A. Name of Organization: Address: Postal Code: Professional Engineers & Geoscientists Newfoundland & Labrador (PEGNL) P.O. Box 21207, St. John's, NL, Canada, A1A 5B2 Tel (709) 753-7714 Fax (709) 753-6131 E-mail: main@pegnl.ca Application for Permit to Practice (Please Print or Type) Telephone No: ( ) Fax No: ( ) E-Mail: Head Office: Branch Offices: B. Type of Organization: Sole Proprietorship Partnership Association of Persons Corporation Joint Venture C. Average number of full time employees in your organization in the following categories: Category Resident in NL Resident Outside NL Professional Engineers Engineers-in-Training Professional Geoscientists Geoscientists-in-Training Technical Other
D. If a Permit to Practice is granted, the Organization will engage in: Engineering Work Geoscientific Work E. Is your principal activity consulting engineering and/or consulting geoscience: Yes No F. Name in full and address of all Partners, Members or Association of Persons, Directors of the Corporation, as the case may be, and Company Officers. If the organization is a joint venture, provide a list of all members of the joint venture. (Use separate sheet if necessary). Name Address Position G. PLEASE NOTE: All Permit to Practice applications are reviewed by the PEG Board of Examiners. The Board requires a detailed description and scope of the professional services that the Permit Holder (Company) intends to offer in or for the province of Newfoundland and Labrador, including fields of specialization and current projects.
H. GUIDELINES FOR COMPLETION OF THE PERMIT TO PRACTICE APPLICATION FORM. It is a requirement of PEG that its members not practise in areas or disciplines of engineering or geoscience for which they do not have the necessary academic training and experience. Some members and licensees have, through a combination of continuing training and experience, acquired the additional skills needed to practice in an area or discipline other than that for which they were initially trained. The Board will consider that Permits covering these additional areas or disciplines be issued only upon full substantiation and documentation of the necessary training and experience. The Board will grant Permits to Practice to firms based on demonstration of current practical experience by the person accepting responsibility for the discipline DISCIPLINE(S) The table of disciplines (following page) is used to identify Primary disciplines for which the Permits to Practice may be granted. Applicants requesting Permits for the sub-disciplines will generally be evaluated against the Primary discipline. Permits will not generally be granted for sub-disciplines. I. PROFESSIONAL LIABILITY INSURANCE In accordance with the Engineers and Geoscientists Act 2008, section 12. (3), all permit holders must carry professional liability insurance. Before we may grant a permit, PEGNL By- Law No. 2 requires that you supply proof of your company s insurance coverage (insurance certificate required). By-Law No. 2 (available on www.pegnl.ca) prescribes the requirements for satisfactory proof of insurance.
J. In order to be granted a Permit to Practice, an Organization must have one or more full-time employees, (see guidelines) who hold professional registration to practise Engineering/Geoscience in Newfoundland and Labrador in each discipline for which the permit is being requested. List below the names of these persons and indicate the discipline (from item H) in which they work. Member or Licensee Name of Registered Person(s) Discipline Registration Category 1. P. Eng. 2. P. Eng. 3. P. Eng. 4. P. Eng. 5. P. Eng. 6. P. Eng. It is required that all Professional Engineers/Geoscientists who seal your drawings and/or specification are listed in section I. All Engineers/Geoscientists listed in section I and all other Engineers/Geoscientists practicing in Newfoundland and Labrador must be registered with PEG. If any such Engineer/Geoscientist working with your firm is not registered as a Professional Engineer/Geoscientist, either as a Professional member (Canadian citizen) or as a Licnesee (not a Canadian citizen and who holds a License to Practice), he/she should immediately apply for individual membership in PEG. K. Member-In-Responsible Charge The Board of Examiners require a recent copy of a CV (Resume) from each of the Professionals listed in section I above, which clearly indicates the detail of their academic qualifications and experience in the discipline field that they have been requested to be added to accept responsibility for. Along with this, each Professional must complete the PEG Personal Profile Form (copies attached).
L. Certification by an officer of the organization. I hereby certify the above information to be true and correct. Name of Organization: Name: Title: Signature: Date: NOTE: Any change in the particulars given on this form must be submitted to the Registrar within fifteen (15) days after the effective date of change, e.g. the resignation of a P. Eng. or Upon approval of Permit to Practice, a Permit Holder Stamp will be issued. 12 Declaration