membership application form 2013

8/9/2019 Membership Application Form 2013

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ASSOCIATION OF STRUCTURAL

ENGINEERS OF THE PHILIPPINES,

INC.Suite 713 Future Point Plaza I, 112 Panay Avenue, QuezonCityPhone: (+632) 1! ! "3 # Fa$: (+632) 11 "6 !6 # %o&ile:(+63) '17 "23 77 3' *ail Are:ae-online./*ail0o*

EVALUATION RATING FORM

Control/ID Number

N!me o" A##l$%!nt

2” x 2”

colored

photo

MEM&ERSHIP GRADE AFFILIATE ASSOCIATE MEM&ER REGULAR MEM&ER

MEM&ER'M$n$mum re(u$rement) #r$or to!##l$%!t$on.

Mu)t be ! *r!+u!te C$$l

En*$neer -$t !t le!)t e 012

3e!r) rele!nt

)tru%tur!l +e)$*n e4#er$en%e

but !)

not #!))e+ te P$l$##$ne&o!r+

E4!m$n!t$on "or C$$lEn*$neer).

M$n$mum o" t-o 052 3e!r) o"

rele!nt

%ont$nuou) e4#er$en%e $n

)tru%tur!l +e)$*n

o" )$*n$%!nt )tru%ture) )u% !)

lo-6 !n+me+$um6r$)e bu$l+$n*) #r$or to

!##l$%!t$on.

M$n$mum o" t-o 052 3e!r) o" rele!nt

%ont$nuou)e4#er$en%e $n )tru%tur!l +e)$*n o" )$*n$%!nt

)tru%ture))u% !) MR&, HR&, to-er) !n+ oter

ert$%!l )tru%ture),br$+*e), or )#e%$!l %$$l en*$neer$n*

)tru%ture) #r$or to!##l$%!t$on !n+ mu)t !e ! tot!l o" e 012

%ont$nuou)

3e!r) rele!nt )tru%tur!l +e)$*n e4#er$en%eo" te )!me.

Item E!lu!t$on Cr$ter$! No. o" R!te+ No. o" R!te+ No. o" R!te+ 3e!r)

No. 7e!r) 3e!r) 7e!r) 3e!r) 7e!r)

8.9 Stru%tur!l +e)$*n e4#er$en%e'

5.9 Te!%$n* e4#er$en%e

0te!%$n* )ub:e%t)rel!te+ to )tru%tur!l

en*$neer$n*2No. o" 3e!r) Po$nt)

; 1 9.19

; 9

; 5, = > 9.59

= 5 9.89

>.9 De)$*n m!n!*ement e4#er$en%eNo. o" 3e!r) Po$nt)

; 1 9.>9

; , = < 9.59

; 5, = > 9.81= 5 9.89

9 ; 81 8.99

/ 5.19

; 5


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= 8B = B 9.59 / 5.89

B.9 Cont$nu$n* #ro"e))$on!l+eelo#ment !tten+e+. Te re(u$re+ m$n$mum our) "or ASSOCIATE $) >9

our)? "or REGULAR B9 our) "or te

l!)t > 3e!r) #r$or to

!##l$%!t$on? !n+ "or UPGRADE TO

REGULAR $) 859 our)

#r$or to !##l$%!t$on. NOTE FULL

HOURS ILL ONL7 &E

CREDITED FOR ASEP6ORGANIED

EVENTS ITH DUL76SIGNED CERTIFICATION.

FINAL RATING

REUIRED MINIMUM RATING TO &E ACCEPTED PLUS THE

MINIMUM CPD HOURSPRIOR TO APPLICATION

5.99

59

our)

>.99

>9 our)

.99

B9 our) REGULAR9 our) UPGRADE

REMARS/ACTION An !##l$%!nt -o $) ! PICES#e%$!l$)t Member $n te el+

o" Stru%tur!l En*$neer$n* m!3 be

!%%e#te+ !) ! REGULARmember.

ASP#%S %e*&erhi- va luation atin/For*#rev2!13!' P a / e

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INC.Suite 713 Future Point Plaza I, 112 Panay

Avenue, Quezon CityPhone: (+632) 1! ! "3 # Fa$: (+632) 11

"6 !6 # %o&ile: (+63) '17 "23 77 3' *ail Are: ae-online./*ail0o*

MEM&ERSHIP APPLICATION FORM

Control/ID Number

D!te Form Subm$tte+

Current O%%u#!t$on

2” x

2”

colored photo

N!me o" Com#!n3/F$rm/Or*!n$!t$on

I. PERSONAL DETAILS 0Ple!)e u)e &LOC LETTERS2

NAME

D

A

T

E

O

F

&

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R

T

H

S

E

J


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N

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7

P

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5/28

A

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L

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E6MAIL

MO&ILE

OR ADDRESS

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E6MAIL

PROFESSION

II. ENGINEERING DISCIPLINE

DEGREE 7EAR INSTITUTIONHERE

SPECIALIATIOFIELD OF

ASP#%S %e*&erhi- A--liation For*#rev2!13!' P a / e

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III. ENGINEERING PRACTICE

LICENSURE EJAM

REGISTRATION NO.

DATE TAEN

ATE ISSUED

LICENSURE EJAM DATE TAEN

REGISTRATION NO. ATE ISSUED

IV. PROFESSIONAL EJPERIENCE

7EAR POSITION RESPONSI&ILIT7 PROGRAM/PROKE

Det!$le+ De)%r$#t$on o" Re)#on)$b$l$t$e) (make additional copy of this tabulation as extra sheet needed following the sameformat)

A##l$%!nt@) Role

A##l$%!nt@) En*$neer$n* or

V. SIGNIFICANT ENGINEERING OR

7EAR RESPONSI&ILIT7 PROGRAM/ &ENEFICIAR7

Det!$le+ De)%r$#t$on o" Re)#on)$b$l$t$e) (make additional copy

of this tabulation as extra sheet needed following the same

format)

A##l$%!nt@) Role



9/28

ASP#%S %e*&erhi- A--liation For*#rev2!13!' P a / e

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To Te ASEP Member)$# S%reen$n* &o!r+

Trou* ASEP Se%ret!r$!t

Te un+er)$*ne+, !##l3 "or member)$# ☐ !) !n AFFLIATE MEM&ER☐ !)

!n ASSOCIATE MEM&ER

☐ !) ! REGULAR MEM&ER ☐ UPGRADE to REGULAR MEM&ER ☐ ELEVATE to

FELLO, !n+ +e%l!re

t!t te !boe +e)%r$#t$on) !re true.

A##l$%!nt@) N!me !n+ S$*n!ture

D!te Re%e$e+ b3

PRC Re*. No.

V!l$+$t3

Checklist for Membership Application: (Please tick checklist when

included / submitted)

☐ 1 Evaluation Rating Form (rev2013.09)

☐ 2 Completel !illed"in #$% #em&er'hip pplication

Form (rev2013.09)☐ 3 *o (2) pc'. o! 2” x 2” +, picture'-

colored

☐ 4 hotocop o! RC +, (!ront and &ac/)

☐ 5 t lea't minimum t*o (2) con'ecutive ear' o! 'tructural de'ign experience !or$$C+E #em&er' or minimum !ive () con'ecutive ear'o! 'tructural de'ign experience !or RE4R #em&er' 5pgrade to RE4R #em&er'

☐ 6 Endor'ement !rom three (3) $E Regular #em&er' ingood 'tanding and5or

$E Fello*' a' Re!erence'

☐ 7 Comprehen'ive curriculum vitae- certi!ied and updated re'ume a''upporting attachment to

the #$% pplication Form

☐ 8 hotocop o! Emploment Certi!icate- certi!ied true cop

☐ 9 hotocop o! ,iploma 5 ran'cript o! Record' (ndergraduate and po't"graduate cour'e')

☐ 10 hotocop o! Certi!icate' !or 'eminar' 5 *or/'hop 5 con!erence'attended *ith program

included


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☐ 11 Electronic !ile cop o! all 'u&mitted document' in ,F !ormat

&urnt in C, 5 ,6, Im#ort!nt Note)

All +o%ument) to be )ubm$tte+ b3 te !##l$%!nt "or member)$# )!ll be!rr!n*e+ $n te or+er !) $n+$%!te+ !boe !n+ )!ll be %om#$le+ $n te

)t!n+!r+ "ol+er #re)%r$be+ b3 MS&.

A##l$%!nt )oul+ )ubm$t te !boe +o%ument) $n )u##ort o" te !##l$%!t$on!n+ ! non6re"un+!ble #ro%e))$n* "ee o" PHP 8,999.99 0USD 512.

U#on !%%e#t!n%e o" te !##l$%!t$on, Entr!n%e "ee o" PHP 8,199.990USD


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INC.Suite 713 Future Point Plaza I, 112 Panay

Avenue, Quezon CityPhone: (+632) 1! ! "3 # Fa$: (+632) 11

"6 !6 # %o&ile: (+63) '17 "23 77 3' *ail Are: ae-online./*ail0o*

MEM&ERSHIP APPLICATION FORM

Control/ID Number

D!te Form Subm$tte+

Current O%%u#!t$on

2” x

2”

colored photo

N!me o" Com#!n3/F$rm/Or*!n$!t$on

I. PERSONAL DETAILS 0Ple!)e u)e &LOC LETTERS2

NAME

D

A

T

E

O

F

&

I

R

T

H

S

E

J


13/28

N

A

T

I

O

N

A

L

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T

7

P

A

S

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R

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N

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H

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14/28

A

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N

T

A

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CS

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15/28

E

E6MAIL

MO&ILE

OR ADDRESS

C

O

N

T

A

C

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F

A

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E6MAIL


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PROFESSION

II. ENGINEERING DISCIPLINE

DEGREE 7EARINSTITUTIONHERE

SPECIALIATIO

FIELD OF

AS(P#%S %e*&er,hi- A--liation For*#rev2!13!') P a / e

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III. ENGINEERING PRACTICE


REGISTRATION NO. DATE ISSUED


REGISTRATION NO. DATE ISSUED




A##l$%!nt@) Role





A##l$%!nt@) Role



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VI. PROKECT/S 0P!)t !n+ #re)ent En*$neer$n* Pro:e%t)2

N!me/Lo%!t$on RESPONSI&ILIT7 Dur!t$on !n+ Co)t CLIENTELE

VII. CONTINUING PROFESSIONAL DEVELOPMENT 0CPD2 (makeadditional copy of this

tabulation as extra sheet needed following the same format)

Pro*r!m De)%r$#t$on

rel!te+

N!me o" Pro$+er /

Cre+$t Un$t)

/

In%lu)$e D!te)

CPD

VIII. REFERENCES (As a reuirement of the !e"ised #mplementing

!ules and !egulations of the$ylaws% applicant should submit names of three (&) !egular

Members% in good standing% and/or 'ellows of the Association he section below should be *lled in

by your named !eferences)

N!me o" Re"eren%e-$t

Re"eren%e Cont!%tDet!$l)

6

Re"eren%e

ASEP IDRem!r) / Comment) "te

S$*ne+

Re". N!me


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MEM&ERSHIP APPLICATION FORM 6 ADDITIONAL SHEETS 0HEN NECESSAR72

A##l$%!nt@) N!me




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VI. PROKECT/S 0P!)t !n+ #re)ent En*$neer$n* Pro:e%t)2

N!me / Lo%!t$on RESPONSI&ILIT7 Dur!t$on !n+ Co)t CLIENTELE


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4 >


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VII. CONTINUING PROFESSIONAL DEVELOPMENT 0CPD2 (makeadditional copy of this

tabulation as extra sheet needed following the same format)

Pro*r!m De)%r$#t$onrel!te+

N!me o" Pro$+er /Cre+$t Un$t)/

In%lu)$e D!te)CPD


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membership application form 2013

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