Application for Membership or Reclassification

Before you begin filling out this form please read the following pages carefully:

Please review the form completely and have all of your information and documents ready before you begin entering your details. You will not be able to save the form and return to finish submitting it later.

If you prefer to submit your application in hard copy by post, please download and print this application form instead of filling out the online form below.

* denotes a required field

A. Personal Information
Name*
Title First Last
Date of Birth*
MM slash DD slash YYYY
Email*
Phone 1*
Type*
Phone 2
Type
Residence Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Name (required if applicable)
Business Address (required if applicable)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Mailing Address*
- Residence
- Business
B. Current Membership
Are you an NBSCETT member in any category?*
- Yes
- No
Category*
Member Number*
Have you ever applied for certified membership with NBSCETT before?*
- Yes
- No
Year (approximate date) of previous application
Are you a member of any other Certified Technician/Technologist Society in Canada?*
- Yes
- No
Name of Society
Type of Membership
Member Number
Have you ever been a member of any other Certified Technician/Technologist Society in Canada?*
- Yes
- No
Name of Socitey
Type of Membership
Member Number
C. References
Provide the name and mailing address of four persons who have direct knowledge of your technical experience. They will be contacted for verification. These individuals should be Certified Engineering Technicians/Technologists, Professional Technologists, Professional Engineers, registered Land Surveyors, or licensed Architects. Immediate supervisors and team colleagues are also appropriate references.

Add at least four (4) entries

Name	Email	Phone	Address	Actions

There are no Entries.

D. Discipline and Option
If you are working in a different discipline from your graduated studies, please indicate the discipline and option of applied science and engineering technology you are working in.
E. Education
You must include complete, documented details of your education, including ALL post-secondary studies. A copy of each diploma, certificate or transcripts must be submitted with this application. (High School documentation is optional)

Must include at least one High School entry AND at least on entry from another Education level

Education Level	Name of Institution or Course Supplier	Start Date	End Date	Diploma or Certificate (or description of Course)	Actions

There are no Entries.

F. Technical Experience
List all of your technical experience, including your present employment, and upload a current resume

Add at least one (1) entry

Employer	Your Job Title	Start Date	End Date	Supervisor's Name	Actions

There are no Entries.

G. Awareness Information
It is very beneficial to NBSCETT if you would complete this form and return it with your membership application. This information will assist the Society in efficient, effective use of resources. Thank you.
By what means did you become interested in NBSCETT?
Name of Member who recommended you to apply
What features of NBSCETT influenced your decision to apply for certified membership?
Does your employer give credit for certification / membership in NBSCETT?
- Yes
- No
If yes, does your employer require certification for promotions?
- Yes
- No
If yes, is certification a condition of employment?
- Yes
- No
Any other information that would be useful in promoting NBSCETT.
H. Document Upload
Education - You must include a copy of your diploma or certificate for each completed education course. If you did not receive a diploma, but completed one or more subjects at college, include a transcript of marks awarded. This can be obtained by contacting the college.
Technical Experience - You must include a copy of your current resume.

Upload the required documents

Upload at least two files. Supported formats are PDF, DOC, and DOCX. Max file upload is 2MB.

File Name	File	Actions

There are no Entries.

I. Wall Certificate and Letter to Employer
Name*
Please carefully type your name exactly as you want it to appear on your wall certificate.
First Last
Letter to Employer
At the completion of the Certification Process, a letter is sent to each new member’s employer. The letter brings to the employer’s attention a number of important aspects of certification and its benefits. You may have the letter sent to the person or persons of your choice. Examples of those you may wish us to send letters to are: Personnel Director / Human Resources, Supervisor, Department Head, etc… A maximum of two letters can be sent.

Employer Information

Addressee Name	Company Name	Actions

There are no Entries.

J. Consent and Acknowledgements
*
- I understand NBSCETT collects, uses and discloses personal information to carry out its mandate under the Engineering Technology Act to protect the public, for professional regulation, research, statistical, educational, planning and database purposes and also to provide of offer services to its members directly or through TD Insurance Meloche Monnex and others (“third parties”) when NBSCETT determines such services may be of interest to members (“services”).
*
- I consent to receiving electronic communications from NBSCETT and third parties respecting such services and understand I may withdraw this consent at any time. I understand I may contact NBSCETT at any time to determine the use of disclosure of information I provide to NBSCETT.
*
- I certify that the preceding statements and related attachments are correct. In making this application I understand that certification does not give me the right to practice professional engineering, and that the wall certificate remains the property of the Society, and must be returned when my membership ceases for any reason.
*
- I hereby agree to abide by the Society’s “Code of Ethics” while a member of NBSCETT/SttagN-B.
Name*
Date*
MM slash DD slash YYYY

The ‘Engineering Technology Act’ of New Brunswick provides fines/imprisonment for knowingly furnishing false or misleading information in respect to an application for certification.
K. Payment
Membership*
- Full Membership - In Good Standing ($150)
- New Membership ($275)
Please call the NBSCETT office at 506-454-6124 to arrange for payment.

A. Personal Information

B. Current Membership

C. References

D. Discipline and Option

E. Education

F. Technical Experience

G. Awareness Information

H. Document Upload

I. Wall Certificate and Letter to Employer

Letter to Employer

J. Consent and Acknowledgements

K. Payment