Scribd
Upload
627 views2 pages

Professional Engineer Reference Statement: Texas Board of Professional Engineers and Land Surveyors

This document is a reference statement form from the Texas Board of Professional Engineers and Land Surveyors. The multi-page form collects information from a reference provider about a professional engineer license applicant. It requests details on the reference provider's relationship to the applicant, their evaluation of the applicant's character and competence, and whether the applicant has sufficient experience and training to be licensed as a professional engineer in Texas.

Uploaded by

A B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
627 views2 pages

Professional Engineer Reference Statement: Texas Board of Professional Engineers and Land Surveyors

This document is a reference statement form from the Texas Board of Professional Engineers and Land Surveyors. The multi-page form collects information from a reference provider about a professional engineer license applicant. It requests details on the reference provider's relationship to the applicant, their evaluation of the applicant's character and competence, and whether the applicant has sufficient experience and training to be licensed as a professional engineer in Texas.

Uploaded by

A B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Texas Board of Professional Engineers and Land Surveyors

PROFESSIONAL ENGINEER REFERENCE STATEMENT

(BEFORE COMPLETING THIS FORM, PLEASE READ THE REFERENCE STATEMENT INSTRUCTIONS.
ONLY ONE COPY OF THIS FORM HAS BEEN PROVIDED.
PLEASE MAKE ADDITIONAL COPIES OF THIS FORM AS REQUIRED.

TO BE COMPLETED BY APPLICANT
Verification for employment engagement #
Firm/Company Name:
From (Date):
To (Date):
Applicant’s Full Legal Name:
Applicant’s Date of Birth:

TO BE COMPLETED BY REFERENCE PROVIDER


Note: Please refer to Sections 133.51, 133.53 and 133.55 of the rules. Reference statements are
confidential and not subject to release to the applicant nor the Texas Public Information Act. You may
attach a page on which to provide more information.

Reference Provider’s Name (Typed or Printed):


Employed by (Include City, State & Zip:
Business Title:
Business Phone:

My current state of primary licensure is: (State):


P.E. No.:
Expiration Date:

Other Professional Engineer Licenses Held:


(If licensed PE in state other than Texas, provide copy of pocket card or other verification)
State:
No.:
Expiration Date:

Reference Evaluation is: ☐ Character & Personal Knowledge of Work Described in of SER
[Be sure to sign the SER]

☐ Character & Review of SER only for Purpose of Reference Statement


[Be sure to sign the SER]

1. How long have you known the applicant?


2. Are you related to the applicant? ☐ No ☐ Yes
If so, how?

3. Was/is your relationship with the applicant ☐ Personal? ☐ Business?


Please explain:

Dates of business relationship:


From: To:

4. The Texas Engineering Practice Act states that a person seeking to obtain a license to practice professional
engineering shall provide evidence of good professional character and reputation which, in the judgment of the
Board, is sufficient to ensure that the individual can consistently act in the best interest of clients and the public
in any practice setting. Such evidence shall establish that the person is able to distinguish right from wrong, is
able to think and act rationally, is able to keep promises and honor obligations, and is accountable for his/her
own behavior. How would you describe the applicant’s character and reputation?

5. Do you know of anything that would negatively affect the applicant’s ability to practice as an independent
professional engineer? ☐ No ☐ Yes If yes, explain:

6. What have you observed that convinces you that the applicant (has/has not) adequately applied engineering
education, training, and experience in the practice of engineering?

7. Do you believe that the applicant’s experience was sufficiently complex and diverse, and of an increasing
standard of quality and responsibility, to provide sufficient professional growth for the applicant to be
recommended for a license? ☐ No ☐ Yes
Please explain and add additional comments:

8. Based on your knowledge and observations, do you believe that the applicant has reached a level of
competency to be placed in responsible charge of engineering work in his/her discipline? ☐ No ☐ Yes
Please explain and add additional comments:

Reference Provider’s Signature:


Date:

You might also like