NYS LS License Application tips · PE/PS exams After receiving a passing result, it will take...

New$York$State$Land$Surveyors$License$Application$!

Joseph!V.R.!Paiva!!!

!• How!to!prepare!yourself!to!collect!the!data!for!your!application!

!• How!to!!apply!once,!correctly,!and!successfully!

!!

1. Begin!at!the!beginning:!New!York!State!Office!of!the!Professions:!http://www.op.nysed.gov/!

!2. Professions!page:!!http://www.op.nysed.gov/prof/!

!3. Land!Surveying!page:!http://www.op.nysed.gov/prof/pels/!

!4. Note:!above!page!is!the!same!page!as!you!get!when!you!click!on!

“Engineering”!!

5. Left!hand!column!of!Land!Surveying!page:!License!requirements/Land!Surveying:!http://www.op.nysed.gov/prof/pels/lsurvlic.htm!

!6. Left!hand!column!of!Land!Surveying!page:!Application!Forms/Land!

Surveying:!http://www.op.nysed.gov/prof/pels/lsurvforms.htm!!

7. Complete!Application!Packet:!http://www.op.nysed.gov/prof/pels/LandSurveyorApplicationPacketUMay2009.pdf!

!!Rules!to!go!by:!!

• Talk!to!people!who!have!applied!recently!• Talk!to!your!mentors!who!are!professionals!• Talk!to!educators!(if!applicable)!• Talk!to!your!employers!and!licensed!surveyors!you!intend!to!use!as!

references!• Go!to!NYSED!website,!find!land!surveying!pages!and!download!EVERYTHING!

as!PDFs!(you!can!later!decide!which!parts!to!print)!• Read!all!the!pertinent!information!about!licensure!as!a!land!surveyor.!Then!

read!the!application!packet!from!beginning!to!end!• Then!read!(again)!application!packet!from!beginning!to!end!

• Then!read!(again)!all!other!pertinent!information!about!licensure!as!a!land!surveyor!

• Now!make!up!a!list!of!all!the!pertinent!information!you!need!to!pull!as!reference!information,!or!which!you!will!need!to!send!as!originals,!certified!copies!or!simply!copies!

• Make!up!a!list!of!all!the!people!you!will!use!as!character!and!professional!experience!references.!

• Now!contact!each!of!these!references,!advise!them!that!you!will!be!applying!for!licensure.!!

• Politely!ask!the!employment!references!to!please!respond!to!the!information!requests!quickly!and!completely.!This!is!also!a!good!time!to!tell!them!that!you!will!be!sending!them!a!copy!of!what!you!believe!your!work!experience!was!with!them!and!the!activities!and!skills!you!learned!with!them.!

• Make!sure!the!character!references!are!willing!to!respond;!be!sure!that!you!WANT!them!as!character!references!!

• Now!start!filling!out!the!forms,!reading!and!reUreading!the!instructions.!Be!clear,!concise!and!accurate!in!your!responses.!Also!be!complete.!Where!it!is!permitted!to!have!addendum!sheets,!prepare!them!in!typewritten!form,!with!clear!titles,!indication!of!which!question!the!page!is!an!addendum!to,!and!if!the!addendum!is!more!than!one!page,!repeat!the!addendum!title!on!top!provide!consecutive!page!numbers!for!each!addendum,!restarting!with!“1”!with!each!new!addendum.!

• As!you!fill!out!the!app,!and!you!have!attachments,!keep!a!log!of!the!attachment!and!forms,!and!make!sure!it!is!in!the!order!you!will!place!the!documents!when!you!assemble!your!packet!for!submission.!

• Be!accurate.!Do!not!stretch!the!truth.!• Use!a!dictionary!to!make!sure!you!spell!words!correctly.!!• Be!aware!of!your!grammar.!Have!someone!you!trust!review!everything!you!

write!on!the!application.!!• IT!IS!LIKELY!YOU!ARE!JUDGED!ON!FITNESS!TO!BE!AN!APPLICANT!ON!HOW!

YOU!FILLED!OUT!THE!APP!AS!WELL!AS!THE!CONTENTS!OF!THE!APP!AND!REQUIRED!DOCUMENTS!

• Take!plenty!of!time!to!get!the!app!filled!out!• Do!not!rush!to!meet!a!deadline;!forearmed!is!forewarned!• Be!patient!• While!your!app!is!processing!start!reviewing!the!information!you!need!to!

know!for!the!exams.!This!is!a!good!time!to!start!building!your!reference!library,!and!taking!land!survey!exam!review!courses,!both!for!the!NCEES!part!as!well!as!the!state!specific!part!

!!

12/27/2014 NYS Professional Engineering & Land Surveying

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Advisory Notices:

October 24th and 25th 2014 Examination Results

When the results of the NCEES examinations (PE and PS) have been validated, NCEES will send an e-mail

informing you that your result can be accessed through your My NCEES account.

The results of the New York State Specific Land Surveying Exam will be mailed directly to each candidate.

PE/PS exams - After receiving a passing result, it will take approximately 3 to 5 weeks for a status review of your

licensure application file. If you meet all requirements for licensure, you will be granted a license as soon as possible.

After 3 to 5 weeks you may check our website at www.op.nysed.gov/opsearches.htm to see if a license has been

issued. If no license is reported on the website, it may mean that your results have not yet been entered;; check again

in a few days. Your cooperation in using our website is appreciated.

April 2015 New York State Application Filing Deadline for NCEES Principles andPractice (PE) Examinations:

The April 2015 New York State Examination Administration Application Filing Deadline for the NCEES

Principles and Practice of Engineering Examination - PE (Part B) has been changed from November 1, 2014

to October 17, 2014. Given this change, we will make every effort to provide a review of those

applications postmarked by November 1, 2014, although reviews for submissions after October 17 cannot be

guaranteed. You are strongly encouraged to submit applications at the earliest possible date.

Once you have received approval from the New York State Board for Engineering and Land Surveying to sit

for the NCEES PE exam you must register through the NCEES website at www.ncees.org

Approximately 30 minutes after completing your registration with NCEES, you will receive an email from

Castle Worldwide that contains a link that will allow you to submit the scheduling/administration fee to

Castle Worldwide, the testing service contracted by NYSED to administer the exam.

The NCEES online registration for the PE exam runs from December 8, 2014 through February 19, 2015

and can be accessed through their website at www.ncees.org. The NCEES online registration and

payment process for the NCEES PE exam closes on February 19, 2015 at 3:00p.m. eastern time;;

there are NO extensions. Please remember it is your responsibility to complete this registration and

payment process by the deadline.

April 2015 New York State Application Filing Deadline for NCEES Principles andPractice of Surveying(PS) and New York State Specific Land SurveyingExaminations:

The April 2015 New York State Examination Administration Application Filing Deadline for the NCEES

Principles and Practice of Surveying(PS) and New York State Specific Land Surveying examinations is

November 1, 2014.

Once you have received approval from the New York State Board for Engineering and Land Surveying to sit

for the NCEES PS and/or NYS Specific Land Surveying exam you must register through the NCEES website

at www.ncees.org

Approximately 30 minutes after completing your registration with NCEES, you will receive an email from

Castle Worldwide that contains a link that will allow you to submit the scheduling/administration fee to

Castle Worldwide, the testing service contracted by NYSED to administer the exam.

The NCEES online registration for the NCEES PS and NYS Specific Land Surveying exams runs from

December 8, 2014 through February 19, 2015 and can be accessed through their website at

www.ncees.org. The NCEES online registration and payment process for these exams closes on

February 19, 2015 at 3p.m eastern time;; there are NO extensions. Please remember it is your

responsibility to complete this registration and payment process by the deadline.

New Eligibility and Registration Procedures for NCEES

Fundamentals of Engineering(FE) and Fundamentals of Surveying

(FS) Computer Based Examinations in 2014/2015

Eligibility and Registration for NCEES Fundamentals of Engineering (FE) Exam

EAC/ABET Engineering programs - Students/applicants who are within twenty credits of graduation (generally your

final semester) or have graduated from an EAC/ABET accredited baccalaureate program in engineering are

automatically eligible to sit for the NCEES FE exam. You may verify whether your program is EAC/ABET accredited

through the ABET website at www.abet.org. If you meet these criteria you are no longer required to obtain approval

from the NYS Board for Engineering and Land Surveying prior to registering for the FE exam with NCEES. To sit for

the FE exam, you must register and pay NCEES directly through their online registration system available via their

website at www.ncees.org. Information is posted on the NCEES website regarding the registration and payment for

the FE exam.

ETAC/ABET Engineering Technology programs - Students/applicants that have graduated from an ETAC/ABET

accredited baccalaureate program in engineering technology are automatically eligible to sit for the NCEES FE exam.

You may verify whether your program is ETAC/ABET accredited through the ABET website at www.abet.org. If you

meet this criterion you are no longer required to obtain approval from the NYS Board for Engineering and Land

Surveying prior to registering for the FE exam with NCEES. To sit for the FE exam, you must register and pay NCEES

directly through their online registration system available via their website at www.ncees.org. Information is posted

Office of the Professions

12/27/2014 NYS Professional Engineering & Land Surveying

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on the NCEES website regarding the registration and payment for the FE exam.

All Foreign and NON-ABET Education programs – Students/applicants who are not enrolled or have not

graduated from an EAC or ETAC ABET accredited baccalaureate program MUST submit an application which consists

of a Form 1, Form 2 with transcripts and a $70 fee to the New York State Board for Engineering and Land Surveying

(NYS Board) for eligibility to sit for the NCEES FE exam. Once you have received approval from the NYS Board to sit

for the NCEES FE exam, you must register and pay the exam administration fee with NCEES through their online

registration system available via their website at www.ncees.org Information is posted on the NCEES website

regarding the registration and payment for the FE exam.

Eligibility for NCEES Fundamentals of Surveying (FS) Exam

EAC or ETAC ABET Surveying programs - Students/applicants who are within twenty credits of graduation

(generally your final semester) or have graduated from an EAC or ETAC ABET accredited baccalaureate program in

surveying are automatically eligible to sit for the NCEES FS exam. You may verify whether your program is EAC or

ETAC ABET accredited through the ABET website at www.abet.org. If you meet these criteria you are no longer

required to obtain approval from the NYS Board for Engineering and Land Surveying prior to registering for the FS

exam with NCEES. To sit for the FS exam, you must register and pay NCEES directly through their online registration

system available via their website at www.ncees.org. Information is posted on the NCEES website regarding the

registration and payment for the FE exam.

All Foreign and NON-ABET Education programs – Students/applicants who are not enrolled or have not

graduated from an EAC or ETAC ABET accredited baccalaureate program in surveying MUST submit an application

with $70 fee to the New York State Board for Engineering and Land Surveying (NYS Board) for eligibility to sit for the

NCEES FS exam. Once you have received approval from the NYS Board to sit for the NCEES FS exam, you must

register and pay the exam administration fee with NCEES through their online registration system available via their

website at www.ncees.org Information is posted on the NCEES website regarding the registration and payment for

the FS exam.

12/27/2014 NYS Land Surveying:License Requirements

http://www.op.nysed.gov/prof/pels/lsurvlic.htm 1/5

License RequirementsLand Surveying

General Requirements | Fee Schedule | Partial Refunds | Education and Experience Requirements | Examination Requirements | Certification as an

Intern Land Surveyor | Interim Practice of Land Surveying

General Requirements

The practice of land surveying or use of the title "land surveyor" within New York State requires licensure.

To be licensed as a land surveyor in New York State you must:

be of good moral character;;be at least 21 years of age;;meet education requirements;;meet examination requirements;; andmeet experience requirements.

You must file an Application for Licensure (Form 1) and the other forms indicated, along with the appropriate fee, tothe Office of the Professions at the address specified on each form. It is your responsibility to follow up withanyone you have asked to send us material.

The specific requirements for licensure are contained in Title 8, Article 145, Section 7206-a of New York's EducationLaw and Part 68 of the Commissioner's Regulations.

You should also read the general licensing information applicable for all professions.

Fee Schedule

The fee for licensure and first registration is $377.

When the Department determines you are eligible for the examination, you will be sent an examination eligibilityletter. The letter will indicate which of the following exams you are eligible to take including;;

Part 1- NCEES Fundamentals of Surveying (FS)Part 2- NCEES Principles and Practice of Surveying (PS)The New York State Specific Land Surveying examination (see Examination Requirements).

Fees paid to NYSED cover the processing and evaluation of your application by the Department, as well as, yourregistration as a land surveyor for three years from the date your New York State license is issued. Fees are subjectto change. The fee due is the one in effect, by law, when your application is received (unless fees are increasedretroactively). You will be billed for the difference if fees have been increased.

Do not send cash.Make your personal check or money order payable to the New York State Education Department. * Yourcancelled check is your receipt.Mail your application and fee to:

NYS Education DepartmentOffice of the ProfessionsP.O. Box 22063Albany, NY 12201.

*NOTE: Payment submitted from outside the United States should be made by check or draft on a United States bankand in United States currency;; payments submitted in any other form will not be accepted and will be returned.

The examination eligibility letter you receive will include instructions on how to schedule and pay an additional fee tosit for the examination with NCEES and our examination administrator - Castle Worldwide Inc. Please refer to yourexamination eligibility letter for scheduling and payment of their fees.

Partial Refunds




Individuals who withdraw their licensure application may be entitled to a partial refund.

For the procedure to withdraw your application, contact the Land Surveying Unit by e-[email protected] or by calling 518-474-3817 ext. 250 or by faxing 518-402-5354.The State Education Department is not responsible for any fees paid to an outside testing or credentialsverification agency.

If you withdraw your application, obtain a refund, and then decide to seek New York State licensure at a later date,you will be considered a new applicant, and you will be required to pay the licensure and registration fees and meetthe licensure requirements in place at the time you reapply.

Education and Experience Requirements

Eligibility for licensure is based on a combination of education and/or experience totaling 8 years beyond high schoolgraduation. The credit awarded for education determines the required number of years of experience needed.

Approved Accredited/Registered Programs

Approved accredited/registered programs are master's, baccalaureate and associate degree programs in surveying,surveying engineering, surveying engineering technology, or a similar surveying-related title accredited by theAccreditation Board for Engineering and Technology (ABET). For such ABET accredited programs, you would receive:

four years of education and experience credit for a baccalaureate degree;; andtwo years for an associate's degree.

Proportional credit may be awarded for other education completed, depending on the course content. Contact theBureau of Comparative Education at [email protected] or 518-474-3817 ext. 300 for further information.Transcripts must be sent directly to the land surveying unit from the institution attended utilizing a Certification ofEducation (Form 2).

For more information about currently accredited academic programs in surveying engineering (EAC), surveyingengineering technology (ETAC), contact ABET at their Web site www.abet.org .

Acceptable Land Surveying Experience

The State Board for Engineering and Land Surveying evaluates acceptable experience based on criteria specified inregulations. The experience must:

1. include 50 percent of the required experience spent in charge of work related to property conveyance and/orboundary line determination;;

2. demonstrate adequate experience in the technical field aspects of the profession;;3. demonstrate adequate experience in charge of the office aspects of the profession;;4. demonstrate experience in the legal aspects of the profession;;5. demonstrate adequate direct supervision of experience by a licensed land surveyor;; and6. include at least two years of experience working on projects requiring a knowledge and use of surveying codes

and practices utilized in the United States.

Acceptable experience should include a full and current knowledge of all surveying equipment and shall includemeasurements of space, water, land and structures to determine boundaries, areas, elevations, alignments andlocations;; evaluation and analysis of field data, appropriate research of public and private land records, preparation ofclient service contracts and final surveying reports, maintenance of survey records and the supervision of field andoffice personnel, all in accordance with legal regulations and statutes and the standards of the professional practice.

"Stake-out" and "line and grade" surveys do not provide adequate training in themselves. However, when suchsurveys, including "right-of-way" surveys, are performed under the supervision and direction of a licensed landsurveyor, the State Board may, at its discretion, consider granting credit for the work toward partial fulfillment of theexperience requirement.

All the experience you wish to have evaluated must be reported on the Report of Professional Experience (Form 4) anddescribed on the Verification of Professional Experience (Form 4A) and should be accounted for chronologically.Experience descriptions must include specific duties you personally performed, the complexity of the work, and makeclear the extent of your responsibility for the work.

Please list your experience in a comprehensive, detailed and explicit manner. The Department will consider onlyexperience that you have completed by the date the application is signed and which is submitted on the forms 4 and4A. The quality of the experience, not merely the calendar time, will be evaluated. Time claimed on the forms cannotexceed actual calendar time.

Examination Requirements

Before you can be licensed, you must pass:

Part 1 - NCEES Fundamentals of Surveying (FS) exam;;



Part 2 - NCEES Principles and Practice of Surveying (PS) exam;; andPart 3 - New York State Specific Land Surveying exam.

Parts 1 and 2 are developed by the National Council of Examiners for Engineering and Surveying (NCEES). Part 3 isdeveloped by the New York State Board for Engineering and Land Surveying. (See General Requirements forinformation about laws and regulations governing licensure as a land surveyor in New York State which may beincorporated in the Part 3 of the exam.)

All exam applicants are required to read the "NCEES Examinee Guide" prior to being allowed to register for the exam. Please use this link to access the "NCEES Examinee Guide" at: ncees.org/exams/cbt/examinee-guide/

Part 1 - Fundamentals of Surveying (FS) Exam

Beginning in 2014, this exam will be delivered via a computer based testing service. The schedule for this exam willbegin in January 2014 with a “two months on and one month off” schedule. See the NCEES website for exact datesand deadlines. www.ncees.org

For candidates from a Baccalaureate EAC or ETAC ABET accredited program in surveying or surveying

technology:

If you are within 20 credits of graduating or have already graduated from a baccalaureate level EAC or ETAC ABETaccredited program in surveying, you are eligible to apply directly to NCEES to take the Fundamentals of Surveying(FS) exam.

To find out if your program is EAC or ETAC - ABET accredited you may go to the ABET web site here

For candidates NOT from a baccalaureate ABET accredited Program:

If you have not graduated from either an EAC or ETAC ABET accredited bachelors program in surveying, you mustdownload and submit the New York State Land Surveying Application Forms and $70 fee so that your qualificationscan be reviewed for approval by the Department. Once approved, you will be made eligible to sit for the FS exam viaa letter sent to you from the NYS Board for Engineering and Land Surveying (Board) that will include instructions forhow to schedule and pay the exam administrative fee with NCEES. Do not attempt to schedule the exam until youhave received your letter of eligibility from the Board.

Part 2 - Principals and Practice of Surveying (PS) and Part 3 - the New York State Specific Land Surveying

examinations :

The NCEES Principles and Practice of Surveying (PS) and Part 3 - the New York State Specific Land Surveyingexaminations are administered twice a year, in April and October, at various sites throughout New York State. Youmust meet two different deadlines: the deadline for submitting your licensure application to the New York StateEducation Department and the deadline for scheduling the examination with NCEES and our examination administratorCastle Worldwide Inc.

The deadlines for submitting a NYS licensure application for these exams are:

Exam Month Deadline for Licensure Applications

April November 1 of previous year

October June 1 of same year

All required licensure application forms must be postmarked by the filing deadlines;; there are no exceptions.

The Department will notify you when you are eligible to take the professional licensing examinations and will includeinstructions on how to schedule and pay an additional fee to sit for the examination with NCEES and Castle Worldwideour examination administrator. Do not attempt to schedule the examination until you receive your notice of eligibility.

Part 3 - New York State Specific Examination

New York State Specific Land Surveying Examination

Test Blueprint - October 2009

NYS SPECIFIC DOMAIN NUMBER of ITEMS PERCENTAGE of TEST



Computations/Analysis 3 6%

Documentation/Land Info Systems 7 14%

Ethics/Professional Responsibility 5 10%

Land Planning/Design 4 8%

Legal Principles 15 30%

Measurement/Location 2 4%

Monumentation 2 4%

Project Management 6 12%

Research 6 12%

PERCENTAGE TOTALS 50 100%

Suggested Bibliography for the New York State Specific Land Surveyor Examination

The references listed here may be located through or obtained from local libraries and their Inter-Library LoanServices;; from the State Library;; from professional colleagues and local and state professional societies (e.g., NewYork State Association of Professional Land Surveyors).

1. NEW YORK STATE LEGAL RESOURCESA. Statutory Authorities

McKinney's Consolidated Laws of New York AnnotatedBook 11 County LawBook 16 Education Law, Articles 130 and 145Book 24 HighwayBook 49 Real Property LawBook 49 ½ Real Property Actions and ProceedingsBook 61 Town LawBook 63 Village Law

B. Legal EncyclopediaNew York Jurisprudence, 2nd

Volume 1 Adjoining LandownersVolume 2 Adverse PossessionVolume 11 Buildings, Zoning and Land ControlsVolume 12 Buildings, Zoning and Land ControlsVolume 25 Counties, Towns and Municipal CorporationsVolume 26 Counties, Towns and Municipal CorporationsVolume 27 Counties, Towns and Municipal Corporations

Black's Law Dictionary, 6th or 7th EditionC. Subdivision Laws

New York State Realty Subdivision LawsArticle 11, Title II, Public Health LawArticle 17, Title 15, Environmental Conservation Law

D. MiscellaneousDescription of Methods Used in Locating Canal Lands Owned by the State of New York Prepared inaccordance with provisions of Chapter 199, Laws of 1910 and Amendatory Laws, includingChapter 51, laws of 1917.New York Zoning Law and Practice, 3rd edition, Anderson, Robert M. (Available from Lawyers Co-operative, Rochester, New York)Code of Practice for Land Surveyors*Highway Law and the Land Surveyor*Legal Issues and the Land Surveyor*Real Property Law and the Land Surveyor*(*Available from the New York State Association of Professional Land Surveyors)

2. SURVEYING TEXTS, MANUALS, ETC.Control of Land Subdivisions: A Manual of Subdivision RegulationsNew York Riparian Law K. AyersBoundary Control and Legal Principles, 4th Edition Brown, Robillard & WilsonEvidence & Procedures for Boundary Location, 3rd Edition Brown, Robillard & WilsonBoundaries & Landmarks: A Practical Manual MilfordClark on Surveying & Boundaries, 6th Edition Robillard & BoumanBoundaries & Adjacent Properties SkeltonGPS for Land Surveyors Van SickleEthics for the Professional Surveyor MoulandDefinitions of Surveying & Associated Terms ACSMElementary Surveying, 9th Edition (or latest edition) Wolf & BrinkerSurveying Theory & Practice, 7th Edition (or latest edition) Anderson & Mikhail



Surveying, 10th Edition (or latest edition) Moffitt & BosslerAdditional Resources may be obtained from the following web sites:

Law Research Center - www.caselaw.findlaw.comNational Council of Examiners for Engineering and Surveying - www.ncees.org

NCEES limits calculators allowed in examination room

NCEES has revised the examination policy concerning materials permitted in the examination room.

NCEES policy prohibits calculators that communicate or that may compromise the security of the examination. NCEESpublishes a list of the calculators that are acceptable for the examinations. Only the models listed on the NCEESwebsite will be permitted in the examination room.

For further information regarding NCEES examinations please visit the NCEES website at www.ncees.org or call 1-800-250-3196.

Accommodations

Individuals with Disabilities/Sabbath Observers/Military

After your licensure/examination application materials have been reviewed and approved by the Department, you willbe sent an eligibility letter. This letter will include instructions on how to schedule and pay the examination fee(s). Theprocess to request a reasonable accommodation or alternate test date will be part of the registration/schedulingprocess with NCEES and Castle through their online system. If you are requesting accommodations, we suggest youbegin the process as soon as the NCEES registration process opens for the exam you plan to take, as this will assist inthe timely processing of your request.

Certification as an Intern Land Surveyor

To be eligible for an identification card as an "Intern Land Surveyor," you must:

be of good moral character;;United States citizen or qualified alien;;have graduated from an ABET accredited baccalaureate degree program in surveying;; andpassed Part 1 – NCEES Fundamentals of Surveying (FS) the licensing examination.

To apply for a Certificate as an “Intern Land Surveyor” you must submit Form 1 with a $70 fee to us and submit Form2 - Certification of Professional Education to your school so they may submit verification of completion of your ABETaccredited baccalaureate degree program in surveying directly to us.

Interim Practice of Land Surveying

Section 7208 (b) of the Education Law allows practice as a land surveyor in New York State by a person who is not aresident, or who has no established place of practice in this State, or who is a New York State resident but has arrivedin New York State within the last six months may practice as a land surveyor in New York State.

However, such a person must have filed an application for licensure as a land surveyor in New York State and mustbe legally qualified for such practice in the state or country of their previous residence or place of

practice. This provision for interim practice is valid only until the Board grants or denies the application for license.During this time of interim practice, no title, sign, card or device shall be used to convey the impression that theperson rendering such service is a professional land surveyor licensed in this State.

You must submit a Notification of Intent to Practice Land Surveying under Section 7208 (b) of Education Law (Form 5)to practice under this provision. You will also need to verify licensure from your current jurisdiction of residence usinga Verification of Out-Of-State Licensure, Registration and/or Examination (Form 3).

15

Land SurveyorLicensing Application Packet

The University of the State of New YorkTHE STATE EDUCATION DEPARTMENT

Office of the ProfessionsDivision of Professional Licensing Services

89 Washington AvenueAlbany, NY 12234-1000

(Rev. 5/09)

Need Additional Information?

Check our Web site for copies of forms, Education Law,approved programs and More!

WWW.OP.NYSED.GOV

THE UNIVERSITY OF THE STATE OF NEW YORKRegents of the University

MERRYL H. TISCH, Chancellor, B.A., M.A., Ed.D. ........................................................New YorkANTHONY S. BOTTAR, Vice Chancellor, B.A., J.D. ........................................................SyracuseROBERT M. BENNETT, Chancellor Emeritus, B.A., M.S. ................................................TonawandaJAMES C. DAWSON, A.A., B.A., M.S., Ph.D. ..................................................................PlattsburghGERALDINE D. CHAPEY, B.A., M.A., Ed.D. ..................................................................Belle HarborHARRY PHILLIPS, 3rd, B.A., M.S.F.S. ............................................................................HartsdaleJAMES R. TALLON, JR., B.A., M.A. ................................................................................BinghamtonROGER TILLES, B.A., J.D. ................................................................................................Great NeckCHARLES R. BENDIT, B.A. ..............................................................................................ManhattanBETTY A. ROSA, B.A., M.S. in Ed., M.S. in Ed., M.Ed., Ed.D.........................................BronxLESTER W. YOUNG, JR., B.S., M.S., Ed. D.......................................................................Oakland GardensCHRISTINE D. CEA, B.A., M.A., Ph.D. ............................................................................Staten IslandWADE S. NORWOOD, B.A. ..............................................................................................RochesterJAMES O. JACKSON, B.S., M.A., PH.D ............................................................................AlbanyKATHLEEN M. CASHIN, B.S., M.S., Ed.D. ......................................................................BrooklynJAMES E. COTTRELL, B.S., M.D. ....................................................................................New YorkT. ANDREW BROWN, B.A., J.D.........................................................................................Rochester

Commissioner of EducationPresident of The University of the State of New YorkJOHN B. KING, JR.

Executive Deputy CommissionerVALERIE GREY

Deputy Commissioner for the ProfessionsDOUGLAS LENTIVECH

Acting Director of the Division of Professional Licensing ServicesSUSAN NACCARATO

Executive Secretary for the State Board for Engineering and Land SurveyingJANE W. BLAIR

The State Education Department does not discriminate on the basis of age, color, religion, creed, disability,marital status, veteran status, national origin, race, gender, genetic predisposition or carrier status, or sexualorientation in its educational programs, services and activities. Portions of this publication can be made availablein a variety of formats, including braille, large print or audio tape, upon request. Inquiries concerning this policyof nondiscrimination should be directed to the Department's Office for Diversity, Ethics, and Access, Room 530,Education Building, Albany, NY 12234. Requests for additional copies of this publication may be made bycontacting the Publications Sales Desk, Room 319, Education Building, Albany, NY 12234.

Contents

Ways to Reach Us ....................................................................................................................................................ii

General Licensing Information ................................................................................................................................1

Applying for a License as a Land Surveyor..............................................................................................................5

Completing the Application Forms ..........................................................................................................................11

Applicant Checklist ..................................................................................................................................................15

Forms

FORM 1 - Application for Licensure

FORM 2 - Certification of Professional Education

FORM 3 - Verification of Out-Of-State Licensure, Registration and/or Examination

FORM 4 - Report of Professional Experience

FORM 4A - Verification of Professional Experience

FORM 5 - Notification of Intent to Practice Land Surveying under Section 7208(b) of Education Law

Additional Forms

FORM AD/NAME - Address/Name Change Form

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FOR FUTURE REFERENCEIN THE EVENT OF AN EMERGENCY that impacts the licensed professions, the Office of the Professionswill provide important information, specific to the situation, through our Web site (www.op.nysed.gov), ourautomated phone system (518-474-3817), and/or our regional offices. This information will include emergencyprovisions for professional practice as well as updates on scheduled events and services (licensing examinations,professional discipline proceedings, examination reviews, etc.).

Ways to reach us...

Other Important Contact Information...

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DGeneral Customer Service The Office of the Professions can be reached at 518-474-3817, TDD/TTY 518-473-1426. Staff are available from8:30 a.m. to 4:45 p.m., Eastern Time, Monday through Friday. You may also fax a message to 518-474-1449 ore-mail us at [email protected].

D On The World Wide Web Information about the Office of the Professions and the 48 licensed professions, including information on alllicensees, is available on our home page at:

www.op.nysed.govD License Application StatusFind out the status of your license application by checking our Web site where your name is added immediatelywhen a license number is issued, or contact:

NYS Education Department, Office of the Professions, Division of Professional Licensing ServicesLand Surveying Unit, 89 Washington Avenue, Albany, NY 12234-1000

PHONE: 518-474-3817 ext. 250 FAX: 518-402-5354 E-MAIL: [email protected] include your name, social security number, date of birth, and the name of the profession.

D Verification of Education Credentials From Foreign or Non-Approved ProgramsIf you have questions about documentation required to verify education completed outside the U.S. or in non-approved programs, contact:

New York State Education Department, Office of the Professions, Bureau of Comparative Education89 Washington Avenue, Albany, New York 12234-1000

PHONE: 518-474-3817 ext. 300 FAX 518-486-2966 E-MAIL [email protected]

D Practice IssuesFor answers to questions concerning practice issues, contact:

NYS Education Department, Office of the Professions, State Board for Engineering and Land Surveying89 Washington Avenue, Albany, NY 12234-1000

PHONE: 518-474-3817 ext. 140 FAX: 518-473-6282 E-MAIL: [email protected]

Licensing ExaminationLicensing examinations for Land Surveying are administered by an independent examination vendor. Once yourapplication for licensure has been reviewed and you are found eligible for examination, you will be sent an examination scheduling form. This includes the filing deadline dates and the fee. If you have any questions abouteligibility for the licensing examination, you may call the Land Surveying Unit or the State Board forEngineering and Land Surveying.

GENERAL LICENSING INFORMATIONPlease read this general licensing information for all professions before proceeding to the detailed instructions for your profession.

INTRODUCTION

A professional license is the authorization to practice and use a professional title in New York State. Yourlicense is valid for life unless it is revoked, annulled, or suspended by the Board of Regents. This application packet contains the forms and instructions you need to apply for a license.

LICENSURE AND REGISTRATION

Once received, your application and all required supporting material will be reviewed. If you meet all thelicensure requirements, we will issue you a license and your first registration certificate. You will be entitled to practice in New York State as of the effective date of the license.

You may find out if your license has been issued (including your license number and effective date oflicensure) by checking for your name in the listing of all licensed professionals on the Web atwww.op.nysed.gov. Written confirmation of licensure -- your license parchment and registrationcertificate -- is mailed within two working days following the licensure date.

To practice in New York under the authority of your license, you must re-register every three years. Youare automatically registered for your first registration period when your license is issued. Thereafter, wewill send you a renewal application to the name and address we have on file (see the Address or NameChanges section on next page), at least four months before your registration expires.

VERIFYING YOUR APPLICATION CREDENTIALS

To ensure authenticity of credentials, the New York State Education Department's Office of the Professionsrequires evidence of your compliance with each licensure requirement directly from the organizationwhere you met the requirement (e.g., school, testing agency, licensing authority, certifying board, hospital,employer, etc.). These records and documents must bear an original (not photocopied) signature of theofficial who maintains the records and stamp or seal of the institution where the credentials are maintained. You are responsible for asking organizations and individuals to complete and directlysubmit to us the documentation you need. Keep a record of your verification requests. To ensure protection of the public, the Office of the Professions regularly re-verifies credentials directly with theissuing institution to assure authenticity. In some cases, this may delay licensure.

NOTE: Forms and transcripts from the originating institution must be mailed directly to theDepartment from the issuing institution in a sealed official envelope bearing the institution's nameand address. Verifying organizations may take eight weeks or more from the date of your request tosend the required independent verifications. The Office of the Professions cannot evaluate yourcredentials until we receive the required documentation. You must consider this time factor indeciding when to submit your application for licensure.

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ADDRESS OR NAME CHANGES

If your mailing address or name changes, you must contact the Department to update your records andprovide the following identifying information: your full name, social security number, profession and dateof birth. Failure to provide the Department with your change of address or name will delay processingyour application.

For address changes you may phone, fax or e-mail:

Phone: 518-474-3817 ext. 250TDD/TTY 518-473-1426

Fax: 518-402-5354

E-mail: [email protected]

For name changes a fax or e-mail is not acceptable. You must provide written notification of any namechange with an original notarized signature in your new name to:

NYS Education Department, Office of the ProfessionsDivision of Professional Licensing Services

Land Surveying Unit89 Washington Avenue

Albany, NY 12234-1000

NOTE: Once you are licensed, Education Law requires that you notify the Department of anychange in your mailing address or name within 30 days of that change. Failure to do so may be considered professional misconduct. It may also delay renewal and result in late fees to renew theregistration of a professional license. You may use the Form AD/NAME located in the back of this packet or print a copy from our Web site at www.op.nysed.gov/anchange.pdf to notify the Department of achange in your address or name.

PROFESSIONAL CONDUCT

All licensed practitioners must adhere to rules of professional conduct. The Education Law includes definitions of professional misconduct, and the Board of Regents has adopted Rules definingunprofessional conduct for all professions. Every licensee is also governed by a set of Laws, Rules, andRegulations for the practice of the profession.

Title 8 of the NYS Education Law is available on our Web site at www.op.nysed.gov/title8.htm

Part 29 of the Rules of the Board of Regents is available on our Web site at www.op.nysed.gov/part29.htm

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RECORDS RETENTION AND DISPOSITION STATEMENT

Applications are considered active while an applicant is providing documentation to meet the requirementsfor a professional license or post-licensure certificate (i.e., examination grades, educational credentials andprofessional work experience).

If you withdraw your application or your application is inactive for five (5) consecutive years, any documents submitted as part of your application may be destroyed in accordance with the RecordsRetention and Disposition schedule on file with the State Archives and Records Administration.

DISCLOSURE OF SOCIAL SECURITY NUMBERS

In accordance with Federal and State laws, the New York State Education Department requires that allapplicants for professional licensure provide their Federal Social Security Number (SSN). Individualswithout a SSN will be assigned a random, computer-generated nine-digit identifier. The agency will usethe SSN or assigned numeric identifier to maintain accurate license and registration records. This information may be shared with other State or Federal agencies, consistent with applicable laws anddepartmental policy, but will otherwise be kept confidential.

The specific statutory authority for requiring Federal Social Security Numbers is in the following: FederalLaw-Privacy Act of 1974 (Section 7 of P.L., 93-579); Welfare Reform Act of 1996 (42 USCA 666 (a));New York State Law-Title 8, Section 6507, paragraph 4(e) Education Law; Section 5 of the Tax Law.

For additional information see: www.oft.state.ny.us/arcpolicy/policy/tp_974.htm

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COMPLETING THE APPLICATION FORMSfor licensure as a Land Surveyor

INSTRUCTIONS

Please type or print all information and sign all forms in black or blue ink. Original signatures are requiredon all forms.

FORM 1 - APPLICATION FOR LICENSURE

All applicants for licensure must complete this form and submit it with the appropriate fee ( $377 forlicensure and first registration, $70 for eligibility to take Part 1 of the exam only,) directly to the Office ofthe Professions at the address at the end of Form 1. Make checks payable to the New York State EducationDepartment. NOTE: Your cancelled check is your receipt.

You must answer all questions and provide all information requested unless otherwise indicated. Failureto complete all required parts of the application will delay its review. Your signature on Form 1 must benotarized by a Notary Public.

FORM 2 - CERTIFICATION OF PROFESSIONAL EDUCATION

This form must be submitted directly by the educational institution(s) you attended. The Office ofthe Professions will not accept this form if submitted by the applicant.

You must at least document your high school graduation.

Section l: Complete this section of the form before sending the entire form to your school. Be sure to signand date item 10.

Section ll: The Registrar or appropriate school official must complete the appropriate parts of this sectionand return both pages of the form directly to the Office of the Professions at the mailing address on theform.

If your associate or baccalaureate degree program was in surveying, surveying engineering, surveyingengineering technology, or a similar surveying-related title and was accredited by ABET at the time ofyour graduation or within one year thereafter for land surveying, the Registrar must complete Parts B andC.

(NOTE: For applicants applying to take Part 1 of the licensing examination based on education only,such a program must be at the baccalaureate level and they must have either graduated from or be within 20 semester hours of graduating from the program.)

If your educational program does not fit the criteria in the preceding paragraph, the Registrar must complete Parts A and C. Remind the school that they must attach an official transcript or marksheetof your studies.

When studies were completed at more than one school, official records need to be sent to the Departmentfrom each school. Please photocopy the form as needed.

FORM 3 - VERIFICATION OF OUT-OF-STATE LICENSURE, REGISTRATION AND/OREXAMINATION

Use this form only if you are or have been licensed as a land surveyor in another jurisdiction or ifyou want to verify that you passed the Fundamentals of Land Surveying Examination and/or thePrinciples and Practice of Land Surveying examination in another jurisdiction.

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If applying for 7208(b) Interim practice, verification of licensure from your current jurisdiction ofresidence is required.

This form must be submitted directly by the licensing authority. The Office of the Professions willnot accept this form if submitted by the applicant.

Section I: Complete this section before sending the entire form to each appropriate licensing authority. Besure to sign and date item 8.

Section II: The licensing authority must complete this section, sign, date and return all pages of the formdirectly to the Office of the Professions at the address at the end of the form.

Please photocopy this form as needed.

FORM 4 - REPORT OF PROFESSIONAL EXPERIENCE

Complete and send both pages of this form directly to the Office of the Professions at the address at theend of the form. List all experience that you wish to be evaluated for licensure. Your experience must belisted in chronological order beginning with your first employment for which experience is being claimed,and include firm name, name of endorser, beginning and ending dates, and total time claimed for each endorser. Be sure to sign and date item 6.

You must also complete a separate Form 4A for every employer you list on this form. Yourapplication will not be reviewed by the Board until a Form 4A for every employer listed has beenreceived.

When an endorsement does not lend credibility to your experience, it may be discounted at the judgementof the Board. A Form 4A that is not endorsed with not receive any credit towards licensure.

FORM 4A - VERIFICATION OF PROFESSIONAL EXPERIENCE

This form must be submitted directly by the endorser. The Office of the Professions will not acceptthis form if submitted by the applicant.

Sections I and II: Complete these sections, in parts A and B of Section II, list your experience in acomprehensive, detailed, and explicit manner. Be sure to sign and date the attestation at the end of SectionII before giving the entire form to the licensed land surveyor who will verify your experience.Descriptions must be specific about your personal contributions to land surveying projects to which youwere assigned. Avoid terms like "…participated in…," "…involved with…," or similar generalities. Stateyour exact duties. Your personal surveying work must be described in reasonable detail. Regardless of thetotal time claimed on a single sheet, you must break the total time down in segments, each of whichdescribes one kind of work you have performed. For each segment, provide a detailed description of yourpersonal activities that would allow the State Board to properly evaluate that work. Remember to indicatein the time column the total time you spent on each specific kind of work. Attach additional sheets ifnecessary.

Section III: The licensed land surveyor who will verify your experience must complete this section, signthe attestation endorsing your professional experience before returning all pages of this form directly tothe Office of the Professions at the address at the end of the form. The endorser’s signature on Form 4Amust be notarized by a Notary Public.

A separate Form 4A must be submitted for each instance of professional experience you list on theReport of Professional Experience form (Form 4). Your application will not be reviewed by theBoard until a Form 4A for every employer listed has been received.

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FORM 5 - NOTIFICATION OF INTENT TO PRACTICE LAND SURVEYING UNDER SECTION 7208 (b)OF EDUCATION LAW (for Endorsement Candidates only)

Use this form only if you wish to engage in interim practice while your application for licensure isbeing reviewed and you:

• are not a resident of New York State; • have no established place of practice in this State, or• are a resident of this State, but have arrived only within the past six months

You must have filed an application for licensure as a land surveyor in New York and must be legallyqualified to practice in the jurisdiction in which you currently reside or have a place of practice, or in yourprevious residence or place of practice (a Verification of Out-Of-State Licensure, Registration and/orExamination form must be submitted to verify this license/current registration). Interim practice will onlybe approved for a limited time to allow the Department time to review your application for licensure. Ifyou are approved to practice for an interim period, you will not be allowed to claim or in any way statethat you are providing services as a land surveyor licensed in New York State.

Completing Additional Forms

FORM AD/NAME - ADDRESS/NAME CHANGE FORM

You are required to notify us within 30 days of any name or address changes. Please read the instructionsand complete the appropriate sections of this form.

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LAND SURVEYORAPPLICANT CHECKLIST

Please complete and keep this checklist as a reminder of what forms you have filed and when you filed them. Thisis for your reference and should not be submitted with your application forms. You should keep a copy of all application forms submitted.

CHECK (9) AND DATE EACH STEP WHEN COMPLETED.

______ 1. Have you completed and sent the following to the Office of the Professions?

______ A. FORM 1 - APPLICATION FOR LICENSURE

______ B. FEE ($377) - FOR LICENSURE AND FIRST REGISTRATION

OR

FEE ($70) - FOR ELIGIBILITY TO TAKE PART 1 OF THE EXAM ONLY

______ C. FORM 4 - REPORT OF PROFESSIONAL EXPERIENCE

______ D. FORM 5 - NOTIFICATION OF INTENT TO PRACTICE LAND SURVEYING UNDER SECTION 7208(b) OF EDUCATION LAW (for Endorsement Candidates only)

______ 2. Have you completed and forwarded the following forms to the appropriate institution(s) or agencies?Keep copies of the requests so that you may check with them to be sure they have submitted the information.

______ A. FORM 2 - CERTIFICATION OF PROFESSIONAL EDUCATION

Sent to the following educational institutions: Date sent

________________________________________________________ __________________

________________________________________________________ __________________

______ B. FORM 3 - VERIFICATION OF OUT-OF-STATE LICENSURE, REGISTRATION AND/OREXAMINATION - Use this form only if you are or have been licensed as a land surveyor inanother jurisdiction or if you want to verify that you passed the Fundamentals of Land SurveyingExamination and/or the Principles and Practice of Land Surveying examination in anotherjurisdiction. You must complete and forward this form to the appropriate licensing authority forsubmission to the Department. If applying for 7208(b) Interim practice, verification of licensurefrom your current jurisdiction of residence is required.

Sent to the following authorities: Date sent

________________________________________________________ __________________

________________________________________________________ __________________

______ C. FORM 4A - VERIFICATION OF PROFESSIONAL EXPERIENCEWith Additional

Sent to: Sheet Date sent

_________________________________________ _____________ __________________

_________________________________________ _____________ __________________

_________________________________________ _____________ __________________

_________________________________________ _____________ __________________

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TO SPEED PROCESSING OF YOUR APPLICATION:

• Submit your application for licensure in plenty of time to allow verifying organizations to send therequired independent verifications to the Office of the Professions. This may take eight weeks ormore.

• Notify the Office of the Professions promptly of any address or name changes.• Respond promptly to requests for additional information from the Office of the Professions.

12/27/2014 NYS Professional Engineering & Land Surveying:30 Day Limited Permits

http://www.op.nysed.gov/prof/pels/pe30daypermit.htm 1/1

30 Day Limited Permits for Professional Engineers & LandSurveyorsThe New York State Education Department can issue a 30 Day Limited Permit to qualified individuals seekingto practice as professional engineers or land surveyors in New York State in accordance with Section 7207 ofthe Education Law. (See page 2 of the application for text of the law.) Limited permit holders are permitted topractice no more than 30 days in any calendar year. Limited permits are only available to applicants who:

are legally qualified to practice engineering or land surveying in his/her own state or country,are not residents of New York State, anddo not have an established place of practice in New York State.

Your practice of engineering or land surveying in New York State under a Limited Permit must be:

as an individual, or;;as an employee of a business entity authorized to provide professional engineering or land surveyingservices in New York State. Your firm must have been issued a Certificate of Authorization from theNew York State Education Department. If your firm is not authorized to provide engineering and/orland surveying services in New York State, the contract with a New York client must be between you(i.e. the individual licensee), and the client and not the corporate employer and the client.

30 Day Limited Permit Application ( 418 KB)


THE STATE EDUCATION DEPARTMENT / THE UN IVERS ITY O F THE STATE O F NEW YORK / ALBANY , NY 12234Office of the Professions, State Board for Engineering and Land SurveyingPHONE: 518-474-3817 ext. 140 FAX: 518-473-6282 E-MAIL: [email protected]: [email protected]

30 Day Limited Permits for Professional Engineers and Land Surveyors

The New York State Education Department can issue a 30 Day Limited Permit to qualified individuals seeking to practice as professional engineers or land surveyors in New York State in accordance with Section 7207 of the Education Law. (See page 2 fortext of the law.) Limited permit holders are permitted to practice no more than 30 days in any calendar year. Limited permits are onlyavailable to applicants who:

X are legally qualified to practice engineering or land surveying in his/her own state or country,

X are not residents of New York State, and

X do not have an established place of practice in New York State.

Your practice of engineering or land surveying in New York State under a Limited Permit must be:

X as an individual, or;

X as an employee of a business entity authorized to provide professional engineering or land surveying services in New York State.Your firm must have been issued a Certificate of Authorization from the New York State Education Department. If your firm isnot authorized to provide engineering and/or land surveying services in New York State, the contract with a New York client mustbe between you (i.e. the individual licensee), and the client and not the corporate employer and the client.

Applying for a limited permit

To apply for a 30 Day Limited Permit you must submit:

I. Form 5A - Application for Project Specific and 30 Day Limited Permit for Applicants Not Seeking Licensure in New YorkState and the required fee of $105.

X Complete all portions of Form 5A and mail it along with the required fee to the New York State Education Department'sOffice of Professions at the address listed at the end of the form.

II. Form 3 - Verification of Out of State Licensure, Registration and/or Examination.

X Complete Part I of Form 3 and forward to the jurisdiction where you currently reside and are licensed and registered. Requestthat the licensing authority complete Part 2 and send the completed form directly to the New York State EducationDepartment's Office of Professions at the address listed at the end of the form.

Online license verification service

To verify that an individual licensee, or business entity is authorized to provide professional engineering and/or land surveying services in New York State please visit our online license verification service at www.op.nysed.gov.

PE-30-LP Page 1 of 2, April 2004

Obtaining a Certificate of Authorization

For more information on obtaining a "Certificate of Authorization to provide engineering and/or land surveying Services in New YorkState", contact the Office of the Professions, Professional Corporations Unit at 518-474-3817 Ext. 400; fax 518-473-5515; [email protected].

Selected Sections of Education Law - Article 145 Engineering and Land Surveying

S 7207. Limited permits. 2. A limited permit to practice as a professional engineer or land surveyor in this state may be issued by thedepartment to a person not a resident in this state and having no established place of practice in this state, when such practice does notaggregate more than thirty days in any calendar year, provided that such person is legally qualified to practice in his own state orcountry. The limited permit authorizing such right to practice in this state shall specify the dates within the calendar year when suchright may be exercised.

Instructions for signing and sealing documents under your limited permits

When signing and sealing documents under your New York Limited Permit, which authorizes you to practice engineering or land surveying in New York, you should use your seal from the jurisdiction where you currently reside, are licensed and registered, andattach a copy of your New York State Limited Permit Certificate to the document.

For additional assistance

New York State Education DepartmentOffice of the ProfessionsState Board for Engineering and Land Surveying89 Washington AvenueAlbany, New York 12234-1000Phone: 518-474-3817 ext. 140Fax: 518-473-6282E-mail: [email protected]: [email protected] Web: www.op.nysed.gov

Contents of this packet

1 - Form 5A - Application For Project Specific And 30 Day Limited Permit For Applicants Not Seeking Licensure In NewYork State

1 - PE Form 3 - Verification Of Out-Of-State Licensure, Registration and/or Examination (Professional Engineers)

1 - LS Form 3 - Verification Of Out-Of-State Licensure, Registration and/or Examination (Land Surveyors)

PE-30-LP Page 2 of 2, April 2004

16 $347 SP

15 $105 SP

16 $105 SP



www.op.nysed.gov

Application for Project Specific and 30 Day Limited Permitfor Applicants Not Seeking Licensure in New York State

A Project Specific Limited Permit (solely in connection with a single specified project) may be issued to a professional engineer legally qualified to practice as a professional engineer in his/her own state or country, where the applicant is not aresident of New York State and does not have an established place of practice in New York State. A project specific limitedpermit is subject to the same registration and revocation restrictions as a license.1. Complete all portions of this form (5A) and mail with the appropriate fee to the address listed at the end of this form. The

fee for a Project Specific Permit is $347. 2. Complete Form 3 and Form 6. Refer to the instructions on each form.A 30 Day Limited Permit may be issued to a professional engineer or land surveyor legally qualified to practice as a professional engineer or land surveyor in his/her own state or country, where the applicant is not a resident of New York Stateand does not have an established place of practice in New York State. Limited permit holders are permitted to practice for nomore than 30 days in any calendar year. 1. Complete all portions of this form (5A) and mail with the appropriate fee to the address listed at the end of this form. The

fee for a 30 Day Limited Permit for Professional Engineering or Land Surveying is $105. 2. Complete Form 3. Refer to the instructions on Form 3.*Please note: Limited Permits are issued to individual licensees, not business entities, according to Section 7207 of

Education Law.

1. Check what you are applying for:

F Project Specific Limited Permit F Original F Renewal

F 30 Day Limited Permit F Original

F Professional Engineering

F Land Surveying 6. Telephone/E-Mail Address

2. Social Security Number Daytime Phone(Leave this blank if you do not have a U.S. Social Security Number)

3. Birth Date Month Day Year Area Code Phone Number

4. Print Name As You Wish It To Appear On Your Limited Permit E-mail Address (please print clearly)

Last

First

Middle

5. Residential Address (You must notify the Department promptly of any address or name changes.)

Line 1

Line 2

Line 3

City

State Zip CodeCountry/Province

7. Work Line 1Address

Line 2

Line 3

City


Professional Engineering/Land Surveying Form 5A, Page 1 of 4, Rev. 12/14

Department Use Only

Date Approved/Rejected

Permit Number

Date Issued

Date Expires

Initials

Applicant Instructions

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Professional Engineering/Land Surveying Form 5A

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4

3

2

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8. Are you licensed in another state, country or jurisdiction? If yes, what jurisdiction? FYes F No

______________________________________________ ____________________ ________________________________________Profession License Number Jurisdiction

______________________________________________ ____________________ ________________________________________Profession License Number Jurisdiction

9. Have you previously applied for New York State licensure in any profession? FYes F No

If “yes”, in what profession(s)? _______________________________________________________________

10. Have you ever been found guilty after trial, or pleaded guilty, no contest, or nolo contendere to a crime FYes F No(felony or misdemeanor) in any court?

11. Are criminal charges pending against you in any court? FYes F No

12. Has any licensing or disciplinary authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of,suspended, placed on probation, refused to renew a professional license or certificate held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you? FYes F No

13. Are charges pending against you in any jurisdiction for any sort of professional misconduct? FYes F No

NOTE: If you answer "Yes" to any questions numbered 10-13, submit a letter giving a complete detailed explanation. Include copies of any courtrecords (conviction records), and if you possess one, a copy of the "Certificate of Relief from Disabilities" or your "Certificate of Good Conduct."

14. Permit Information

A. Please provide a brief description of the project and scope of practice anticipated under the limited permit.(Attach additional sheets if necessary.)

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

B. ________________________________________________________________________________________________________________Client name

________________________________________________________________________________________________________________Project Address

________________________________________________________________________________________________________________City State Zip Code

C. Project Duration: Specific dates of anticipated practice.

Practice begins: _______ / _______ / _______ and ends: _______ / _______ / _______mo. day yr. mo. day yr.

15. Gender And Ethnicity: (This item is optional.)Information on gender and ethnicity is sought solely to allow the Education Department to collect and analyze data concerning diversityin the licensed professions. The ethnic and gender data you provide will be used only for statistical, research, and program evaluationpurposes. It will not be released to the public. This information has absolutely no bearing on your qualification for licensure.

Gender: FMale FFemale

Ethnicity: FWhite (not Hispanic) FBlack (not Hispanic) FAsian FHispanic FNative American


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16. Citizenship/Immigration Status: Federal law limits the issuance of professional licenses, registrations and limited permits to United States citizens or qualified aliens. Tocomply with this Federal law, complete this section of this form and check the appropriate box below which indicates yourcitizenship/immigration status.

I am:

FA. A United States citizen or National.

FB. An alien lawfully admitted for permanent residence in the United States.

FC. An alien granted asylum under Section 208 of the Immigration and Nationality Act.

FD. A refugee granted asylum under Section 207 of the Immigration and Nationality Act.

FE. An alien paroled into the United States under Section 212 (d)(5) of the Immigration and Nationality Act for a period of at least 1year.

FF. An alien whose deportation is being withheld under Section 243 (h) of the Immigration and Nationality Act.

FG. An alien granted conditional entry pursuant to Section 203 (a)(7) of the Immigration and Nationality Act as in effect prior to April1980.

FH. Non Immigrant (Temporarily in U.S.)

Please list Visa type or immigration status or attach a copy of your passport if you are not required to have a Visa to enter theUnited States: _________________________________________________________________________________________

FI. I do not reside in the United States.

If you checked any of the boxes from B-H, enter your alien registration number or control number issued by the United StatesCitizenship and Immigration Services (USCIS): ___________________________________________

USCIS numberQUESTIONS ABOUT YOUR IMMIGRATION STATUS AND WHETHER OR NOT IT IS A QUALIFYING STATUS UNDER FEDERALLAW SHOULD BE DIRECTED TO THE U.S. CITIZENSHIP AND IMMIGRATION SERVICES (USCIS) BY CALLING 1-800-375-5283,OR VISIT THEIR WEB SITE AT WWW.USCIS.GOV.

18. Child Support Obligation

Everyone applying for a professional license, permit, or registration, or any renewal thereof, must file a written statement that, as of thedate of the filing, she or he is, or is not, under an obligation to pay child support*. Individuals who are four months or more in arrears inchild support or who have failed to comply with a summons, subpoena or warrant relating to a paternity or child support proceeding maybe subject to suspension of their business, professional, drivers and/or recreational licenses and permits. The intentional submission offalse written statements for the purpose of frustrating or defeating the lawful enforcement of support obligations is punishable undersection 175.35 of the Penal Law.

You must complete this section before we can issue the credential for which you have applied. Individuals who are not in compliancewith their obligation to pay child support can be issued a credential for no more than six months in order to comply with their child support obligations.

Check only A or B below. If you check B, you must check one of the five statements listed below it.

A. FI am not under an obligation to pay child support

OR

B. FI am under an obligation to pay child support and (please check only one of the following)

FI am current and am not four months or more in arrears in the payment of child support; or,FI am making payments by income execution or by court agreed payment plan or by a plan agreed to by the parties; or, FThe child support obligation is the subject of a pending court proceeding; or,FI am receiving public assistance or supplemental security income; or,FNone of the above four statements apply.

* New York State General Obligations Law, section 3-503.


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Out of State Stamp:

21. Affidavit With Acknowledgment (Notarization required.)

Applicant

I declare and affirm that the statements made in this application, including accompanying documents, are true, complete and correct. Iunderstand that any false or misleading information in, or in connection with, my application may be cause for denial or loss of licensureand may result in criminal prosecution.

Signature of the applicant: ______________________________________________________________________________________

Date __________ / __________ / __________ Month Day Year

Notary

State of __________________________________________________ County of __________________________________________

On the ____________ day of ______________________ in the year __________ before me, the undersigned, personally appeared

__________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual

whose name is subscribed to this application and acknowledged to me that he/she executed the application and swore that the

statements made by him/her in the application and all supporting materials are true, complete, and correct.

Notary Public signature _________________________________________________________________________________________

Notary ID number _______________________________

Expiration date __________ / __________ / __________ Month Day Year

Mail this form and appropriate fee to: New York State Education Department, Office of the Professions, PO Box 22063, Albany, NY12201. DO NOT SEND CASH. Make check or money order payable to the New York State Education Department.


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Notary Stamp



www.op.nysed.gov

VERIFICATION OF OUT-OF-STATE LICENSURE, REGISTRATION AND/OR EXAMINATION

(Must be filed by all applicants who are or have been licensed in another jurisdictionor want to verify passing parts of the licensing examination in another state)

Applicant InstructionsComplete Section I. Be sure to sign and date item 8.A. Verification of Examination(s) for Licensure

• If you are applying for admission to the Principles and Practice Examination and have passed the Fundamentals Examination inanother jurisdiction, send this form to that jurisdiction and request that they complete Section II and forward directly to the addressat the end of this form*.

• If you are applying for licensure on the basis of endorsement of your examination grades, send this form to the jurisdiction(s) whereyou took and passed the licensing examination(s) and to the jurisdiction where you are currently licensed and registered and askthat they complete Section II and send directly to the address at the end of this form*.

B. Verification of Licensure/Registration for a Limited Permit.• If you are applying for a Limited Permit, complete Section I and send this form to the jurisdiction where you currently reside and are

legally qualified to practice and ask they complete Section II and send directly to the address at the end of this form*.* Be sure to include any fee required by the licensing authority.

Section I: Applicant Information

1. Print Full Name As It Appears On Your Application for Licensure (Form 1) 3. Social Security Number

Last

First (Leave this blank if you do not have a U.S. Social Security Number)

Middle

2. Mailing Address (You must notify the Department promptly of any address or name changes.) 4. Birth Date

Line 1

Line 2 Month Day Year

Line 3

City


5. I am applying for: (check one) FNYS license FLimited Permit

6. If licensed by examination in the United States, give state or territory: _____________________________________________________

7. Print or type your name in the exact form in which the engineering license was issued:

_____________________________________________________________________________________________________________

8. To the Engineering State Board of: ________________________________________________________________________________

Check Appropriate boxes:

FI hereby make application for the transfer of examination grades and related information.

FI am a licensed Engineer of your state. License number: _______________________ Date issued: _______ / _______ / _______mo. day yr.

I request and give permission to the licensing authority above to complete the information on this form and send any documentationrequested, including that requested on this form, to the New York State Education Department.

_________________________________________________________________________________ _______ / _______ / _______Applicant’s Signature mo. day yr.

Professional Engineering Form 3, Page 1 of 2, Rev. 12/14

Professional EngineeringForm 3

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NOTE: Licensure or registration inanother jurisdiction is not a requirementfor licensure in New York.

Section II: Certification of Licensure/ExaminationInstructions to Licensing Authority Official: Complete Section II, sign this form, and mail it directly to the Office of the Professions at the

address at the end of this form.1. Print or type the name of the applicant in the exact form in which engineering registration was issued: (If different from name in Section I)

__________________________________________________________________________________________________________________________

2. Record of Examination

a. For Fundamentals of Engineering: (Check One)F Written Examination in your state.

Hours __________ Grade __________ Date _______ / _______ / _______ NCEES exam? FYes FNomo. day yr.

F Endorsement of examination taken in another state or territory.

F Waiver of written examination based on: (Check all that apply)

FAccredited engineering degree.

FOral examination. Hours __________ Date _______ / _______ / _______mo. day yr.

FDemonstrated proficiency in engineering over a period of __________ years.

FOther (Specify): __________________________________________________________________________________________________

b. For Principles and Practice of Engineering: (Check One)F Written Examination in your state or territory. Discipline: _____________________________________________________________________


F Endorsement of examination taken in another state or territory State or territory: _________________________________________________



FDemonstrated proficiency in engineering over a period of __________ years.

FOther (Specify): __________________________________________________________________________________________________

3. a. If the applicant holds a current license to practice engineering in your state, what is his/her:Expiration date of

License number __________________________ Date issued _______ / _______ / _______ most recent registration _______ / _______ / _______mo. day yr. mo. day yr.

b. Was there ever any disciplinary action against this license? FYes FNo

If so, please explain ______________________________________________________________________________________________________

c. Are any disciplinary charges pending against this license? FYes FNo


AttestationI certify that to the best of my knowledge and belief the foregoing is a true statement of the record of the applicant named on this form. I further certifythat, other than those listed above or in attached correspondence, this licensing authority has never taken any disciplinary action against this person andthat, in so far as the licensing authority has knowledge, there have been no charges preferred nor has any information been presented to the licensingauthority relating to any question of unprofessional or immoral conduct except as noted in question 3 above.

Signature ______________________________________________________________ Date _______ / _______ / _______mo. day yr.

Print name ____________________________________________________________

Title __________________________________________________________________

Agency _______________________________________________________________ (Licensing Authority Seal)

Address _______________________________________________________________

Telephone __________________________ Fax number ________________________

E-mail ________________________________________________________________

Return Directly to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services, ProfessionalEngineering Unit, 89 Washington Avenue, Albany, NY 12234-1000.

Professional Engineering Form 3, Page 2 of 2, Rev. 12/14

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www.op.nysed.gov

VERIFICATION OF OUT-OF-STATE LICENSURE, REGISTRATION AND/OR EXAMINATION

(Must be filed by all applicants who are or have been licensed in another jurisdictionor want to verify passing parts of the licensing examination in another state)

Applicant InstructionsComplete Section I. Be sure to sign and date item 8.A. Verification of Examination(s) for Licensure

• If you are applying for admission to the Principles and Practice Examination and have passed the Fundamentals Examination inanother jurisdiction, send this form to that jurisdiction and request that they complete Section II and forward directly to the addressat the end of this form*.

• If you are applying for licensure on the basis of endorsement of your examination grades, send this form to the jurisdiction(s) whereyou took and passed the licensing examination(s) and to the jurisdiction where you are currently licensed and registered and askthat they complete Section II and send directly to the address at the end of this form*.

B. Verification of Licensure/Registration for a Limited Permit.• If you are applying for a Limited Permit, complete Section I and send this form to the jurisdiction where you currently reside and are

legally qualified to practice and ask they complete Section II and send directly to the address at the end of this form*.* Be sure to include any fee required by the licensing authority.

Section I: Applicant Information

1. Print Full Name As It Appears On Your Application for Licensure (Form 1) 3. Social Security Number

Last

First (Leave this blank if you do not have a U.S. Social Security Number)

Middle

2. Mailing Address (You must notify the Department promptly of any address or name changes.) 4. Birth Date

Line 1

Line 2 Month Day Year

Line 3

City


5. I am applying for: (check one) FNYS license FLimited Permit

6. If licensed by examination in the United States, give state or territory: _____________________________________________________

7. Print or type your name in the exact form in which the engineering license was issued:

_____________________________________________________________________________________________________________

8. To the Land Surveying State Board of: _____________________________________________________________________________

Check Appropriate boxes:

FI hereby make application for the transfer of examination grades and related information.

FI am a licensed land surveyor of your state. License number: ____________________ Date issued: _______ / _______ / _______mo. day yr.

I request and give permission to the licensing authority above to complete the information on this form and send any documentationrequested, including that requested on this form, to the New York State Education Department.

__________________________________________________________________________________ _______ / _______ / _______Applicant’s Signature mo. day yr.

Land Surveyor Form 3, Page 1 of 2, Rev. 12/14

Land SurveyorForm 3

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NOTE: Licensure or registration inanother jurisdiction is not a requirementfor licensure in New York.

Section II: Certification of Licensure/ExaminationInstructions to Licensing Authority Official: Complete Section II, sign this form, and mail it directly to the Office of the Professions at the

address at the end of this form.1. Print or type the name of the applicant in the exact form in which engineering registration was issued: (If different from name in Section I)

__________________________________________________________________________________________________________________________

2. Record of Examination

a. For Fundamentals of Land Surveying: (Check One)F Written Examination in your state.


F Endorsement of examination taken in another state or territory.


FAccredited land surveying degree.


FDemonstrated proficiency in land surveying over a period of __________ years.

FOther (Specify): __________________________________________________________________________________________________

b. For Principles and Practice of Land Surveying: (Check One)F Written Examination in your state or territory. Discipline: _____________________________________________________________________

(if more than one part or grade, list separately on an attached sheet.)Part __________ Hours __________ Grade __________ Date _______ / _______ / _______ NCEES exam? FYes FNo

mo. day yr.F Endorsement of examination taken in another state or territory NCEES exam? F“Colonial” F“Public Domain”



FDemonstrated proficiency in land surveying over a period of __________ years.

FOther (Specify): __________________________________________________________________________________________________

3. a. If the applicant holds a current license to practice engineering in your state, what is his/her:Expiration date of

License number __________________________ Date issued _______ / _______ / _______ most recent registration _______ / _______ / _______mo. day yr. mo. day yr.

b. Was there ever any disciplinary action against this license? FYes FNo


c. Are any disciplinary charges pending against this license? FYes FNo


AttestationI certify that to the best of my knowledge and belief the foregoing is a true statement of the record of the applicant named on this form. I further certifythat, other than those listed above or in attached correspondence, this licensing authority has never taken any disciplinary action against this person andthat, in so far as the licensing authority has knowledge, there have been no charges preferred nor has any information been presented to the licensingauthority relating to any question of unprofessional or immoral conduct except as noted in question 3 above.

Signature ______________________________________________________________ Date _______ / _______ / _______mo. day yr.

Print name ____________________________________________________________

Title __________________________________________________________________

Agency _______________________________________________________________ (Licensing Authority Seal)

Address _______________________________________________________________

Telephone __________________________ Fax number ________________________

E-mail ________________________________________________________________

Return Directly to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Land SurveyingUnit, 89 Washington Avenue, Albany, NY 12234-1000.

Land Surveyor Form 3, Page 2 of 2, Rev. 12/14

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About seminar presenter Joseph V.R. Paiva Dr. Joseph V.R. Paiva, is principal and CEO at GeoLearn, LLC (www.geo-learn.com) which is an online provider of professional and technical education since February 2014. He continues to serve as a consultant in the field of geomatics and general business, particularly to lawyers, surveyors and engineers, and international developers, manufacturers and distributors of instrumentation and other geomatics tools. One of Joe’s previous roles was COO at Gatewing NV, a Belgian manufacturer of unmanned aerial systems (UAS) for surveying and mapping during 2010-2011. He also is a writer in many magazines and journals and has been on the “seminar circuit,” delivering continuing education to geospatial professionals, as well as technician and exam preparation courses. Joe was previously managing director of Spatial Data Research, Inc., a GIS data collection, compilation and software development company; senior scientist and technical advisor for Land Survey research & development, VP of the Land Survey group, and director of business development for the Engineering and Construction Division of Trimble; vice president and a founder of Sokkia Technology, Inc., guiding development of GPS- and software-based products for surveying, mapping, measurement and positioning. Other positions include senior technical management positions in The Lietz Co. and Sokkia Co. Ltd., assistant professor of civil engineering at the University of Missouri-Columbia, and partner in a surveying/civil engineering consulting firm. He has continued his interest in teaching by serving as an adjunct instructor of online credit and non-credit courses at Texas A&M-Corpus Christi and the Missouri University of Science and Technology. His key contributions in the development field are: design of software flow for the SDR2, SDR20 series and SDR33 Electronic Field Books and software interface for the Trimble TTS500 total station. He is a Registered Professional Engineer and Professional Land Surveyor, was an NSPS representative to ABET serving as a program evaluator, where he previously served as team chair, and commissioner, and has more than 30 years experience working in civil engineering, surveying and mapping. He writes for POB and The Empire State Surveyor magazines, occasionally contributes to other publications and has been a past contributor of columns to Civil Engineering News. GeoLearn is the online learning portal provider of the Missouri Society of Professional Surveyors and the Geographic and Land Information Society. To access these sites, find the links to their portals at these organizations’ websites. More organizations are set to partner with GeoLearn in 2015. [email protected]$or$on$Skype$at$joseph_paiva.$$

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$www.GeoLearn.com$

Jan2015

NYS LS License Application tips · PE/PS exams After receiving a passing result, it will take...

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