Peng Sample

_________________________________________________________________ ENGINEER-IN-TRAINING REPORT ON EXPERIENCE *NEW: Indicate here if this is an Interim Report or the Final Report: Interim:

Final: X

This is the Final Report only if it is the last one you will be submitting to the APEGS office prior to applying for Professional Member. All other reports are submitted as Interim Reports (including international experience unless it is experience from the United States, which can be submitted as a Final Report). Separate reports are required for separate jobs. A separate report is required even if it is work for the same employer but there was a change in job function. Complete sections A and B, and Parts 1 to 4. Your supervisor(s) completes section C and mentor(s) completes section D (mentor required only if the direct supervisor is not a P.Eng. or P.Geo.). Both the supervisor and mentor answer questions and fill in comments on each page of Parts 1 to 6. This form must be shared electronically so that the supervisor(s) and mentor(s) have an opportunity to enter comments. Print all pages up to the end of the Report Summary Form (8 pages minimum) when it is completed. After printing, initials are required throughout the report from supervisors and mentors. Signatures of all those contributing to the report are required on the final page.

A. PERSONAL INFORMATION Name: John Smith – names have been changed for confidentiality Home address: Apt 123, ABC Street, Cityname, SK, A1B 2C3 Bachelor degree (month/yr completed): 05/01 Masters degree (month/yr completed): Doctorate degree (month/yr completed): Other degree (month/yr completed): Discipline: Civil Discipline: Discipline: Discipline: University: University of Saskatchewan University: University: University: E-mail: home@123.com

B. EMPLOYER INFORMATION FOR THE REPORTING PERIOD Employer name: ABC Consulting Ltd. Business address: Box 123, ABC Street, Cityname, SK, A1B 2C3 Business phone: (306) 123-4567 Nature of...