Instructions for Completing Professional Experience Forms


Note: Share these instructions with each endorser completing a Form 4A.

Introduction

These instructions are intended to assist the applicant and the qualified professional who intends to serve as the endorser validating the applicant’s professional experience to meet the requirements for licensure as a professional engineer 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 Engineering Unit at opunit1@mail.nysed.gov or call 518-474-3817 ext. 250 or contact the State Board for Engineering and Land Surveying at enginbd@mail.nysed.gov or call 518-474-3817, ext. 140 or write to:

The New York State Education Department
Office of the Professions
State Board for Engineering and Land Surveying
89 Washington Avenue
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 his/her professional experience as an engineer.


Form 4

You must complete Form 4 and submit it to the State Education Department at the address at the end of the form. Indicate the discipline that most closely relates to the majority of your professional experience being submitted for evaluation. List all experience that you wish to be evaluated for licensure. Your experience must be listed 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 the attestation in item No. 6.

Your experience must be endorsed by someone who is familiar with your work and can attest that it has been done as stated and is accurately described. 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 the reasons, must be provided with the Form. 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.

When an endorsement does not lend credibility to your experience, it may be discounted at the judgement 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 official envelope.

  • 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.
    • If you worked for the same company 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 in order 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 part time the number of hours worked each week. Time claimed must match that claimed on Form 4 and cannot exceed calendar time. The Department will not process your application, if the time claimed for each endorser on forms 4 and 4A is not consistent.

  • Section II
    • Part A should be a concise description of your overall engineering duties. This section should be written in general terms.
    • Part B should be 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.
    • Part C should contain a detailed description of the engineering work you personally performed during the time period claimed for the endorser. When writing the description of your experience, be specific about your personal engineering 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. To accomplish this, the description of your experience should be broken down into intervals of no more than two years. 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 the Regulations of the Education Commissioner, in Part 68.2.
Last Updated: December 8, 2009