ASSMT CERTIFIED MEMBER APPLICATION

ASSMT CERTIFIED MEMBER APPLICATION
ALBERTA SOCIETY OF SURVEYING AND MAPPING TECHNOLOGIES
14843 118 Ave Edmonton, AB T5L 2M7 780-412-1318
Name*

First NameLast Name
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Place of Birth (optional)
Date of Birth (Optional)
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you a Canadian Citizen*

YesNo
If not, please give status: (i.e., Permanent Resident, Sponsored, etc)
CERTIFICATION Desired in*

Cadastral SurveysDrafting/G.I.S.Civil SurveysPhotogrammetry, Remote Sensing
Please mark the field(s) in which you have gained experience*

Cadastral SurveyField OfficeCivil SurveyControlGeophysicalMiningHydrographicConstructionEngineeringCivil SurveysPhotogrammetry, Remote SensingPhotogrammetric compilationPhotogrammetric Ortho---mappingComputer Control AdjustmentRemote SensingAerial Photography
Experience Record Summary
Please provide a summary of all experience applicable to your field of technology to attain maximum experience credit. Description of Work and Duties: *
Previous Work Record

Please list most recent experience first and all experience applicable to your field of technology to attain maximumexperience credit.
Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name*
Supervisor's Title*
Supervisor's Name Phone Number*
Please enter a valid phone number.
Supervisor's Name Email*
example@example.com
From Date*

MonthDayYear
Date
To Date*

MonthDayYear
Date
Specific Description of Work Duties*
2 - Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name
Supervisor's Title
Supervisor's Phone Number
Please enter a valid phone number.
Supervisor's Email
example@example.com
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Specific Description of Work Duties
Education
The greatest cause of delay in the certification process is improper or missing documentation of educational achievement. In all cases, please clearly indicate the courses claimed, credits received and diplomas or certificates granted. DOCUMENTATION MUST BE SUBMITTED AS CONFIRMATION OF EDUCATION, particularly documentation of your highest academic level. It is requested that transcripts of marks be used as documentation. An official transcript is one which bears the seal of the institute attended. Where photocopies are submitted, these must be signed by a (1) Commissioned Land Surveyor, (2) Professional Engineer, (3) Certified Technologist or other professional person as a true copy of the original. All documents in a language other than English must be accompanied by a Certified English Translation
High School
From

MonthDayYear
Date
To

MonthDayYear
Date
Credit Diploma
Technical Institute and/or College
From

MonthDayYear
Date
To

MonthDayYear
Date
Degree, Credit Diploma or Certificate
Official Transcript - Technical Institute and/or College

Cancelof
University
From

MonthDayYear
Date
To

MonthDayYear
Date
Degree, Credit Diploma or Certificate
Official Transcript - University

Cancelof
References
Give names and addresses of at least three individuals who are in a position to verify previous work experience.

At least one should be a Certified Survey Technologist, Professional Engineer, Geologist or Commissioned Land Surveyor.

Additionally letters of reference may be submitted to verify experience.
1 - Name*

First NameLast Name
Company*
Position *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 1*

Cancelof
2 - Name*

First NameLast Name
Company *
Position*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2*

Cancelof
3 - Name*

First NameLast Name
Company*
Position*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 3*

Cancelof
NOTE: Please upload a letter to be signed and dated by a person who has detailed knowledge of the applicant's work, preferably a Commissioned Land Surveyor, Professional Engineer, or Certified Survey Technologist (CST). Additional comments may be submitted as well.

Please have the letter say:

From personal knowledge, I hereby certify that the information given in Experience Recod Summary is an accurate description of the applicant's present position and duties.
File Upload*

Cancelof
To the best of my knowledge, the answers given on this application are true and if membership is granted, I agree to abide by the Society's Objects and By Laws.
Signature

Clear
Date

MonthDayYear
Date
Please ensure your application form has the below uploaded:

1. Certified copies of official transcripts
2. Letters of Reference (recommended)
3. Course Outlines (as required)
4. Certified Translation of all documents (if in a language other than English)

To pay the application fee you can E Transfer executive.assistant@assmt.ca

or

Mail A Cheque to:

ASSMT 14843 118 Ave Edmonton, AB T5L 2M7

If you wish to pay by Credit Card please email executive.assistant@assmt.ca to request an Invoice.
Fees can be paid by Cheque or Credit Card payments can be made through your Quickbooks Invoice. You can also E Transfer executive.assistant@assmt.ca

***It is the responsibility of all Members to notify ASSMT of any changes to address or program details***

To promote the knowledge, skill and proficiency of Technicians and Technologists
involved in the fields of surveying and mapping.”
Should be Empty:

ASSMT CERTIFIED MEMBER APPLICATION

Experience Record Summary

Previous Work Record

Education

References

To the best of my knowledge, the answers given on this application are true and if membership is granted, I agree to abide by the Society's Objects and By Laws.