ECSA

ENGINEERING COUNCIL OF SOUTH AFRICA (17/05/2012) Form B1.1

Private Bag X 691 Waterview Corner, 1st Floor,
BRUMA 2026 2 Ernest Oppenheimer Avenue
Tel: (011) 607-9500 Bruma Lake Office Park
Fax: (011) 622-9295 BRUMA
Email: [e-mail] Johannesburg
Website: www.ecsa.co.za 2198

A P P L I C A T I O N F O R M
REGISTRATION AS A PROFESSIONAL ENGINEERING TECHNOLOGIST
NB: Please consult the Information Sheets (Sheets B1.1 & B1.2) before completing this Application.

1. General Information:
Surname:
Oliver

First Names:
Jason Grant

PHOTOGRAPH
(Passport-type.
Please paste - do not staple)

Alternatively, insert electronically in JPEG or similar format
Date of Birth:
12/12/1978

Identity No:
7812125134081
or

*Race Group:
Please tick the applicable block
Asian
Black
Passport No. and Country:

Country of normal residence:

Coloured X
White

Home Address:

16 Castellano Private Estate
Cedar Avenue West
Broadacres
Fourways

Postal Address:

16 Castellano Private Estate
Cedar Avenue West
Broadacres
Fourways

Name & Address of present Employer:
TUV Nord Southern Africa (Pty) Ltd.

Tel. No. (Home): N/A

Tel. No. (Work): [phone]

Cell No.:0835663944

E-mail: [e-mail]

Title of Position held:
Mechanical Engineer
Tel. No. (Employer): [phone]

Fax No.: (include area codes)

E-mail:

*Completion of this section is necessary in order to accurately reflect equity statistics in terms of Government Policy.

2. Qualifications: (All qualifications at tertiary level) (List of subjects to be provided on Form B1.3)
Educational Institution
Qualification
Attendance from to
Date of final examination Office use NB: Kindly initial this page in the presence of a Commissioner of Oaths / Justice of Peace.

Commissioner Of Oaths/
Applicant: …………………………. Justice Of Peace: ……………………………………… -2- (17/05/2012) Form B1.2

3. Previous / Current Registration or Application Details: (eg. Candidate Engineering Technologist,
Registered Lift Inspector, etc.)
Type
Category
Number
Date

Previous Registration:

Current Registration:

Previous Application:

4. Membership of Voluntary Associations recognised in terms of Act No 46 of 2000 (or other):
(If more space is needed, please supply information separately.)
Name of Association / Institute / Society
Membership grade and date accepted
Number of years
Office held

5. Application Fee: (See item 5 of the Information Sheet)

My Application fee of R (cheque) is transferred electronically.

6. Referees:
(1)

E-mail:
Tel No:
(2)

E-mail:
Tel No:
(3)

E-mail:
Tel No:

7. Declaration:

I, (full names) hereby apply for Registration as a Professional Engineering Technologist and undertake to abide by all the provisions of the Engineering Profession Act, 2000 (Act No. 46 of 2000) and any Rules published thereunder, including the Code of Professional Conduct. I declare that Section 19(3)(a) of the Act does not preclude me from registration. I solemnly declare that, to the best of my knowledge, all the information contained herein is true.

Signature: __________________________

Sworn to/Affirmed before me at ___________________________

on this the ________ day of _____________________(month & year).

Commissioner of Oaths/
Justice of Peace: ……………………………………………… (Commissioner’s stamp)

Office Use Only

Application fee: R ______________________

Received by: ________________________ Date: ______________________

(Council’s stamp)
Engineering Council of South Africa (17/05/2012) Form B1.3

Detailed information on

TERTIARY ENGINEERING QUALIFICATIONS

Professional Engineering Technologist

Name of Qualification:

All subjects passed
Year
Obtained
Marks obtained
(if available)

Extra subjects passed for incomplete qualifications

Total Credits

_____________________________________
Signature of Applicant
Engineering Council of South Africa (17/05/2012) Sheet B1.1

Information Sheet for Applicants Applying for
Registration as a Professional Engineering Technologist

This document briefly sets out the information required by the Registration Committee to evaluate applications.

A. General:

All applicants should read, understand and provide all the information/documentation required in Sheets B1.1, B1.2, B2.1, B2.2, B4 and B5 of this application form. If the prescribed requirements are not met in the correct format, it is unlikely that applicants will be registered.

The onus is on the Applicant to provide all the evidence for consideration of the Council. The evidence must demonstrate/show competency in accordance with the specification requirements of Policy Statement R2/1B: Acceptable Engineering Work for Registration of a Professional Engineering Technologist.

Your application will only be considered by the Council if the following documents are submitted:

Completed Application Form (B1.1 & B1.2).
Certified copies of qualifications.
Completed detailed information on Qualifications (Form B1.3).
Completed Experience Report (Forms B2.1), for each experience period and a Summary of Experience Reports (Form B2.2).
Completed recent Engineering Report (Form B2.3).
Completed Educational Development Report (Form B18), if applicable.
Referee Reports, each duly completed.(Form B4).
Completed Initial Professional Development Report (Form B5).

All supporting documentation must be clearly identified. If you are unable to complete any of the sections, please explain the reasons in a covering letter.
In completing all paper forms use type or print clearly in black ink and minimum font size 10 to ensure clear copying. Forms may not be substituted but may be photocopied or recreated in electronic format.
 It is imperative to present records of only the most significant work and achievements. The Registration Committee considers that an application of fifty (50) A4 pages or less, is sufficient to assess an applicant and that longer presentations may not be to the applicant’s advantage.
 Your application for registration will only be considered when all referee reports have been received by the Council. If the referee reports do not reach the Council within a reasonable time, you will be notified accordingly. You will then be expected to contact the referees.
 If you are in doubt regarding any aspects please contact the Council’s offices.
The registration process may take 6 (six) months or longer to complete and each applicant will be informed of the Council’s decision as soon as it becomes available.
Information regarding the progress of any application will not be given telephonically.

Please note that it is your responsibility to ensure that all reports reach Council’s offices timeously.

For registration as a Professional Engineering Technologist applicants must have the benchmark academic qualification and three years of approved experience as a technologist, of which at least a minimum of one year must be in a position of acceptable engineering responsibility. If the applicant does not have the benchmark academic qualification (BTech), their application will be considered by the alternate route. The difference must be made up by extended periods of both engineering experience and responsibility. The exact periods will depend upon the level of the qualifications held by the applicant. It must be clearly understood that the work which the candidates are doing or have done, as well as the submission of the completed Educational Development Report (Form B18) and the Initial Professional Development Report (Form B5), are important factors in determining registrability.

B. The Application Form:

The following information is given to assist applicants to complete this form – the numbers refer to the equally numbered sections of the Application Form.

1. General Information: Ensure that all personal details are correct. A recent passport type photograph of the applicant is required.

2. Qualifications:
 Original certified copies of your qualification certificate(s) must be submitted. (They must be certified by a Commissioner of Oaths or Justice of Peace. A Police Officer or Post Master will usually be able to help you.) -2- (17/05/2012) Sheet B1.2
 If your documents are not in English, please supply certified translations.
 The benchmark academic qualification required by Council for registration is a BTech degree awarded by a South African University of Technology or Comprehensive University.

3. Previous / Current Registration or Application Details:

If you have previously applied for registration in any category or were previously registered but your registration was cancelled for any reason, please provide category and previous registration number in relevant block. If you are currently registered in another category, also complete the appropriate block.

4. Membership of recognised Voluntary Associations:

A list of associations is attached as Addendum A. Proof of current membership of such association will qualify you for a reduction in your annual fee should your application be successful.

Persons who have applied for membership of any of the above-mentioned associations, but who have not yet been accepted, must indicate this in the appropriate block. Membership of other institutes/societies (not recognised) may be stated, but this does not qualify the applicant for a reduction in the annual fee.

5. Application and Annual Fees:

Only cheques must accompany your application form, as no cash or postal orders will be accepted. If you do not have a cheque account, you may deposit cash at any Standard Bank into ECSA’s account. Please contact our Accounts Department at [phone]/1/2/3 or Reception at [phone] to obtain our banking details. Alternatively you may make payment (1) via the internet, or (2) you may ask your bank for a bank cheque to be made out to ECSA, (3) contact your bank’s telephone banking division to make payment into ECSA’s account or (4) by credit card by phoning our Accounts Department. When making the deposit please ensure that your name and initials are entered in the field named “Depositor’s name or reference number” and attach a copy of the proof of deposit to your application form. Refer to separate sheet regarding fees payable, visit ECSA’s website at http://www.ecsa.co.za, click on “Finance” or contact the Council’s offices at [phone] to determine the current fee.

6. Referees:

Each applicant must, with the permission of the persons concerned, supply the Council with the names and addresses of three referees, who have personal knowledge of the applicant's work. Referees must be registered with ECSA as a Professional Engineering Technologist or a Professional Engineer, and in exceptional circumstances a Professional Certificated Engineer or a Professional Engineering Technician, of which one must be a direct supervisor. In case of the supervisor not being registered with ECSA a forth registered referee must be provided.

Use Form B3 for formal correspondence with each referee, and enclose copies of the referee report (Form B4) and the guideline for referees (Sheet B4). It is suggested that you provide each referee with an addressed envelope with prepaid postage for the referee to forward the report direct to the Council.

7. Declaration: Section 19(3)(a) of the Engineering Profession Act, 2000 (Act No. 46 of 2000) reads:

“Despite subsection (2), the Council may refuse to register an applicant -

(i) if the applicant has been removed from an office of trust on account of improper conduct;
(ii) has been convicted of an offence in the Republic, other than an offence committed prior to 27 April 1994 associated with political objectives, and was sentenced to imprisonment without an option of a fine, or, in the case of fraud, to a fine or imprisonment or both;
(iii) if the applicant has, subject to paragraph (b), been convicted of an offence in a foreign country and was sentenced to imprisonment without an option of a fine, or, in the case of fraud, to a fine or imprisonment or both;
(iv) if the applicant is declared by the High Court to be of unsound mind or mentally disordered, or is detained under the Mental Health Act, 1973;
(v) for as long as the applicant is disqualified from registration as a result of any punishment imposed on him or her under this Act;
(vi) if the applicant is an unrehabilitated insolvent whose insolvency was caused by his or her negligence or incompetence in performing work falling within the scope of the category in respect of which he or she is applying for registration.”

Note that your application must be sworn to or affirmed before a Commissioner of Oaths or a Justice of Peace. Your attention is drawn to the initialling required at the bottom of the first page of the Application Form.

Page No. of
Consult the Information Sheet (Sheet B2) before completing this report.

Engineering Council of South Africa
Training and Experience Report Form B2.1 (17/5/2012)
As part of the Application for Registration as Professional Engineering Technologist
Applicant’s Name
Applicant’s
Signature
Date:
Period No:
Start date:
End date:
No of weeks:
Position held:
Employer’s Name and Address for this period: (This is the employer and site at which the work took place, e.g. the site the applicant has been seconded to).

Did you train under a Commitment and Undertaking (CU)?

Yes

No

If yes, provide number of CU:
No:

Supervisor’s Name and Address:

ECSA Registration No:
Supervisor’s
Signature:

Date:
Report:
Write in proper paragraphs in the first person singular. Compulsory paragraphs shown as *. Other fields should be selected as required.
*Nature and purpose of this period of training or experience:

*Discipline of Engineering: (Aeronautical, Agricultural, Chemical, Civil, Electrical, Industrial, Mechanical, Metallurgical, Mining)
*Discipline Specific Field: (e.g. Power Transmission, Electronic Communication, Transportation, Structures, Automotive, Roads, etc.)
*Organogram showing two levels above and below applicant (if present), with individual’s name and ECSA registration category, if registered. Identify the applicant’s supervisor:

*Nature of problem(s) addressed in this period; method of analysis, developing solution and evaluation, decisions and judgement:

Documentation, reports, presentations prepared:

Management of materials, machines, manpower, methods or money, contracts:

Interaction with clients, stakeholders and other disciplines:

Health and safety considerations, hazards and environmental considerations; other legislation:

*Applicant’s contribution to the work; nature and degree of applicant’s responsibility.
Describe:
Degree of responsibility:
Tick:

A. Being exposed

B. Assisting

C. Participating

D. Contributing

E. Performing

For office use only: Level assessed for this period:
Artisan/Specified Category
Technician
Technologist
Technologist + Complex
Engineer

Engineering Council of South Africa (17/05/2012) Form B2.3

Engineering Report

Use this form to submit a report under Outcomes 1 to 10 below in about 2500 to 3000 words on recent engineering work to which you have made a significant contribution. The report may cover conceptualisation, design and analysis, specification, tendering and adjudication, manufacturing, project and construction management, commissioning, maintenance, measurement and testing or planning at a broadly-defined level. Please also provide a sample relevant calculations and drawings as an addendum.

Name of Applicant:

Designation of work and dates:
(