Fillable Engineer-in-Training Reference Form (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Engineer-in-Training Reference Form (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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The Engineer-in-Training Reference Form (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General) form is 1 page long and contains:

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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Professional Engineers and Land Surveyors
P.O. Box 45015, Newark, New Jersey 07101
(973) 504-6460
Engineer-in-Training Reference Form
(Please print clearly.)
Name of Reference Name of Applicant
_________________________________________________ _____________________________________________
Lastname First Middle Lastname First Middle
_________________________________________________ _____________________________________________
Streetaddress Streetaddress
_________________________________________________ _____________________________________________
City State ZIPcode City State ZIPcode
Theapplicantforcerticationasanengineer-in-trainingwhosenameandaddressaregivenabovehassentyouthis
referencestatementregardinghis/herprofessionalqualications.He/sheindicatedthatyouhavepersonalknowledgeofhis/
hercharacterandprofessionalexperience.
Please answer the following questions and return this form to the State Board of Professional Engineers and Land
Surveyors,P.O.Box45015,Newark,N.J.
Statement of Reference(From your own personal knowledge.)
1. Yourbusinessorprofession:_____________________________ 2. Lengthofacquaintance: ___________________
3. Relationship,ifany:______________________ 4. Applicant’smoralhabitsorcharacter: _____________________
______________________________________________________________________________________________
5. Applicant’sgeneralreputationinthecommunity:_______________________________________________________
______________________________________________________________________________________________
6. Ifyouhavebeenassociatedwiththeapplicantinprofessionalpractice,pleasesupplythefollowinginformation.
Positionheldbytheapplicant:______________________________________________________________________
Characteroftheworkperformedbytheapplicant:______________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
7. Inviewofyourknowledgeoftheapplicant,doyourecommendhim/herforacerticateofregistrationasanengineer-
in-training?
Yes No
___________________________________ _______________________________________________________
Date Name(pleaseprint)
_______________________________________________________
Signature
Ifyouareaprofessionalengineer,pleasegiveyourlicensenumber:___________________________,___________ .
Stateoflicensure
For ofce use only
Application
number _______________________
Date_________________ ,________
Rev.4/11/17
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Engineer-in-Training Reference Form (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 15 August 2020

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