Story Transcript
ESTADO LIBRE ASOCIADO DE PUERTO RICO
Secretaría Auxiliar de Juntas Examinadoras
Departamento de Estado
Junta Examinadora de Ingenieros y Agrimensores de Puerto Rico
Apartado Postal 9023271, San Juan, PR 00902-3271 - Tel. 787-722-2122 - Ext. #227; Fax: 787-722-4818 http://www.estado.gobierno.pr - http://www.estado.gobierno.pr/ingenieros_y_agrimensores_puertorico.htm
___________________________ Fecha
Solicitud de Licencia por Reciprocidad [ ] Ingeniero(a) [ ] Agrimensor(a) Señores(as): Por la presente, solicito se me extienda una certificación para ejercer como [ ] Ingeniero [ ] Agrimensor por Reciprocidad en el Estado Libre Asociado de Puerto Rico.
Datos Personales Nombre: _____________________________________________________________________. 1er. Apellido
2do. Apellido
Nombre
Inicial
Dirección postal: _______________________________________________________________. Código postal + 4 dígitos.
Dirección física: _______________________________________________________________. Código postal + 4 dígitos.
Teléfono residencia: ______________________. Teléfono trabajo: _______________________. Teléfono celular: _________________________. Correo electrónico: __________________________________. (E-mail)
Número de Seguro Social: __________-________-__________. Fecha y lugar en que aprobó el examen Profesional: ______________ Puntuación: ______________________
Fecha Expedición: ________________
Numero Licencia y Lugar de Expedición :_____________ Certifico que esta información es correcta y exacta:
Fecha de Expiración:_______________
____________________________________ Firma (Ver instrucciones al dorso)
REQUISITOS PARA SOLICITAR LICENCIA POR RECIPROCIDAD DE INGENIERO(A) ó AGRIMENSOR (A) EN PUERTO RICO [
]
Formulario de Solicitud de Licencia de Ingeniero(a) o Agrimensor(a) por Reciprocidad contestando todas las preguntas y suministrando todos los documentos requeridos en dicho documento.
[
]
Listado con nombre, dirección, y teléfono de tres (3) Ingenieros o Agrimensores debidamente Licenciados (incluir número de licencia) en P.R. con conocimiento directo y personal de la reputación moral y la experiencia profesional, si alguna, del (de la) solicitante.
[
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Documentación acreditativa de su jurisdicción autorizando el ejercicio de su profesión y certificación de una entidad reconocida por la Junta en Puerto Rico de que su grado académico es sustancialmente equivalente a uno acreditado por ABET.
[
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Certificación en original de la Junta del País, Estado, Territorio o Posesión de los Estado Unidos de América que haya emitido la licencia correspondiente y que confirme el mismo privilegio a los Profesionales licenciados en el Estado Libre Asociado de Puerto Rico.
[
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Original Certificado de Antecedentes Penales de la Policía de Puerto Rico o de la policía o de un funcionario autorizado del país, territorio, o posesión de los Estados Unidos de América del cual provenga. reciente de seis (6) meses máximo de expedido.
[
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Original Certificado negativo de deuda de la Administración para el Sustento de Menores-ASUME según requerido por el Artículo 30 la Ley #86 del 17 de agosto de 1994. Si tiene deuda, deberá someter certificación y prueba de acogida a plan de pagos y que este al día en los mismos. Estos documentos con no más de 30 días de emisión.
[
] La copia amarilla o recibo electrónico de un comprobante de pago de Rentas Internas del Departamento de Hacienda por la cantidad de ciento sesenta dólares (US$160.00). Deberá indicar que lo ingresen a la cuenta 5143.
[
] Dos (2) fotografías a color tamaño 2” x 2” recientes indicando al dorso su nombre en letra de molde .
[
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Evidencia de haber tomado el examen sobre Ética, Leyes y Procedimientos emitido por la Junta Examinadora de Ingenieros y Agrimensores de Puerto Rico.
[
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Carta de Autorización a la Junta Examinadora para solicitar información adicional.
Nombre: ______________________________________________ Seguro Social: __________________________________________
Nota Importante El Departamento de Estado del Estado Libre Asociado de Puerto Rico reconocerá el recibo de la solicitud y sus documentos aplicando el sello oficial de recibo de la agencia e indicando la fecha y hora de recibido. Si algún o algunos de los requisitos aquí establecidos no son incluidos en la radicación de la solicitud, la Junta Examinadora podrá no recibirlos y ordenaría ser devueltos a la persona que los envió para que los someta nuevamente una vez todos los requisitos sean incluidos.
ESTADO LIBRE ASOCIADO DE PUERTO RICO
Departamento de Estado
Secretaría Auxiliar de Juntas Examinadoras
Carta de Autorización Por la presente autorizo a la Junta Examinadora de Ingenieros y Agrimensores de Puerto Rico a solicitar cualquier información adicional de ser necesaria para la tramitación de mi solicitud de Licencia por Reciprocidad para la práctica de la Ingeniería o Agrimensura en el Estado Libre Asociado de Puerto Rico. Nombre: _________________________________________ Dirección: ________________________________________ ________________________________________ Certifico que este documento fue firmado ante mí por ____________________, a quien doy fe de conocer personalmente o se identifica mediante lo siguiente_________________.
_________________________________ Firma del Notario
(Sello Notarial)
P.O. Box 9023271 San Juan, Puerto Rico 00902-3271
Tel. 722-2122
Commonwealth of Puerto Rico DEPARTMENT OF STATE Examining Board of Engineers and Land Surveyors of Puerto Rico Date Received ________________________
License Architect No. ________________
Dated _________________
Receipt No. _____________________ Issued
Graduate Architect No. _______________
Dated _________________
See Important Notice on Page 4 RECIPROCITY APPLICATION FOR ENGINEERS I hereby make application for a license to practice Engineering pursuant to the provisions of Law #173 of August 12, 1988 and submit the following statements, under oath: Every false statement knowingly made by the applicant in this paper, or connived at by him in any clause in this application, is good cause for rejection or for revocation of license afteer license has been granted. AFFIDAVIT State or Territory { of County or City An unmounted bust photograph of applicant, taken not more than six months before the date of application, must be pasted in this space and must not be loarger that the space provided and must not be smaller than 2½ by 2½ inches.
}as { of
I, ________________________________________, being duly sworn, declare that I am the person referred to in this application and that the statements herein contained are true in every respect, and that the attached photograph is a true likeness of myself taken within the last six months.
(Passport photograph requested.)
(Signature of Applicant) Subscribed and sworn to before me this __________________ day of _________________________, _____. Witness my hand and seal here unto attached. (Signature of Notary Public)
THE APPLICANT MUST GIVE FULL ANSWER TO THE FOLLOWING Name ____________________________________________________________________________ Age __________________ Years (Full Name)
Date of birth __________________________ Place of birth ____________________________________________________________ (Month-Day-Year)
(City)
(Country)
(State)
Present address ________________________________________________________________________________________________ Are you a legal resident of the Goverment of Puerto Rico
Yes
No
How long have you been a resident of Puerto Rico? ____________ years. PHYSICAL DESCRIPTION OF APPLICANT Color of hair ________________________ Color of Eyes _____________________ Height _______________ Weight ____________ Are you a citizen of the United States? ______________________________________ If naturalized, give date and place of naturalization__________________________________________________________________________________________________ Has your surname ever been changed? __________________________ If so, give date and place of such change ___________________ ________________________________________________________ Give original surname __________________________________ Have you ever been convicted of, or indicted for, any crime involving moral turpitude? ________________________________________ If so, state facts in the case here or on separate sheet and attach ___________________________________________________________ Have you read carefully and fully understand the laws containing the information and rules governing the registration? Have you ever been convicted of, or indicted for, any violation of the above mentioned law?
Yes
No
Yes
No
EDUCATION (State in chronological order the name and location of each college, university, or technical school attended, the time spent at each, and if graduate, the year of graduation, also list graduate work, evening school, research work, etc.) Name and Location of Institution
Years From - To
Date Graduated
Technical Course
Degree Received
REGISTRATION IN OTHER STATE BOARDS In case you have registered in any other State Board, fill out the following: Name of State Board _________________________________________________________________________________________ Clasification ____________________________________________ Number & Date of Certificate ___________________________ Written or oral examination taken? _________________________ If not, how registered? _________________________________ If Certificate now in force? _____________________ If not, why? ____________________________________________________ Has Certificate ever been revoked? _______________ If so, why? ____________________________________________________ State of first registration: (Name State) __________________________________________________________________________ Other States in whick registered ________________________________________________________________________________
CERTIFICATE OF GOOD MORAL CHARACTER (To be Signed by a Licensed Enginner in "Good Standing" or a well known citizen in the community) Date I hereby certify that since _______________________________________ , I have been so closely associated with (Insert date)
______________________________________, residingin ___________________________________________________ (Insert name of applicant)
(Insert name of City and State)
whose signature appears above, as to be able intelligently to express an opinion as to his character, mental condition, and habits, and that to the best of my knowledge and belief, he is of good moral character and free from mental defects and drug habits liable to interfere with the proper practice of Surveying. Remarks:
License No. _____________ (Signature) (Type or Printed Name) (Address)
CERTIFICATE OF GOOD MORAL CHARACTER (To be Signed by a Licensed Enginner in "Good Standing") Date I hereby certify that since _________________________________________ , I have been so closely associated with (Insert date)
______________________________________, residingin ___________________________________________________ (Insert name of applicant)
(Insert name of City and State)
whose signature appears above, as to be able intelligently to express an opinion as to his character, mental condition, and habits, and that to the best of my knowledge and belief, he is of good moral character and free from mental defects and drug habits liable to interfere with the proper practice of Surveying. Remarks:
License No. _____________ (Signature) (Type or Printed Name) (Address)
CERTIFICATE OF GOOD MORAL CHARACTER (To be Signed by a Licensed Enginner in "Good Standing") Date I hereby certify that since _________________________________________ , I have been so closely associated with (Insert date)
______________________________________, residingin ___________________________________________________ (Insert name of applicant)
(Insert name of City and State)
whose signature appears above, as to be able intelligently to express an opinion as to his character, mental condition, and habits, and that to the best of my knowledge and belief, he is of good moral character and free from mental defects and drug habits liable to interfere with the proper practice of Surveying. Remarks:
License No. _____________ (Signature) (Type or Printed Name) (Address)
GENERALINSTRUCTIONSTOAPPLICANT
Date From To
Title of Position, Name of Employer, and Character of each Engagement. Make statement concide and explicit, include magnitude and complexity of work, on which engaged, your duties and degree of responsibility; any necessary may be made on separate sheet. List engagements in chronological order
Name, Title & Address of some person (not deceased) familiar with each engagement. The person must be an Engineer having a direct and personal knowledge of the professional experience of the applicant.
TOGETER WITH THE APPLICATION YOU MUST SEND THE FOLLOWING DOCUMENTS:
1.
Certification of the University or Certified copy of the Diploma verifying your graduation as a BS in Engineering.
2.
Official Certification of the State in which it was originaly registered stating grades obtained in the National Examination.
3.
Official Money Order in the Amount of $160.00 issued to the Secretary of the Treasury of Puerto Rico.
4.
N.C.E.E.S. Record in support of the application for State Registration (803) 654-6824.
5.
The Board could Request additional information if necessary. RECORD OF ACTION TAKEN BY THE BOARD ON THIS APPLICATION THE UNDERSIGNED MEMBERS OF THIS BOARD APPROVED THE FOLLOWING:
DATE ____________________________
ACT NUMBER _____________________
Commonwealth of Puerto Rico Department of State
CERTIFICATION
Mr. President of the Board This letter is given to authorized the Board to request additional information, if necessary, for approval of my application for Reciprocity to achieve registration as a Licensed Professional Engineer (P.E.) in Puerto Rico. Yours very truly, ___________________________ Your Names
___________________________ State of
___________________________ Country of The foregoing instrument was acknowledge before me this ___________ day of ___________ by _______________________________ who is personally known to me.
___________________________ Signature of Notary
(Seal of Notary)
Commonwealth of Puerto Rico Department of State BOARD OF EXAMINERS OF ENGINEERS AND LAND SURVEYORS OF PUERTO RICO REQUIREMENTS FOR CONSIDERATION OF RECIPROCITY OR COMITY TO PRACTICE ENGINEERING OR LAND SURVEYING IN PUERTO RICO (
)
Submit application for Reciprocity or Comity.
( )
Money Order in the amount of $150.00 issued to the Secretary of the Treasury of Puerto Rico, plus ten dollars ($10.00) for the ID card.
( )
Certified copy of Diploma from University recognized by A.B.E.T. with a Bachelor in Science of Engineering degree or Surveying degree.
( )
Submit the NCEES record (Blue Book).
( )
Certification of Criminal Record from your jurisdiction.
( )
Certification of Child Support from your jurisdiction.
( )
Letter of authorization for the Board to request additional information if necessary.
( )
Two 1 x 1 inches photo in order to prepare the identification card.
The State Department will acknowledge receipt of the application by stamping on it the date it is officially received. If all of the above documents are not present and fully complete, they will not be accepted and will be returned to the applicant. 1
1
Article 23- Exemption from Residency Requirements The Board may exempt licensed engineers, architects and land surveyors from the residency requirements established under this law in the followings cases: (a) When the jurisdiction from which the professional originates exempts the same professionals originating from Puerto Rico from its residency requirements. (b) When the applicant associates for the practice of his or her profession with another architects, engineer or land surveyor licensed and domiciled in the Commonwealth of Puerto Rico, according to those requisites established by the Board by Regulation. To those professionals who are exempted from complying with the residency requirements, the Board will grant a licensed conditioned to the requisites of the exemption under which it is granted. They will be subject to the special norms established to this effect by the College or Architects or the College of Engineers and Land Surveyors, as the case may be. Furthermore, they will be obligated to renew such conditioned license annually, with the prior payment of the corresponding fees.