LETTER OF REFERENCE - (F3)

Applicant's Name:
Address:

has applied to this Board for registration as:


Engineer Intern Land Surveyor Intern Architect
Professional Engineer Professional Land Surveyor Landscape Architect

and indicated that you are conversant with his/her qualifications for such registration and/or examination. In order that the applicant's qualifications may be properly evaluated, your assistance in answering the following questions is appreciated.

After completing this form, please sign, stamp or seal and return it in a sealed envelope to the applicant at your earliest convenience as no action will be taken until all references have responded. This Letter of Reference is CONFIDENTIAL and will not be accepted by the Board if not properly filled and sealed. Thank you for your assistance.


Sincerely,


1. How long have you personally known the applicant? Years Months.
2. Are you related to the applicant?  Yes   No
What was or is the relationship?
3. Have you ever employed the applicant?  Yes   No
If yes, describe his duties briefly:
4. Why did the applicant leave your employ?

5. If registered, would you employ the applicant?  Yes   No
6. Please comment on the applicant relating to ethics in dealing with clients and the public:
7. If the applicant was not in your employ, how did you obtain your knowledge of him/her?
 
8. Are you a registered Professional Engineer, Architect, Landscape Architect or Land Surveyor?  Yes   No
If yes, please indicate below:
Engineer Certificate #: State:
Branch:
 Architect Certificate #: State:
 Land Surveyor Certificate #: State:
 Landscape Architect Certificate #: State:
9. Do you consider the applicant professionally qualified to be given the registration and/or examination in which he/she is applying for?  Yes   No
10. Please comment on the applicant’s character, personal and professional reputation:
11. The Board will appreciate any additional information you can share regarding the applicant’s appropriateness for licensing:


I, the undersigned, certify that the reference given on this form is true and complete to the best of my knowledge.
Please PRINT the following:

Your Name:
Your Address:
City: State: Zip Code:



Registrant's Signature Date


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 (e.g. photocopy of your current pocket registration card, certificate, etc).