Download - Membership Application Form 2013
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ASSOCIATION OF STRUCTURAL
ENGINEERS OF THE PHILIPPINES,
INC.Suite 713 Future Point Plaza I, 112 Panay Avenue, QuezonCityPhone: (+632) 1! ! "3 # Fa$: (+632) 11 "6 !6 # %o&ile:(+63) '17 "23 77 3' *ail Are:ae-online./*ail0o*
EVALUATION RATING FORM
Control/ID Number
N!me o" A##l$%!nt
2” x 2”
colored
photo
MEM&ERSHIP GRADE AFFILIATE ASSOCIATE MEM&ER REGULAR MEM&ER
MEM&ER'M$n$mum re(u$rement) #r$or to!##l$%!t$on.
Mu)t be ! *r!+u!te C$$l
En*$neer -$t !t le!)t e 012
3e!r) rele!nt
)tru%tur!l +e)$*n e4#er$en%e
but !)
not #!))e+ te P$l$##$ne&o!r+
E4!m$n!t$on "or C$$lEn*$neer).
M$n$mum o" t-o 052 3e!r) o"
rele!nt
%ont$nuou) e4#er$en%e $n
)tru%tur!l +e)$*n
o" )$*n$%!nt )tru%ture) )u% !)
lo-6 !n+me+$um6r$)e bu$l+$n*) #r$or to
!##l$%!t$on.
M$n$mum o" t-o 052 3e!r) o" rele!nt
%ont$nuou)e4#er$en%e $n )tru%tur!l +e)$*n o" )$*n$%!nt
)tru%ture))u% !) MR&, HR&, to-er) !n+ oter
ert$%!l )tru%ture),br$+*e), or )#e%$!l %$$l en*$neer$n*
)tru%ture) #r$or to!##l$%!t$on !n+ mu)t !e ! tot!l o" e 012
%ont$nuou)
3e!r) rele!nt )tru%tur!l +e)$*n e4#er$en%eo" te )!me.
Item E!lu!t$on Cr$ter$! No. o" R!te+ No. o" R!te+ No. o" R!te+ 3e!r)
No. 7e!r) 3e!r) 7e!r) 3e!r) 7e!r)
8.9 Stru%tur!l +e)$*n e4#er$en%e'
5.9 Te!%$n* e4#er$en%e
0te!%$n* )ub:e%t)rel!te+ to )tru%tur!l
en*$neer$n*2No. o" 3e!r) Po$nt)
; 1 9.19
; 9
; 5, = > 9.59
= 5 9.89
>.9 De)$*n m!n!*ement e4#er$en%eNo. o" 3e!r) Po$nt)
; 1 9.>9
; , = < 9.59
; 5, = > 9.81= 5 9.89
9 ; 81 8.99
/ 5.19
; 5
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= 8B = B 9.59 / 5.89
B.9 Cont$nu$n* #ro"e))$on!l+eelo#ment !tten+e+. Te re(u$re+ m$n$mum our) "or ASSOCIATE $) >9
our)? "or REGULAR B9 our) "or te
l!)t > 3e!r) #r$or to
!##l$%!t$on? !n+ "or UPGRADE TO
REGULAR $) 859 our)
#r$or to !##l$%!t$on. NOTE FULL
HOURS ILL ONL7 &E
CREDITED FOR ASEP6ORGANIED
EVENTS ITH DUL76SIGNED CERTIFICATION.
FINAL RATING
REUIRED MINIMUM RATING TO &E ACCEPTED PLUS THE
MINIMUM CPD HOURSPRIOR TO APPLICATION
5.99
59
our)
>.99
>9 our)
.99
B9 our) REGULAR9 our) UPGRADE
REMARS/ACTION An !##l$%!nt -o $) ! PICES#e%$!l$)t Member $n te el+
o" Stru%tur!l En*$neer$n* m!3 be
!%%e#te+ !) ! REGULARmember.
ASP#%S %e*&erhi- va luation atin/For*#rev2!13!' P a / e
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ASSOCIATION OF STRUCTURAL
ENGINEERS OF THE PHILIPPINES,
INC.Suite 713 Future Point Plaza I, 112 Panay
Avenue, Quezon CityPhone: (+632) 1! ! "3 # Fa$: (+632) 11
"6 !6 # %o&ile: (+63) '17 "23 77 3' *ail Are: ae-online./*ail0o*
MEM&ERSHIP APPLICATION FORM
Control/ID Number
D!te Form Subm$tte+
Current O%%u#!t$on
2” x
2”
colored photo
N!me o" Com#!n3/F$rm/Or*!n$!t$on
I. PERSONAL DETAILS 0Ple!)e u)e &LOC LETTERS2
NAME
D
A
T
E
O
F
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J
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P
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L
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E6MAIL
MO&ILE
OR ADDRESS
C
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T
A
C
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P
H
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N
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F
A
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E6MAIL
PROFESSION
II. ENGINEERING DISCIPLINE
DEGREE 7EAR INSTITUTIONHERE
SPECIALIATIOFIELD OF
ASP#%S %e*&erhi- A--liation For*#rev2!13!' P a / e
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III. ENGINEERING PRACTICE
LICENSURE EJAM
REGISTRATION NO.
DATE TAEN
ATE ISSUED
LICENSURE EJAM DATE TAEN
REGISTRATION NO. ATE ISSUED
IV. PROFESSIONAL EJPERIENCE
7EAR POSITION RESPONSI&ILIT7 PROGRAM/PROKE
Det!$le+ De)%r$#t$on o" Re)#on)$b$l$t$e) (make additional copy of this tabulation as extra sheet needed following the sameformat)
A##l$%!nt@) Role
A##l$%!nt@) En*$neer$n* or
V. SIGNIFICANT ENGINEERING OR
7EAR RESPONSI&ILIT7 PROGRAM/ &ENEFICIAR7
Det!$le+ De)%r$#t$on o" Re)#on)$b$l$t$e) (make additional copy
of this tabulation as extra sheet needed following the same
format)
A##l$%!nt@) Role
A##l$%!nt@) En*$neer$n* or
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To Te ASEP Member)$# S%reen$n* &o!r+
Trou* ASEP Se%ret!r$!t
Te un+er)$*ne+, !##l3 "or member)$# ☐ !) !n AFFLIATE MEM&ER☐ !)
!n ASSOCIATE MEM&ER
☐ !) ! REGULAR MEM&ER ☐ UPGRADE to REGULAR MEM&ER ☐ ELEVATE to
FELLO, !n+ +e%l!re
t!t te !boe +e)%r$#t$on) !re true.
A##l$%!nt@) N!me !n+ S$*n!ture
D!te Re%e$e+ b3
PRC Re*. No.
V!l$+$t3
Checklist for Membership Application: (Please tick checklist when
included / submitted)
☐ 1 Evaluation Rating Form (rev2013.09)
☐ 2 Completel !illed"in #$% #em&er'hip pplication
Form (rev2013.09)☐ 3 *o (2) pc'. o! 2” x 2” +, picture'-
colored
☐ 4 hotocop o! RC +, (!ront and &ac/)
☐ 5 t lea't minimum t*o (2) con'ecutive ear' o! 'tructural de'ign experience !or$$C+E #em&er' or minimum !ive () con'ecutive ear'o! 'tructural de'ign experience !or RE4R #em&er' 5pgrade to RE4R #em&er'
☐ 6 Endor'ement !rom three (3) $E Regular #em&er' ingood 'tanding and5or
$E Fello*' a' Re!erence'
☐ 7 Comprehen'ive curriculum vitae- certi!ied and updated re'ume a''upporting attachment to
the #$% pplication Form
☐ 8 hotocop o! Emploment Certi!icate- certi!ied true cop
☐ 9 hotocop o! ,iploma 5 ran'cript o! Record' (ndergraduate and po't"graduate cour'e')
☐ 10 hotocop o! Certi!icate' !or 'eminar' 5 *or/'hop 5 con!erence'attended *ith program
included
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☐ 11 Electronic !ile cop o! all 'u&mitted document' in ,F !ormat
&urnt in C, 5 ,6, Im#ort!nt Note)
All +o%ument) to be )ubm$tte+ b3 te !##l$%!nt "or member)$# )!ll be!rr!n*e+ $n te or+er !) $n+$%!te+ !boe !n+ )!ll be %om#$le+ $n te
)t!n+!r+ "ol+er #re)%r$be+ b3 MS&.
A##l$%!nt )oul+ )ubm$t te !boe +o%ument) $n )u##ort o" te !##l$%!t$on!n+ ! non6re"un+!ble #ro%e))$n* "ee o" PHP 8,999.99 0USD 512.
U#on !%%e#t!n%e o" te !##l$%!t$on, Entr!n%e "ee o" PHP 8,199.990USD
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ASSOCIATION OF STRUCTURAL
ENGINEERS OF THE PHILIPPINES,
INC.Suite 713 Future Point Plaza I, 112 Panay
Avenue, Quezon CityPhone: (+632) 1! ! "3 # Fa$: (+632) 11
"6 !6 # %o&ile: (+63) '17 "23 77 3' *ail Are: ae-online./*ail0o*
MEM&ERSHIP APPLICATION FORM
Control/ID Number
D!te Form Subm$tte+
Current O%%u#!t$on
2” x
2”
colored photo
N!me o" Com#!n3/F$rm/Or*!n$!t$on
I. PERSONAL DETAILS 0Ple!)e u)e &LOC LETTERS2
NAME
D
A
T
E
O
F
&
I
R
T
H
S
E
J
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N
A
T
I
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N
A
L
I
T
7
P
A
S
S
P
O
R
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N
O
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E6MAIL
MO&ILE
OR ADDRESS
C
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N
T
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MI
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E6MAIL
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PROFESSION
II. ENGINEERING DISCIPLINE
DEGREE 7EARINSTITUTIONHERE
SPECIALIATIO
FIELD OF
AS(P#%S %e*&er,hi- A--liation For*#rev2!13!') P a / e
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III. ENGINEERING PRACTICE
LICENSURE EJAM DATE TAEN
REGISTRATION NO. DATE ISSUED
LICENSURE EJAM DATE TAEN
REGISTRATION NO. DATE ISSUED
IV. PROFESSIONAL EJPERIENCE
7EAR POSITION RESPONSI&ILIT7 PROGRAM/PROKE
Det!$le+ De)%r$#t$on o" Re)#on)$b$l$t$e) (make additional copy of this tabulation as extra sheet needed following the sameformat)
A##l$%!nt@) Role
A##l$%!nt@) En*$neer$n* or
V. SIGNIFICANT ENGINEERING OR
7EAR RESPONSI&ILIT7 PROGRAM/ &ENEFICIAR7
Det!$le+ De)%r$#t$on o" Re)#on)$b$l$t$e) (make additional copy of this tabulation as extra sheet needed following the sameformat)
A##l$%!nt@) Role
A##l$%!nt@) En*$neer$n* or
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VI. PROKECT/S 0P!)t !n+ #re)ent En*$neer$n* Pro:e%t)2
N!me/Lo%!t$on RESPONSI&ILIT7 Dur!t$on !n+ Co)t CLIENTELE
VII. CONTINUING PROFESSIONAL DEVELOPMENT 0CPD2 (makeadditional copy of this
tabulation as extra sheet needed following the same format)
Pro*r!m De)%r$#t$on
rel!te+
N!me o" Pro$+er /
Cre+$t Un$t)
/
In%lu)$e D!te)
CPD
VIII. REFERENCES (As a reuirement of the !e"ised #mplementing
!ules and !egulations of the$ylaws% applicant should submit names of three (&) !egular
Members% in good standing% and/or 'ellows of the Association he section below should be *lled in
by your named !eferences)
N!me o" Re"eren%e-$t
Re"eren%e Cont!%tDet!$l)
6
Re"eren%e
ASEP IDRem!r) / Comment) "te
S$*ne+
Re". N!me
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MEM&ERSHIP APPLICATION FORM 6 ADDITIONAL SHEETS 0HEN NECESSAR72
A##l$%!nt@) N!me
IV. PROFESSIONAL EJPERIENCE
7EAR POSITION RESPONSI&ILIT7 PROGRAM/PROKE
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V. SIGNIFICANT ENGINEERING OR
7EAR RESPONSI&ILIT7 PROGRAM/ &ENEFICIAR7
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VI. PROKECT/S 0P!)t !n+ #re)ent En*$neer$n* Pro:e%t)2
N!me / Lo%!t$on RESPONSI&ILIT7 Dur!t$on !n+ Co)t CLIENTELE
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AS(P#%S %e*&er,hi- A--liation For*#rev2!13!') P a / e
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VII. CONTINUING PROFESSIONAL DEVELOPMENT 0CPD2 (makeadditional copy of this
tabulation as extra sheet needed following the same format)
Pro*r!m De)%r$#t$onrel!te+
N!me o" Pro$+er /Cre+$t Un$t)/
In%lu)$e D!te)CPD
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AS(P#%S %e*&er,hi- A--liation For*#rev2!13!') P a / e
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