IEPNG Membership and Registration Form

CA01

                                                            THE INSTITUTION OF ENGINEERS PAPUA NEW GUINEA INC.

Post Office Box 881 WAIGANI NCD 131, Papua New Guinea

Phone: (675) 325 8763   Facsimile: (675) 3258718 Email: memberservices@iepng.org
1.        Non refundable application fee must accompany this application

2.        Attach recent passport size photo of applicant

                         APPLICATION FOR MEMBERSHIP & REGISTRATION                                                                                                                                                                                           

 IEPNG Membership Number
(if known)
  1. Applicant Details
Surname Title
Other Names
Preferred Name Date of birth –(dd/mm/yy) Gender                M   F
  1. Please select what you are applying for
                Head Office: IEPNG HAUS

Unit 2 & 3, Spring Garden Road,

Gordons, NCD

Tick the applicable box.

Registration – Application to be registered by the Professional Engineers Registration Board of PNG
Professional Engineer (PE)

 (RegEng)

 Date when registration commences

(dd/mm/yyyy)

                                                                          

3 years same as work permit

 

 Date when registration expires

(dd/mm/yyyy)

 

3 years from commencement date

 
IEPNG Membership – Application to be a member or fellow of the institution of Engineers PNG inc
Professional Membership

Fellow (FIEPNG)

Member (MIEPNG)

 

  

 

  

 

 

Same as registration date

  

 

  

Same as registration date

 
  1. COntact Details
Home Address Business Address
Address: Company: Barrick (Nugini) Limited
Position:
Address: PO Box 484
Mount Hagen
Post code Western Highlands Province Post code
Telephone Telephone 3224800
Email – Gmail account
Fax

 

 Email
Fax:

tgubag@porgerajv.com                        3224824
Address you would prefer your mail to go to Home Business
Address to be shown on any register(s) if authorized Home Business
  1. Qualifications

Certified copies of your academic qualifications (degree etc) and the academic transcript must be provided with your application if not previously supplied to IEPNG.

Qualification

(State Degree/Diploma or Certificate)

 Length of qualification (Years of study) Discipline (Engineering Branch)

(eg Civil, Mechanical etc)

 Education Provider

(eg. PNG University of Technology)

 Country

(Country where qualification acquired)

 Year

(Year of Graduation)
  1. Professional Memberships/ Registration

Please list any professional memberships, competence-graded registrations or licenses that you currently hold or have previously held.

Certified copies of your membership/registration/license certificates must be provided with your application if not previously supplied to IEPNG

Institution/ Organization

(eg Engineers Australia)

 Class or Membership category Still current? Yes/No Membership and/ or Registration Number Year joined

(Date of admission)
  1. Information for Assessment Purposes
    • Practice Area

All applicants are assessed for competence in their personal practice area. Refer to document Instructions to fill in Ca01 application Part6 for more information.

Use 15 to 25 words to describe your practice area – describing both the nature of your engineering activities (using words like ‘design’, ‘production’, ‘construction monitoring’ or ‘certification’) and the area in which you have current knowledge and skills (using terms like ‘electricity generation and reticulation’, ‘biomass fuels’, ‘roading networks’, ‘heavy road transport vehicles’ or ‘reinforced concrete structures’). Use ‘bullet point’ type statements rather than full sentences. Include supporting evidence for everything specified in your practice area description and exclude things from the practice area description that are not supported by evidence. [NB – those seeking registration as a Registered Structural Engineer under the Building Act 1977 should include ‘Designer of Seismic Capable Structures in accordance with the detail requirements of the PNG Codes of Practice (or internationally equivalent) in their practice area description.]

Please copy this information into your Referee Declaration and Evaluation (Form CA06).
  • Practice Field(s)

Please select one but no more than two engineering practice field(s) within which you believe your practice area best fits. This information is only used for selecting suitable assessors and has no relevance to your assessment outcome.

Civil Mechanical Electrical Mining
Communications Environmental Management Transportation
Building services Fire Surveying Oil & Gas
Chemical Geotechnical Aviation & Avionics Marketing
Marine Industrial Petroleum  

Mineral Processing

 
_______________ _____________
  • WORK SAMPLES

You are required to present work samples as evidence that you are ‘still able to practice competently’ as an engineer.

Summarise below what your work samples show:

  1. The technological, regulatory and ‘good practice’ changes that have occurred in your practice area (250 words)

Click here to enter text.

  1. The actions you have taken to keep abreast with the changes in your practice area (250 words)

Click here to enter text.

  1. The factors that contribute to the complexity of your engineering work (250 words)

Click here to enter text.

  1. You are still able to practice competently as an engineer (250 words)

Click here to enter text.

  • COMPETENCE ASSESSMENT – EVIDENCE CHECKLIST

You may send your portfolio of evidence in electronic or printed form.  If your portfolio of evidence is over 2 MB in size, do NOT email it but send it by memory stick or CD. If you send your portfolio of evidence in printed form, you must send 1 copy.  Refer to the Competence Assessment Registration Guide (CARG) for details of the documentation requirements:

Check that you have completed all the required documentation and tasks below Number copies required if printed Please

Tick
  Application for Membership to IEPNG & Registration to PERB (Form CA01) 1  Copy required
Competence Self Review Form (Form CA03) 1 Copy required
Work History Summary (Form CA04) OR CV covering engineering activities since your last assessment 1  Copy required
Continuing professional development activities (Form CA05) OR CPD records since your last assessment 1  Copy required
Referee Declaration and Evaluation Form (Form CA06) 1 copy required
Certified copy of any academic qualifications or professional memberships gained since your last assessment 1 Copy required
Supporting work samples 1 Copy required
  • Assessment Centre

If you are required to attend an interactive assessment please indicate your preferred location. Individual arrangements will be made by Assessment panel on date and time to talk to you .

Port Moresby Lae Mt Hagen Kokopo
  1. REFEREES

Name two referees who are familiar with your engineering activities and can provide comment as to whether you    demonstrate competence in each element of the relevant standard. Referees must meet certain eligibility requirements – such as being independent. Referees must have been previously assessed at the level of competence assessment for which you are applying for.

Refer to   for information.

Tick the box to confirm:

·         I confirm both referees meet the eligibility requirements

·         I have supplied both referees with a Referee Declaration and Evaluation (Form CA06) and my completed Competence Self Review (Form CA03) and asked them to submit Form CA06 to IEPNG Head Office.

·         I have filled in my application deadline date and my practice area on Form CA06

  

 
Referee Name   Referee Name
Address Address
Contact telephone
Fax

 

 Contact telephone
Fax

 
Email address Email address
  1. IEPNG Communications and PRIVACY REQUIREMENTS

8.1          IEPNG COMMUNICATIONS

Please select the level of communication you wish to receive. (Tick one from the option below)  
Financial information Only- I only wish to receive my annual invoice for payment and associated reminders  such as Statements (i.e. I do not wish to receive any other IEPNG publications).
IEPNG information  – I wish to receive financial information, regular IEPNG publications and occasional publications of interest such as Informatory Notes and Branch Newsletters.
Marketing Information – I wish to receive all items listed above, as well as information promoting IEPNG events such as Short Courses and Seminars, Luncheons, Technical Meetings, Conferences, AGM, etc . From time to time there may also be promotional material from selected suppliers of goods and services.
Board Elections information – I wish to receive Board Nomination form and also to receive the Ballot paper to cast my vote

Please Note: In the case of mail outs promoting goods and services provided by other organisations, confidentiality is maintained at all times through the use of third party mailing houses.

8.2          Return of work samples

IEPNG will retain one copy of application documents on file.

Work samples will be destroyed unless you request that they are returned to you. Tick ‘yes’ to have a copy of any work samples returned to you else tick ‘No’ for the samples to be destroyed. Yes No

8.3          Publication of Personal Details

IEPNG publishes the names of all registrants on the appropriate web-based register.  The names and other information is also published on the PNG Government National Gazette for Professional Engineers and on the newspapers when required.

  1. DECLARATIONS

9.1          Convictions

Do you have any convictions for offences punishable by imprisonment for a term of 6 months or more? Please provide details of any such convictions below: Yes No
Click here to enter text.

 9.2         Declarations and Authorizations for Membership/Registration

Please complete the appropriate declarations by ticking the relevant boxes below.

I am applying for IEPNG membership. I agree to be bound by the Rules and Regulations of IEPNG including the Code of Ethics, which may be amended from time to time.
I am applying for registration as a Professional Engineer. I agree to be bound by the Professional Engineers Registration Act (PERA) as amended from time to time and the current Professional Engineers Rules, including the code of ethical conduct, which may be amended from time to time.  I also agree that I will inform the Professional Engineers Registration Board (PERB) of any matters that may affect my fitness for registration.
For the purposes of assessment I authorize IEPNG Head Office staff and IEPNG-appointed assessors to contact my referees. I also agree that IEPNG can use reports from any of my previous competence assessments in evaluating this application.

9.3          For Expatriate Applicants  ONLY.

Details of your Overseas Registration
Date and Jurisdiction of Registration Registration Number
Conditions on registration (if any) Click here to enter text.
For Expatriate Applicants  ONLY.

I certify that:

1.         I seek registration in Papua New Guinea as a Professional Engineer in accordance with the Professional Engineers Registration Act (Amended 2007) in relation to the occupations of the IEPNG membership and registration class/category.

2.         I am currently registered / not registered with another professional body and my registration is neither cancelled nor suspended. (cross out one)

3.         I am not the subject of:

a.         Any preliminary investigations or action that might lead to disciplinary proceedings, or

b.         Any disciplinary proceedings, or

c.         Any special conditions in practicing as a Professional Engineer as a result of criminal, civil or disciplinary proceedings.

4.         I have declared all convictions that could be punished by imprisonment for a term of 6 months or more.

5.         I understand the codes of ethics, legislation and regulations applicable to Papua New Guinea within my practice area.

I agree to be bound by the current Professional Engineers Registration Act (Amended 2007), including the Code of Ethical Conduct and any amendments as made from time to time. I also agree that I will inform the Professional Engineers Registration Board (PERB) of any matter that may affect my fitness for registration. I am aware that I will need to undertake a current competence assessment at intervals not exceeding three (3 ) years to remain on the register.

9.4   Certification and Consent

 
I certify that all information on this form and in my portfolio of evidence is true and accurate. I also consent to my name being published on the IEPNG website for a period not exceeding 21 days along with an invitation to the public to provide evidence about whether I meet the competence standard for registration.
Signature:   Date

Send your completed application to the Institution of Engineers PNG Inc at one of the addresses below:

Courier Address:

 

 

 IEPNG Head Office,

IEPNG HAUS, Unit 2 & 3

Spring Garden Road

Gordons, NCD

Papua New Guinea

 Postal Address: IEPNG Head Office

PO Box 881

Waigani, NCD

Papua New Guinea
Email: memberservices@iepng.org Website: www.iepng.org.pg
Phone: +675 325 8763 Fax: +675 325 8718