South African National Institute of Rock Engineering

AP P L I C A T I O N F O R M

Grandfathering Process

Surface Mining Rock Engineering Certificate

NB:Please consult the enclosed Information Sheet (Sheet A1.1) before completing this Application.

Form A1.1 (04/05/2010)

1.General Information:

Surname: / First Names:
Date of Birth: / Identity No. OR Passport No. & Country:
Nationality: / Country of Normal Residence:
Postal Address: / Name & Address of Employer:
Title of Position Held by Applicant:
APPLICANT:
Tel. No. (Work): (include area codes)
Cell No.:
E-mail: / EMPLOYER:
Tel. No.: (include area codes)
Fax No.: (include area codes)
E-mail:

2.Qualifications:

(All qualifications at tertiary level or rock mechanics certificates, include certified copies and where possible academic records)

Educational Institution / Qualification / Attendance
From:To: / Date of Final
Examination

Form A1.1 continued/

Form A1.1 continued/

3.Previous / Current Registration or Application Details with Professional Body:

(e.g. SACNASP, ECSA, PLATO, etc.)

Professional Body / Category / Registration Number / Date

4.Membership of Voluntary Associations:

(If more space is needed, please supply information separately.)

Name of Association / Institute / Society / Membership Grade
and Date Accepted

5.Referee 1:Referee 2:

Name:
Employer:
Designation:
Professional Registration:
Registration Number:
Email address:
Office contact no:
Cell no:
Signature:
______/ Name:
Employer:
Designation:
Professional Registration:
Registration Number:
Email address:
Office contact no:
Cell no:
Signature:
______

6.Declaration:

I, ______(state full names)
hereby solemnly declare that, to the best of my knowledge, all the information contained herein is true and correct.
Signature: ______
signed on this the ______day of ______(month & year).

Information Sheet for Applicants applying for

Grandfathering as Surface Mining Rock Engineers

Sheet A1.1 (04/05/2010)

A.General:

Your application for grandfathering as a Surface Mining Rock Engineer will be considered only if the following documents are submitted:

  • Completed Application Form (Form A1.1).
  • Certified copies of qualifications and academic records.
  • Completed Training/Experience Report (Form A2.1),Project Executive Summary Reports (Form A2.2) and the discipline specific Self Assessment Form (Form A2.3).
  • CV with detailed project list with project reports referenced.

Please note the following:

  • The submitted information must be complete, on the prescribed forms and all questions must be answered.
  • In completing all forms use type or print clearly in black ink to ensure clear copying.
  • The supporting documents must beclear copies ortyped and must be marked clearly for purposes of identification.

B.The Application Form:

The following information is given to assist applicants to complete this form - the numbers refer to the equally numbered sections of the Application Form.

B.1General Information

Ensure that all personal details are correct. A recent passport-type photograph of the applicant is required.

B.2Qualifications:

This should specifically include your first degree and/or rock engineering certificate. Ensure that copies of all qualification documents are certified. Copies of a certified copy are not acceptable.

Note: A list of subjects passed is required.

B.3Current Registration or Application Details with Professional Bodies:

Please provide details of registration with Professional Statutory Bodies (The Engineering Council of South Africa – ECSA, South African Council for Natural Scientific Professions – SACNASP, etc.) and include your registration category (Professional Engineer – Pr.Eng, Professional Natural Scientist – Pr.Sci. Nat.).

B.4Membership of Voluntary Associations:

Applicants must provide details of registration with Voluntary Association, e.g. SANIRE, SAIEG, SAICE, etc.

Sheet A1.1 continued/

Sheet A1.1 continued/

B.5Referees:

Each applicant must be nominated by 2 competent rock engineering practitioner referees. Nominators must meet the following criteria:

  • Have experience in the field of surface mining rock engineering.
  • Have a working knowledge of the applicant’s relevant experience in surface mining rock engineering.
  • Be in possession of either a:
  • Chamber of Mines Certificate in Rock Engineering.
  • Relevant degree (i.e. Geology, Engineering Geology, Geotechnical Engineering, Mining Engineering or Civil Engineering)
  • Be registered with at least one of the following bodies:
  • Engineering Council of South Africa (ECSA) as a Professional Engineer.
  • South African Council of Natural Scientific Professions (SACNASP) as a Professional Natural Scientist in the field of Earth Science.
  • South African National Institute of Rock Engineering (SANIRE) as a Fellow or Member.

C.The Training/Experience Report:

Your application must be accompanied by the Training/Experience Report (Forms A2.1) in which your engineering experience from the date of obtaining your first degree/rock engineering certificate to the date of application is recorded in chronological order and typed or printed in black ink. In exceptional cases, pregraduate engineering experience (not courses or holiday work) may be considered as acceptable training, provided that details are submitted on a separate A4 sheet.

  • Number the periods in chronological order, which may not overlap.
  • Cover the period from graduation to date of application.

A training/experience period ends when:

  • your work environment has changed, e.g. when a major task or project has been completed;
  • your type of work has changed;
  • your responsibilities or level of function have changed (for instance, as in a promotion);
  • you have changed employer;
  • your training is interrupted (for instance by study or prolonged illness).

D.Project Executive Summary Reports:

In addition to the Training/Experience Reports (Form A2.1) please provide at least 2 but not more than 4 Project Executive Summary Reports (Form A2.2), reporting on surface mining projects to which you have made a significant contribution.

E.Self Assessment Form:

Furthermore, please complete and submit the Self Assessment Form (Form A2.3) in order to evaluate your competency in each of the facets indicated. Please ensure that your self assessed competency can be crossreferenced with the project list and reports as requested in the detailed CV.

South African National Institute of Rock Engineering

Summary of Training/Experience Reports : Surface Mining Rock Engineering

Form A2.1 (04/05/2010)

Surname and Initials:______Page ___ of ___

Period
No. / Date
From:To: / No. of
Months / Employer / Position Held / Subject and Type of Work
Total Months:

Signature of Applicant: ______Date: ______

South African National Institute of Rock Engineering

Project Executive Summary Report

Surface Mining Rock Engineering

Form A2.2 (04/05/2010)

Use this form to report on a project to which you have made a significant contribution. Use a new form for each project. Submit completed forms for at least two but not more than four projects.

Surname and Initials:

Project name and date(s)
Engineering brief and objective
Environment
(industry, laboratory, theory or modelling/simulation)
Summary
(state engineering problem and solution)
Your contribution to the project
(state aspects of engineering judgement)
Title of the report or publication
Budget

Signature of Applicant:______

Date:______

Signature of Nominator/ Employer/Client:______