In navigating the intricacies of professional licensure, the PS Exam Approval Application, designated as form PES 1011-PS, emerges as a fundamental step for engineering and surveying aspirants in Ohio aiming to take the Principles and Practice of Surveying examination for the first time. Managed by Ohio’s State Board of Registration for Professional Engineers and Surveyors, this form outlines a comprehensive procedure, beginning with the validation of registration qualifications as stipulated by specific Ohio Revised Code (R.C.) sections and Administrative Code (A.C.) sections, to the submission details including a $75 non-refundable application fee. Essential personal information, including contact details and a required passport-style photograph, set the stage for a rigorous assessment of qualifications. Furthermore, the application meticulously collects academic credentials, only recognizing degrees from ABET-accredited or board-approved institutions, alongside detailed records of relevant professional experience which must include verification from supervisors. Prospective candidates are also obliged to disclose any past disciplinary actions or legal transgressions, cementing the board's commitment to upholding high standards of character and professionalism within the field. The encapsulation of these elements within the PES 1011-PS form underscores its centrality to the licensure process, acting as a gateway for those seeking to contribute their expertise to Ohio's engineering and surveying landscape.
| Question | Answer |
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| Form Name | Form Pes 1011 Ps |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | boardpes, ps form 1011, OHIO, liteblue gov usps employees forms ps form 1011 |
OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS BOARD USE ONLY |
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pS Exam Approval Application |
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Registration qualiications
this PS Exam Approval Application is oNlY for candidates who are applying to take an ncEES Principles and Practice of Surveying examination for the irst time in ohio. registration qualiications can be found in ohio r.c. section 4733.11 through section 4733.13 and ohio A.c. section
locations, and a notarized afidavit is required on Page 4. An incomplete application cannot be reviewed and will be returned.
<< Your initials indicate that you have read the registration qualiications.
$75.00 nonrefundable application fee
An application and fee is required for each exam cycle. A $75.00 nonrefundable application fee, using check or money order; and made payable in u.S. funds to Treasurer, State of ohio; is required by ohio r.c. section 4733.12, section 4733.13 and ohio A.c. section
<<Your initials indicate that you understand the nonrefundable application fee is required by Ohio law and that the Board only accepts check or money order. Applications with cash will be returned.
contact, personal information
rEAd dIScLoSurE StAtEmEnt, PrIVAcY notIcE on PAgE 4
the Board requires your full name as it will oficially appear on any subsequent certiicate of registration. ImpoRTANT! We must assume your name is in u.S. order — irst, middle, last. Initials may be used. Your name on this application, and any subsequent ncEES- administered examination registration, must be the same.
Your fuLL nAmE In u.S. ordEr — fIrSt, mIddLE, LASt — InItIALS mAY BE uSEd |
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mAILIng AddrESS LInE 1 |
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p.o. box is NoT acceptable |
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mAILIng AddrESS LInE 2 >> oNlY if needed |
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cItY |
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u.S. StAtE, ZIP |
cAnAdA ProVIncE, PoStAL codE |
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EmAIL AddrESS |
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tELEPHonE |
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Required photo
Your REQUIREd photograph must be securely attached within this 2" by 2" space.
Passport, or
required, by ohio A.c. section
u.S. SocIAL SEcurItY numBEr
REQUIREd by ohio R.c. section 3123.50
BIrtH dAtE >> mm/dd/YYYY
countY >> REQUIREd if ohio address
countrY >> only if NoT U.S. or canada
Higher education oHIo A.c. SEctIon
ImpoRTANT! only AbET and
InStItutIon |
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Surveying courses worksheet attached? rEQuIrEd for APPLIcAntS WItH cIVIL EngInEErIng dEgrEE
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Yes: the surveying courses worksheet, PES 1012, is included with this application. |
PES |
Page 1 of 4 |
Surveying exam, licensure information VErIfIcAtIon rEQuIrEd for
FS exam |
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current p.S. licensure LISt no morE tHAn 3 |
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StAtE EXAm dAtE >> mm/dd/YYYY S.I. cErtIfIcAtE numBEr [1] |
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StAtE P.S. cErtIfIcAtE numBEr |
EXP. dAtE >> mm/dd/YYYY |
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pS exam
StAtE EXAm dAtE >> mm/dd/YYYY P.S. cErtIfIcAtE numBEr
Engineering exam, licensure information VErIfIcAtIon rEQuIrEd for
FE exam |
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current p.E. licensure LISt no morE tHAn 3 |
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StAtE EXAm dAtE >> mm/dd/YYYY E.I. cErtIfIcAtE numBEr [1] |
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StAtE P.E. cErtIfIcAtE numBEr |
EXP. dAtE >> mm/dd/YYYY |
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pE exam
StAtE EXAm dAtE >> mm/dd/YYYY P.E. cErtIfIcAtE numBEr
PE EXAm dIScIPLInE
[1]NoTE: S.I. and E.I., formerly S.I.t. and E.I.t., are ohio’s abbreviations for Surveyor Intern and Engineer Intern. Some states, including ohio, do not issue surveyor intern or engineer intern numbers.
References oHIo r.c. SEctIon 4733.12
List 5 persons, at least 3 of whom are registered surveyors, from whom the Board may request information in regard to your character, experience and professional ability. do not name your relatives or members of this Board.
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P.S./P.E. rEgIStrAtIon |
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PES |
Page 2 of 4 |
Experience oHIo A.c. SEctIon
What is the nature and extent of your experience? do not list college education. make as many copies of this page as needed. If using plain sheets to furnish additional engineering experience, be sure to date and sign each additional sheet. Include title of your position, name and location of employer, character of each employment and degree of responsibility. Explain your surveying experience in suficient detail to indicate degree of responsibilities and work performed. Have your supervisor complete and sign the supervisor information. If the supervisor is unavailable or unwilling to provide the information, attach a letter to this application with an explanation. You should only list fulltime employment.
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position, employer, location, work responsibilities |
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tImE
Years months
PErcEntAgE (%) of tImE
Surveying Engineering
SuPErVISor InformAtIon
Supervisor must complete
nAmE
P.S./P.E. rEgIStrAtIon
NumberState
EmAIL >> optional
tELEPHonE
SIgnAturE
dAtE
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EXPErIEncE dEtAIL |
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position, employer, location, work responsibilities |
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tImE
Years months
PErcEntAgE (%) of tImE
Surveying Engineering
SuPErVISor InformAtIon
Supervisor must complete
nAmE
P.S./P.E. rEgIStrAtIon
NumberState
EmAIL >> optional
tELEPHonE
SIgnAturE
dAtE
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EXPErIEncE dEtAIL |
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mm/YY |
position, employer, location, work responsibilities |
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tImE
Years months
PErcEntAgE (%) of tImE
Surveying Engineering
SuPErVISor InformAtIon
Supervisor must complete
nAmE
P.S./P.E. rEgIStrAtIon
NumberState
EmAIL >> optional
tELEPHonE
SIgnAturE
dAtE
PES |
Page 3 of 4 |
disciplinary actions oHIo r.c. SEctIon 4733.20
FEloNY, moRAl TURpITUdE Have you been convicted, found guilty, pled guilty or received treatment in lieu of conviction for a felony or any offense involving moral turpitude in ohio or another u.S. state or jurisdiction?
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Yes |
If YES, provide a written statement, signed and dated, explaining the incident(s) and attach statement(s) and |
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supporting documentation to this application. documentation should include, but is not limited to, court and |
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police records. |
lIcENSE, REGISTRATIoN Have you had a disciplinary action involving a professional or vocational license, or registration, or had an application for the same denied in ohio or another u.S. state or jurisdiction?
no |
Yes |
If YES, provide a written statement, signed and dated, explaining the incident(s) and attach statement(s) and |
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supporting documentation to this application. |
disclosure statement, privacy notice
dIScloSURE STATEmENT the State Board of registration for Professional Engineers and Surveyors is requesting disclosure of information that is necessary to accomplish our statutory purpose as required by chapter 4733 of the revised code and Administrative code. failure to provide required information may result in your application approval being delayed or in your application being returned.
pRIVAcY NoTIcE most documents and records maintained by the state of ohio are public records under ohio law. this means that information submitted to us from you may be subject to disclosure if there is an oficial public records request. EXcEpTIoNS: Your u.S. social security number and any college transcripts submitted to the Board are NoT public records and cannot be released through a public records request.
<< Your initials indicate that you have read the disclosure statement, privacy notice.
Notarized afidavit oHIo r.c. SEctIon 4733.09
StAtE of
AFFIANT
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being the duly sworn, or afirmed, applicant say that my statements in this application are true to the best of my knowledge and belief.
AffIAnt SIgnAturE
NoTARY
Subscribed and sworn, or afirmed, to me this
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Witness my hand and seal hereon.
notArY SIgnAturE
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[ tHIS SPAcE IntEntIonALLY BLAnK ]
deliver completed pS Exam Approval Application with fee to:
pS EXAm AppRoVAl ApplIcATIoN StAtE BoArd of rEgIStrAtIon for ProfESSIonAL EngInEErS And SurVEYorS 50 W BroAd St StE 1820
coLumBuS oH
Questions?
EmAIL pes.board@pes.ohio.gov
(614)
(877)
(614)
PES
OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS |
BOARD USE ONLY |
1012 |
Surveying courses Worksheet
this Surveying courses Worksheet must be completed by applicants seeking eventual registration in ohio as a Professional Surveyor who do not have a B.S. degree in surveying. ohio r.c. section 4733.11 (B) allows an applicant with an
including at least 6 semester hours (or 8 quarter hours) of courses in property surveying. the course category requirements are listed below. This form must be accompanied by original transcripts showing a b.S.c.E. degree and completion of the courses listed herein. underline the surveying courses on your submitted transcripts.
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Your fuLL nAmE In u.S. ordEr — InItIALS mAY BE uSEd |
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u.S. SSn |
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dAtE SuBmIttEd |
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FIRST, mIddlE, lAST |
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lAST 4 oNlY |
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list courses in correct categories |
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totAL |
BoundArY |
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crEdIt |
SurVEYIng |
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courSE tYPE |
courSE numBEr |
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SEm ▼ QTR |
SEm ▼ QTR |
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Boundary |
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oneleastathavemustcourse categoriesiveirsttheofeachin |
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courses1 |
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surveying2 |
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Historic develop- |
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ment of ohio |
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surveying |
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route or |
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construction |
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surveying3 |
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ohio minimum |
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standards laws |
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▼and ethics
upper level surveying courses4
Totals
1must include colonial and public land surveying methods and legal description writing
2must include ohio state plane coordinate system
3If construction surveying, must contain horizontal and vertical curve topics
4List any upper level courses
SEm ▲ QTR |
SEm ▲ QTR |
must be at least |
must be at least |
16 semester hours or |
6 semester hours or |
24 quarter hours |
8 quarter hours |
ImpoRTANT! this surveying courses worksheet assumes that all required college/university prerequisites to the issued courses and/or subject areas were completed in the B.S.c.E. program. courses such as surveying fundamentals, computer, and cAd courses not part of the B.S.c.E. program, may be required as bridge work by the academic institution offering the required courses in the form of a certiication program.
SURVEYING coURSES WoRKSHEET StAtE BoArd of rEgIStrAtIon for ProfESSIonAL EngInEErS And SurVEYorS 50 W BroAd St StE 1820
coLumBuS oH
Questions?
EmAIL pes.board@pes.ohio.gov
(614)
(877)
(614)
PES 1012 (rev. 09/2012) 0903 |
Page 1 of 1 |
OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS
licensure, Examination Veriication Request
use this form only if you acquired your E.I., S.I., P.E. and/or P.S. in a u.S. jurisdiction or state other than ohio.
1.To bE complETEd bY ApplIcANT
nAmE
AddrESS
cItY, StAtE, ZIP
BOARD USE ONLY |
1013 |
u.S. SSn
last 4 oNlY |
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BIrtH dAtE >> mm/dd/YYYY |
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VErIfIcAtIon rEQuEStEd from
rEQuEStIng VErIfIcAtIon for (cHEcK ALL tHAt APPLY): |
E.I. |
S.I. |
P.E. |
P.S. |
2.To bE complETEd bY VERIFYING boARd
Applicant is certiied or registered as:
cErtIfIcAtE numBEr |
ISSuEd >> mm/dd/YYYY |
VALId untIL >> mm/dd/YYYY |
E.I. Engineer Intern .............
S.I. Surveyor Intern .............
p.E. Professional Engineer...
p.S. Professional Surveyor...
licensure method Applicant is certiied or registered by:
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NcEES |
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HourS rESuLtS |
YES no |
EXAm dAtE >> mm/dd/YYYY |
Written examination fE
fS
PE
PE exam discipline
PS
other...................................
Has disciplinary action been taken against applicant?
no |
YES >> If YES, PLEASE IncLudE SourcE of SuPPortIng documEntAtIon |
Veriied by:
PrIntEd nAmE, tItLE
SIgnAturE |
dAtE |
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VERIFIcATIoNS
StAtE BoArd of rEgIStrAtIon for ProfESSIonAL EngInEErS And SurVEYorS 50 W BroAd St StE 1820
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Questions?
EmAIL pes.board@pes.ohio.gov
(614)
(877)
(614)
PES 1013 (rev. 09/2012) 0903 |
Page 1 of 1 |