NICET ENGINEERING TECHNICIAN CERTIFICATION Experience Application, Part II: Verifier Data. To be completed by the Verifier only

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1 NICET ID No: Experience Application, Part II: Verifier Data (Please print legibly or type) To be completed by the Verifier only Verifier s Name: Title: Current employer: Daytime phone: Professional licenses/certifications: My observation of the candidate occurred during my employment at: Current employer Previous employer: My observation of the candidate occurred as a part of my role as: Candidate s direct supervisor Candidate s indirect supervisor/manager responsible for the candidate s work results/outcomes Engineer on one of the candidate s projects Governmental authority: Contract supervisor for: client, or general contractor Other: I have (Check all that apply): directly observed the candidate s work. directly observed the results of the candidate s work. received reliable reports from those who have directly observed the candidate s work. observed the candidate s ability to supervise others who are doing this work. During what time period were you in the above-indicated relationship with the candidate? From / to / Mo. Yr. Mo. Yr. Verifier s Statement: I certify that: I understand and have carefully considered each performance measure that I have verified or will verify. I have not verified, and will not verify, any performance measure that I have not either personally observed or received reliable and specific reports from one who has personally observed the performance. I have not signed, and will not sign, any verification statement on a form that does not have the candidate s name at the top. I have not asked nor will I ask anyone to sign my name in my stead. Signature Date Initials 12/16

2 witnessed that capability in the candidate s performance of his/her job. Level I Performance Measures Group A : All of the following must be verified. The candidate has repeatedly demonstrated an ability to: Verifier s Initials Determine and wear person protective equipment (PPE) Attend safety training Inspect soils test equipment Identify unsafe conditions Apply job safety analyses Obtain soils samples Identify type of materials sampled Reduce soils sample to test size Dry the soils samples Determine the weight of the soil samples Process the soils samples through a sieve Moisture-condition the soils samples Identify type of material at field density test locations Perform assigned field density tests Perform Atterberg limit tests Perform Proctor tests Perform soils sieve analyses Perform soils (washed) -No. 200 sieve tests Perform moisture content tests Verify soils test equipment calibrations. 4/17 Performance Measures Continued to Next Page

3 Level I Performance Measures (cont.) Group B : At least 8 of the following must be verified. The candidate has repeatedly demonstrated an ability to: Relate plans to the field (e.g. find locations on plans and establish relative elevations) Document soils sample locations Transport soils samples back to the laboratory Log soils samples or I.D. the samples for laboratory testing Identify where to take the field density tests Determine the number of field density tests Document field density test locations Document results of field density tests Document field density test limitations Inform client of presence Give verbal report of observations to supervisor Complete soils testing forms. witnessed that capability in the candidate s performance of his/her job 4/17

4 witnessed that capability in the candidate s performance of his/her job. Level II Performance Measures Group A : All of the following must be verified. The candidate has repeatedly demonstrated an ability to: Verifier s Initials Determine density test method Perform particle size analyses Perform specific gravity tests Observe basic fill placement operations Observe basic shallow foundation installations Observe basic installations of deep foundations Observe proof-rolling Determine whether results meet specifications Perform verification/calibration of test equipment. Performance Measures Continued to Next Page 9/17

5 witnessed that capability in the candidate s performance of his/her job Level II Performance Measures (cont.) Group B : At least 10 of the following must be verified. The candidate has repeatedly demonstrated an ability to: Relate plans to the field (e.g., find locations on plans, establish relative elevations) Determine soils sampling locations Document soils sampling locations Determine number of required field density tests Document field density test locations Document field density test results Document field density test limitations Perform dynamic cone penetrometer (DCP) tests Perform unconfined compressions Perform soils organic content tests Perform laboratory California Bearing Ratio (CBR) tests Perform soils ph tests Perform testing for soil stabilization mix trials Perform shrinkage tests Perform R-Value tests Observe soil stabilization (e.g., cement, fly ash, lime) Recognize suspect test results Prepare written reports for supervisors Give verbal reports to field representatives, consultants, and contractors. 9/17