Landscape Architects - Form 2 - Report of Professional Experience

SECTION I: TO BE COMPLETED BY APPLICANT. (This Section Must Be Typed).

Name:


LAST	FIRST	MIDDLE

Address:


STREET	CITY	STATE	ZIP

Telephone: (home)

(work)

Social Security Number:

Date of Birth:

/	/

Experience described on the second page of this RPE form was obtained while employed by:

Firm or Organization Name:

Address:

Beginning:

and Ending:

Full time

Part time,

hrs/wk

I hereby certify that the work experience described on page 2 of this RPE form and the time claimed for that experience are true and accurate.


Applicant's Signature	Date

SECTION II: TO BE COMPLETED BY ENDORSER (Preferably not in the presence of applicant. Please Type.)

INSTRUCTIONS TO ENDORSER:
1.	Read carefully the applicant's Report of Professional Experience on the second page of this RPE form and continuation sheets (if any).
2.	Provide the requested information below and answer questions 1-6. Please type.
3.	If you disagree with any information presented by the applicant on this form, or wish to provide any other information for consideration by the Board relative to the applicant, please submit a separate letter with this form. If you do so, please identify applicant by full name and social security number in your letter and indicate that they are an applicant for landscape architect licensure.
4.	SIGN THE ENDORSER'S AFFIDAVIT IN SECTION IV ON THE SECOND PAGE AT THE BOTTOM OF EACH CONTINUATION SHEET(FORM 2A), IF ANY, or if you do not sign the affidavit please explain in a separate letter attached to this form.
5.	DO NOT RETURN ORIGINAL TO APPLICANT. MAIL COMPLETED FORM DIRECTLY TO THE BOARD AT THE ADDRESS ABOVE.

Endorser Name:

Phone No:

Address:


Street	City	State	Zip

Are you a licensed Landscape Architect?

YES


STATE	LICENSE NO.

WITH RESPECT TO THE APPLICANT'S REPORT OF PROFESSIONAL EXPERIENCE AS DESCRIBED ON THE SECOND PAGE OF THIS FORM:
1.	Does that description accurately reflect the work personally preformed by the applicant?	YES NO
2.	Does the time claimed by the applicant for this experience reasonably reflect the actual time?	YES NO
3.	Was the applicant's work performed in an adequate, reliable and professional manner?	YES NO
4.	Are you attaching a separate letter with additional information about the applicant?	YES NO
5.	IDENTIFY YOUR WORK RELATIONSHIP TO THE APPLICANT AT THE TIME. IF NONE, EXPLAIN.

6.	Comments:

SECTION III: TO BE COMPLETED BY APPLICANT.(This section must be typed.)

Describe your Landscape Architecture duties during your employment with the firm named on the first page of the RPE:

Describe in separate paragraphs the specfic Landscape Architecture work you personally performed while employed by the firm named on the first page of this RPE. Use specific project assignments as examples. Then indicate separately in the TIME column at the right the time you spent on each such kind of work. If you need more than one endorser from a single form, USE SEPARATE RPE FORMS FOR EACH ENDORSER. If you do not have sufficient space on this form to fully report the experience to be verified by a single endorser, use one or more RPE Continuation sheet (Form 2A). BOTH YOU AND YOUR ENDORSER MUST SIGN EVERY SHEET.

	TIME YRS/MOS

Total this sheet

Indicate here the number of RPE CONTINUATION SHEETS (Form 2A) for this endorser. If zero, enter "0".

C.	Describe briefly your personal level of responsibility or authority for work described above. Explain here any changes in your title resulting from promotions or other job changes during this period of employment.

SECTION IV: ENDORSER'S AFFIDAVIT: (ALSO COMPLETE SECTION II ON FIRST PAGE).

I have read the applicant's Report of Professional Experience. I hereby certify that I am knowledgeable about, and qualified to attest to, the applicant's work and Landscape Architecture ability and that , except as otherwise noted on this form, or in attached correspondence, the work experience described by the applicant and the time claimed therefore are generally true and accurate.


ENDORSER'S SIGNATURE

SEAL


DATE

I cannot so certify. Letter of explanation attached.

	State of Maryland Department of Labor Maryland Board of Examiners of Landscape Architects 1100 N. Eutaw St Baltimore, Maryland 21201 (410) 230-6322 (Baltimore area), (888) 218-5925 (Toll Free)