Instructions for Completing Professional Experience Forms

NOTE: Share these instructions to your endorser with Form 4A. Make a copy for your records.

Introduction

These instructions are intended to assist the applicant and the qualified professional (employer, supervisor or professional colleague) who intends to serve as the endorser validating the applicant's professional experience to meet the requirements for licensure as a professional geologist in New York State. If there are any questions about these guidelines, or any other aspect of licensure, please feel free to contact the Office of the Professions, Professional Geology Unit at opunit1@nysed.gov or call 518-474-3817 ext. 250 or contact the State Board for Engineering, Land Surveying and Geology at geology@nysed.gov or call 518-474-3817, ext. 140 or write to:

The New York State Education Department
Office of the Professions
Board for Engineering, Land Surveying and Geology
89 Washington Avenue, Second Floor
Albany, New York 12234-1000.

Both the applicant and the endorser should read and be thoroughly familiar with these instructions. The form used to list professional experience (Form 4) requires a comprehensive listing of all endorsers and places of employment where the applicant gained the professional experience as a geologist that he/she would like to be considered for licensure purposes.


Form 4

You must complete Form 4 and submit it to the State Education Department at the address at the end of the form. Your experience must be listed in chronological order beginning with your first employment for which experience is being claimed, and include company/firm name, name of endorser, beginning and ending dates, and total time claimed for each endorser. Be sure to sign and date the attestation in item No. 6.

Your experience must be earned:

  • under the supervision of either a licensed professional geologist or licensed professional engineer; or
  • under a geologist or engineer that the Board recognizes as qualified to assume responsible charge of the geologic work done; or
  • if the applicant was the person in responsible charge of the work, someone who can attest that it has been done as stated and is accurately described; or
  • In lieu of the practical experience in geological work requirements set forth in part 68.8 of regulations of the commissioner, the board may accept research in, or the teaching of, geological sciences at the college or university level as qualifying practical experience in geological work, if, in the judgment of the board, the research or teaching is comparable to the practical experience obtained in the practice of geology.

Your endorser should preferably be the person who was your supervisor at the time the work was performed. If this is not possible, a letter documenting how the individual knows your work and why you selected that individual to endorse your work must be provided with the Form 4A.

If you are unable to obtain a supervisor's endorsement, select another person (coworker or client) you worked with who is sufficiently knowledgeable about your work to attest to the accuracy of your experience description. Please note: NYSED is unable to accept endorsements from Human Resources personnel.

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


Form 4A

Complete Sections I and II and send this form to your endorser to complete Section III. Upon completion, your endorser must return the form directly to the State Education Department in a sealed envelope bearing the endorser's return address.

Section I

  • Complete Form 4A for each endorser listed on Form 4.
  • Use a separate Form 4A for each endorser, even if they work for the same company/firm.
  • If you worked for the same company/firm more than once, with other employment interrupting that work period, you must use a separate form for each period you worked for the same company, even if they are to be endorsed by the same person. This is required so that your experience can be arranged in chronological order.
  • For each Form 4A, in item No. 6 you must indicate the duration of your experience with that endorser, whether your experience was full time or part time, and if it was part time, the number of hours worked each week. Time claimed must match that claimed on Form 4 and cannot exceed calendar time, even if project dates overlap. The Department will not process your application, if the time claimed for each endorser on forms 4 and 4A is not consistent.

Section II Should contain the following:

  • A brief description of your level of responsibility for the work performed for the experience being reported for the endorser. You should indicate your title and any title changes resulting from promotions or other job changes during the time period described.
  • A detailed description of the geological work you personally performed during the time period claimed for the endorser. When writing the description of your experience, be specific about your personal geological contributions to the project and describe your work in sufficient detail to give the Board a sense of the complexity and breadth and depth of your work. Please note: the description of your work experience should avoid generalities such as "involved with" or "participated in" and focus on your individual contributions.
  • Indicate the duration or your work experience in the "Time" (years/months) column, and complete the totals at the bottom of each page of Form 4A.
  • Whether or not your work experience is accepted toward fulfillment of state licensure requirements is determined, in part, by the extent to which the general characteristics of that work conform with the criteria established by Part 68.8 of the Regulations of the Commissioner.

Section III

  • This section is to be completed by the endorser.
  • The endorser should complete the top half of the page with the requested information.
  • The endorser should answer each of the 7 questions regarding your description of professional experience as described on the form. The endorser may attach additional comments to the form should he/she desire.

Section IV

  • The endorser must complete the Affidavit by signing and dating in the space provided.
  • If an endorser is unable to certify, he/she should check the box provided, and provide a letter of explanation in the same envelope in which he/she returns the completed form 4A and that is sent directly to NYSED at the address on the bottom of the last page.
Last Updated: September 15, 2016