BOARD OF ENGINEERING OF THE COMMONWEALTH OF DOMINICA

APPLICATION FOR ENGINEER REGISTRATION

A: PERSONAL INFORMATION

Surname: NAME TITLE: MAILING ADDRESS

Mr
Maiden Name: Mrs
Miss
First Name:
Ms
Dr

Other Names: Other:

DATE OF BIRTH ELECTRONIC CONTACTS

Tel
Home Work
Day / Mth / Yr
Fax

NATIONALITY Email

Other:

B: PROFESSIONAL INFORMATION
ACADEMIC QUALIFICATIONS1 FIELD OF STUDY
TITLE OF COURSE/PROGRAMME
Aeronautical
Agricultural
TYPE OF DEGREE DATE OF AWARD Chemical
Civil
NAME OF UNIVERSITY OR POLYTECHNIC Electrical
Industrial
ADDRESS OF UNIVERSITY OR POLYTECHNIC Marine
Mechanical

ACADEMIC QUALIFICATIONS 1 Mining

TITLE OF COURSE/PROGRAMME Metallurgical
Nuclear
TYPE OF DEGREE DATE OF AWARD Petroleum
Project Management
NAME OF UNIVERSITY OR POLYTECHNIC ____________
____________
ADDRESS OF UNIVERSITY OR POLYTECHNIC _______________

C: CATEGORY OF ENGINEERING PRACTICE

This application is for registration in the following field of practice:

Field: ____________________________________________________ Code:________________
With sub-Category Specialisations in:__________________________________ Code:________________
in:_________________________________ Code:________________
Field: ____________________________________________________ Code:________________
With sub-Category Specialisations in:__________________________________ Code:________________
in:_________________________________ Code:________________

1: Attach copies of Certificates

Form 1, Second Schedule Page 1 of 4
 BOARD OF ENGINEERING OF THE COMMONWEALTH OF DOMINICA
APPLICATION FOR ENGINEER REGISTRATION
D: PROFESSIONAL EXPERIENCE
PROFESSIONAL WORKING EXPERIENCE2

Chronological
Dates Employer Position Held Nature of Work

E: MEMBERSHIP OF PROFESSIONAL BODY

NAME AND ADDRESS OF PROFESSIONAL BODY OR GRADE OF YEAR OF

ORGANIZATION MEMBERSHIP ELECTION

2: Attach details where appropriate

3: Sponsor to be a Registered Engineer or a Member of the Dominica Association of Professional Engineers.
Form 1, Second Schedule Page 2 of 4
 BOARD OF ENGINEERING OF THE COMMONWEALTH OF DOMINICA
APPLICATION FOR ENGINEER REGISTRATION

F: DECLARATIONS
I apply for registration as an Engineer under Sections 20, 24 and 25 of the Engineering Profession Act No. 22 of 2002. I
acknowledge that in the event of my registration I will be governed by the said Act and any regulations made thereunder. I
declare the information given on this form is true and correct.

APPLICANT’S: Signature Date

G: SPONSORS
I certify that the applicant is known by me personally for past ______ years, has the requisite qualifications and is a fit and
proper person, in all respects, to become a Registered Engineer. I recommend to the Board of Engineers that, subject to he/she
satisfying the Board’s requirements, he/she be admitted as a Registered Engineer.

Full Name: Registration No.

Sponsor’s3 :
Signature Date

I certify that the applicant is known by me personally for past ______ years, has the requisite qualifications and is a fit and
proper person, in all respects, to become a Registered Engineer. I recommend to the Board of Engineering that, subject to
he/she satisfying the Board’s requirements, he/she be admitted as a Registered Engineer.

Full Name: Registration No.

Sponsor’s3 :
Signature Date

H: FOR OFFICIAL USE ONLY

The Board of Engineering has accepted/rejected this application for Registration

in the following fields and Sub-Categories:

Field: ______________________________________________________ Code:________________

With sub-Category Specialisations in:__________________________________ Code:________________
in:_________________________________ Code:________________
Field: _____________________________________________________ Code:________________
With sub-Category Specialisations in:__________________________________ Code:________________
in:_________________________________ Code:________________

on _____, ______________ 20___. Registration Number:

Secretary, Date
Board of Engineering

2: Attach details where appropriate

3: Sponsor to be a Registered Engineer or a Member of the Dominica Association of Professional Engineers.
Form 1, Second Schedule Page 3 of 4
 BOARD OF ENGINEERING OF THE COMMONWEALTH OF DOMINICA
APPLICATION FOR ENGINEER REGISTRATION

Notes:
In accordance with clause 24 of the Engineering Profession Act, No. of 2001, of the Commonwealth of Dominica,
the Board of Engineering lists hereunder the qualifications and institutions recognised by the Board in respect of the
engineering training required by the Act:-
i) Bachelor of Science in Engineering, University of the West Indies.
ii) Approved institutions in the published list – Commonwealth Engineering Council – headquartered in
England.
iii) Those listed by the Accreditation Board for Engineering and Technology – headquartered in the U.S.A.
iv) Other qualifications and institutions considered and approved by the Board.

The following fields of and sub specialisations are recognised by the Board:

Field of Practice Sub-category specialisation Registration Code

Aeronautical 01
Agricultural 02
Chemical 03
Civil General 04
Structural 04/S
Environmental 04/E
Roads and Highway 04/W
Construction Management 04/M
Geotechnical 04/G

Electrical General 05
Power 05/P
Electronics 05/E
Computer 05/C
Instrumentation and Controls 05/I
Telecommunications 05/T
Industrial 06
Marine 07
Mechanical 08
Refrigeration and Air Conditioning 08/R
Power & Generation 08/G
Mining 09
Metallurgical 10
Nuclear 11
Petroleum and Gas 12
Project Management 13

2: Attach details where appropriate

3: Sponsor to be a Registered Engineer or a Member of the Dominica Association of Professional Engineers.
Form 1, Second Schedule Page 4 of 4