who has defaulted on an educational loan or scholarship provided by or guaranteed by the Illinois
Student Assistance Commission or any governmental agency of this State; however, the Department may issue a license or renewal if the
aforementioned persons have established a satisfactory repayment record as determined by the Illinois Student Assistance Commission or other
appropriate governmental agency of this State." (Proof of a satisfactory repayment record must be submitted.)
Are you in default on an educational loan or scholarship provided/guaranteed by the Illinois
Student Assistance Commission or other governmental agency of this State?
PART IX:
Yes
No
Certifying Statement
Under penalties of perjury, I declare that I have examined the application and all supporting documents submitted by me
in connection therewith, and to the best of my knowledge, they are true, correct, and complete.
Signature of Applicant
Date
I UNDERSTAND THAT FEES ARE NOT REFUNDABLE. My signature above authorizes the Department of Financial and Professional
Regulation to reduce the amount of this check if the amount submitted is not correct. I understand this will be done only if the amount
submitted is greater than the required fee hereunder, but in no event shall such reduction be made in an amount greater than $50.
IL486-1019
PART VI: Personal History Information (This part must be completed by all applicants)
APPLICANT:
1.
NAME
SUPPORTING DOCUMENT
CERTIFICATION BY LICENSING
AGENCY/BOARD
CT-ENG
Complete the applicant section of this form then forward this form to the state or territory in which
you are requesting certification of your examination status, license or examination scores. Contact
the certifying jurisdiction for appropriate fee. Photocopying this form is permissable.
LAST
FIRST
MIDDLE
2.
DATE OF BIRTH
3.
__ __ / __ __ / __ __ __ __
4.
5.
6.
7.
Month
Day
Year
REFER TO REFERENCE SHEET. Record profession name and three
digit profession code for which you are making Illinois application.
Profession Name
APPLICANT TELEPHONE NUMBER
Area Code (
8.
Profession Code
COMPLETE THE FOLLOWING INFORMATION REGARDING YOUR REQUEST, INDICATE ALL PROFESSIONS FOR WHICH A CERTIFICATION IS BEING REQUESTED.
PROFESSION
LICENSE NUMBER
ISSUANCE DATE
Engineer Intern
Professional Engineer
Structural Engineer
I hereby authorize
Financial and Professional Regulation or its designated testing service, the information requested below.
Signature
LICENSING AGENCY:
Date
The Illinois Department of Financial and Professional Regulation will accept other forms of
certification provided all applicable information requested on this form is contained in the
Certification. Please record N/A in areas which are not applicable. Return the completed
form to the applicant in a sealed envelope to be submitted with the application.
LICENSE NUMBER
ISSUANCE DATE
EXPIRATION DATE
Engineer Intern
Professional Engineer
Structural Engineer
B. LICENSURE METHOD
Active
Inactive
Lapsed
Other (Explain)
Written
Practical
Oral
Essay
SUBJECT
DATE OF
EXAMINATION
SCORE
Engineer Intern:
NCEES Fundamentals of Engineering
Other:
Professional Engineering:
NCEES Principles and Practice
Other:
Discipline
Structural Engineering:
NCEES Structural I
NCEES Structural II
State Constructed Structural Examination
Have there ever been any formal sanctions imposed against the applicant as a matter of public
record including but not limited to fine, reprimand, probation, censure, revocation, suspension,
surrender, restriction or limitation? (If yes, attach a certified copy of disciplinary action.) Yes
No
I certify that the information contained herein is true and correct according to the official records of the State.
Print Name
Title
Signature
SEAL
Agency/Board Street Address
Date
Area Code (
City, State, ZIP Code
IL486-0872 04/06 (PE)
)
Telephone Number
SUPPORTING DOCUMENT
APPLICANT:
1. NAME
VERIFICATION OF
EMPLOYMENT / EXPERIENCE
Complete the application section of this form. Forward the form to the professional supervisor from whom you
obtained your experience. Your supervisor must return the completed form to the applicant in a sealed envelope
to be submitted with the application. If additional forms are needed, you are authorized to photocopy this form.
LAST
FIRST
MIDDLE
2. DATE OF BIRTH
__ __ / __ __ / __ __ __ __
4. ADDRESS
VE-PNG
STREET,
CITY,
STATE,
__ __ __ - __ __ - __ __ __ __
Month
Day
Year
5. REFER TO REFERENCE SHEET. Record profession name and
three digit profession code for which you are making Illinois application.
ZIP CODE
Profession Name
6. MAIDEN OR GIVEN SURNAME
7. SUPERVISOR NAME
8. DATES OF EMPLOYMENT
From __ __ / __ __ / __ __ __ __ To __ __ / __ __ / __ __ __ __
Month
Day
Year
Month
Day
Year
TO SUPERVISOR FROM APPLICANT
I am applying for the ___________exam. This form needs to be submitted to the Department by
May 15
Nov. 15
SUPERVISOR: Complete the remainder of this form. Return the completed form to the applicant in a sealed envelope to be submitted with the application.
NOTE:
The supervisor does not have to be licensed, if exempt by statute, but must have direct supervision and control over the engineering activities of the applicant. The Board will rely on your
answers to the following questions in determining whether or not this applicant should be approved to take the examination or issued a license as a professional engineer in Illinois. Please
recognize the importance of this information and give due care to your responses.
B. EMPLOYER'S NAME
E. STATE OF REGISTRATION
Area Code (___ ___ ___) ___ ___ ___ _ ___ ___ ___ ___
PART II - APPLICANT EMPLOYMENT INFORMATION
B. TOTAL TIME EMPLOYED
A. TYPE OF EMPLOYMENT
Full-time
Part-time
____Years
____Months
From __ __ / __ __ / __ __ __ __ To __ __ / __ __ / __ __ __ __
Month
Day
Year
Month
Day
Year
D. DESCRIBE ENGINEERING WORK/PROJECTS IN WHICH THE APPLICANT WAS ENGAGED. SEE DEFINITION ON REVERSE SIDE. (Attach additional sheet if more space is required.)
E. Record any additional comments that may be beneficial in determining licensure for this applicant.
F. In your opinion, is there any reason why the applicant should not be licensed to practice the profession of professional engineering?
Yes
No If "Yes," explain:
I do hereby declare that this applicant was employed by me or worked under my personal supervision for the time
period(s) listed and that the information I have reported herein is true and correct to the best of my knowledge.
Date
Signature
The definition of Professional Engineering as revised by the 225 Illinois Compiled Statutes 1992, 325/4. Definitions.
In this Act:
(n) "Professional Engineering" means the application of science to the design of engineering systems and facilities using the knowledge, skills,
ability and professional judgment developed through professional engineering education, training and experience.
(o) "Professional Engineering practice" means the consultation on, conception, investigation, evaluation, planning, and design of, and selection
of materials and methods to be used in, administration of construction contracts for, or site observation of an engineering system or facility, where
such consultation, conception, investigation, evaluation, planning, design, selection, administration, or observation requires extensive knowledge of
engineering laws, formulae, materials, practice, and construction methods. A person shall be construed to practice or offer to practice professional
engineering, within the meaning and intent of this Act, who practices, or who, by verbal claim, sign advertisement letterhead, card, or any other
way, is represented to be a professional engineer, or through the use of the initials "P.E." or the title "engineer" or any of its derivations or some
other title implies licensure as a professional engineer, or holds himself out as able to perform any service which is recognized as professional
engineering practice.
Examples of the practice of professional engineering include, but need not be limited to, transportation facilities and publicly owned utilities for a
region or community, railroads, railways, highways, subways, canals, harbors, river improvements; irrigation works; aircraft, airports and landing
fields; waterworks, piping systems and appurtenances, sewers, sewage disposal works; plants for the generation of power; devices for the utilization
of power; boilers; refrigeration plants, air conditioning systems and plants; heating systems and plants; plants for the transmission or distribution
of power; electrical plants which produce, transmit, distribute, or utilize electrical energy; works for the extraction of minerals from the earth; plants
for the refining, alloying or treating of metals; chemical works and industrial plants involving the use of chemicals and chemical processes; plants
for the production, conversion, or utilization of nuclear, chemical, or radiant energy; forensic engineering, geotechnical engineering including,
subsurface investigations; soil classification, geology and geohydrology, incidental to the practice of professional engineering; energy analysis,
environmental design, hazardous waste mitigation and control; recognition, measurement, evaluation and control of environmental systems and
emissions; automated building management systems; or the provisions of professional engineering site observation of the construction of works
and engineering systems. Nothing contained in this Section imposes upon a person licensed under this Act the responsibility for the performance
of any of the foregoing functions unless such person specifically contracts to provide it.
IL486-1536 04/06 (LT)