| Please select one: I am applying for: |
{typeA} |
| Name: |
{name} |
| Job Function (choose one) |
{jobFunction} |
| Your Title |
{yourTitle} |
| Employer Name |
{employerName} |
| Applicant Employer Address: |
{applicantEmployer} |
| Professional Certifications (select all that apply): |
{professionalCertifications128} |
| Personal Email: |
{personalEmail} |
| Preferred Phone Number: |
{phoneNumber} |
| Employer (work) Email: |
{employerwork} |
| |
{typeA1028} |
| I hereby certify that the information furnished above is true and complete. I acknowledge that the name indicated above is my current full legal name. I furthermore understand that this information can be used to register me for the certification examination and that it matches my legal ID that will be required at a Prometric testing facility. |
{iHereby} |
| Please select one: |
{pleaseSelect959} |
| Month: |
{typeA1031} |
| Year: |
{typeA1030} |
| Workshop Venue: |
{typeA1058} |
| Please select ONE: |
{pleaseSelect} |
| Education Summary: |
{educationSummary} |
| Upload a copy of your degree or transcript (if applicable). Photo copy is acceptable. |
{uploadA} |
| Upload Functional Resume (if applicable) |
{uploadFunctional} |
| Current Employer: |
{currentEmployer} |
| Month: |
{typeA1037} |
| Year: |
{typeA1038} |
| Employer Address: |
{employerAddress} |
| Previous Employers: List all that are appropriate that encompass the time period that supports the applicant’s experience. |
{previousEmployers} |
| All Applicants must successfully pass the certification exam. Applicants are eligible to sit ONLY after their application has been approved by the DBCB and they have completed the core courses. |
{allApplicants} |
| Enter your Elective Credit Hours (must be events taken within the last 2 years) |
{enterYour} |
| Total CEHs Provided Above: |
{totalCehs} |
| Please select which type(s) of experience you would like to demonstrate in your application: |
{pleaseSelect1119} |
| |
{pleaseSelect1118} |
| Please confirm this is a design-build project. MUST BE design-build project to continue. |
{pleaseConfirm} |
| Project #1 - Project Name |
{project1} |
| Project #1 Location |
{project11299} |
| Project #1 - Owner/Client Name |
{project11301} |
| Project #1 - Project Team (list of companies involved and primary role, eg. Acme Inc.-construction): |
{project11300} |
| Your Client Company: |
{yourClient} |
| Client Contact: |
{clientContact} |
| Client Contact Number: |
{clientContact967} |
| Client Contact Email: |
{clientContact968} |
| Applicant Firm Role on Project: |
{applicantFirm} |
| Applicant Position/Role on the Project |
{applicantPositionrole149} |
| Month: |
{month} |
| Year: |
{year} |
| Month: |
{month296} |
| Year: |
{year298} |
| Does your personal duration on this project overlap your personal duration on any other projects submitted? |
{doesYour1113} |
| Were you 100% on this project ONLY for the duration of time listed? (i.e. 40 hours FTE) |
{wereYou} |
| If No, Please explain how your involvement over time varied. If your personal duration overlaps with your personal duration on any other project submitted, your project time across all projects cannot exceed 100% for a given month. |
{ifNo} |
| Indicate the project phases you had personal involvement with on this project, select all that apply. |
{indicateThe} |
| Q1. State the type of Project and a brief concise description of the project scope of work. Explain how and why this project qualifies as design-build experience. |
{q1State} |
| Q2. Please provide a description of the Team (Owner-Builder-Designer) organization and integration. Explain how your role fit into the organization (who did you work for, who was your client) and how your role was integrated in the overall design-build process (interaction with overall team). |
{q2Please} |
| Q3. Explain your hands on experience on the project by providing two project specific examples of how the project implemented DBIA®’s Best Practices, and/or Implementing Techniques and your unique role in that implementation. |
{q2Please75} |
| Please confirm this is a design-build project. MUST BE design-build project to continue. |
{pleaseConfirm1211} |
| Project #2 - Project Name |
{project2} |
| Project #2 Location |
{project21309} |
| Project #2 - Owner/Client Name |
{project21310} |
| Project #2 - Project Team (list of companies involved and primary role, eg. Acme Inc.-construction): |
{project21311} |
| Your Client Company: |
{yourClient1214} |
| Client Contact: |
{clientContact1215} |
| Client Contact Number: |
{clientContact1216} |
| Client Contact Email: |
{clientContact1217} |
| Applicant Firm Role on Project: |
{applicantFirm1219} |
| Applicant Position/Role on the Project |
{applicantPositionrole} |
| Month: |
{month1192} |
| Year: |
{year1193} |
| Month: |
{month1195} |
| Year: |
{year1196} |
| Does your personal duration on this project overlap your personal duration on any other projects submitted? |
{doesYour} |
| Were you 100% on this project ONLY for the duration of time listed? (i.e. 40 hours FTE) |
{wereYou1198} |
| If No, Please explain how your involvement over time varied. If your personal duration overlaps with your personal duration on any other project submitted, your project time across all projects cannot exceed 100% for a given month. |
{ifNo1199} |
| Indicate the project phases you had personal involvement with on this project, select all that apply. |
{indicateThe1200} |
| Q1. State the type of Project and a brief concise description of the project scope of work. Explain how and why this project qualifies as design-build experience. |
{q1State1205} |
| Q2. Please provide a description of the Team (Owner-Builder-Designer) organization and integration. Explain how your role fit into the organization (who did you work for, who was your client) and how your role was integrated in the overall design-build process (interaction with overall team). |
{q2Please1207} |
| Q3. Explain your hands on experience on the project by providing two project specific examples of how the project implemented DBIA®’s Best Practices, and/or Implementing Techniques and your unique role in that implementation. |
{q3Explain} |
| Please select the integrated delivery method |
{pleaseSelect1258} |
| Project #3 - Project Name |
{project3} |
| Project #3 Location |
{project31304} |
| Project #3 - Owner/Client Name |
{project31305} |
| Project #3 - Project Team (list of companies involved and primary role, eg. Acme Inc.-construction): |
{project31307} |
| Your Client Company: |
{yourClient1227} |
| Client Contact: |
{clientContact1228} |
| Client Contact Number: |
{clientContact1229} |
| Client Contact Email: |
{clientContact1230} |
| Applicant Firm Role on Project: |
{applicantFirm1232} |
| Applicant Position/Role on the Project |
{applicantPositionrole1233} |
| Month: |
{month1238} |
| Year: |
{year1239} |
| Month: |
{month1241} |
| Year: |
{year1242} |
| Does your personal duration on this project overlap your personal duration on any other projects submitted? |
{doesYour1243} |
| Were you 100% on this project ONLY for the duration of time listed? (i.e. 40 hours FTE) |
{wereYou1244} |
| If No, Please explain how your involvement over time varied. If your personal duration overlaps with your personal duration on any other project submitted, your project time across all projects cannot exceed 100% for a given month. |
{ifNo1245} |
| Indicate the project phases you had personal involvement with on this project, select all that apply. |
{indicateThe1246} |
| Q1. State the type of Project and a brief concise description of the project scope of work. Explain how and why this project qualifies as design-build experience. |
{q1State1251} |
| Q2. Please provide a description of the Team (Owner-Builder-Designer) organization and integration. Explain how your role fit into the organization (who did you work for, who was your client) and how your role was integrated in the overall design-build process (interaction with overall team). |
{q2Please1253} |
| Q3. Explain your hands on experience on the project by providing two project specific examples of how the project implemented DBIA®’s Best Practices, and/or Implementing Techniques and your unique role in that implementation. |
{q3Explain1254} |
| Please select the integrated delivery method |
{pleaseSelect1265} |
| Project #4 - Project Name |
{project4} |
| Project #4 Location |
{project41318} |
| Project #4 - Project Team (list of companies involved and primary role, eg. Acme Inc.-construction): |
{project41319} |
| Your Client Company: |
{yourClient1268} |
| Client Contact: |
{clientContact1269} |
| Client Contact Number: |
{clientContact1270} |
| Client Contact Email: |
{clientContact1271} |
| Applicant Firm Role on Project: |
{applicantFirm1273} |
| Applicant Position/Role on the Project |
{applicantPositionrole1274} |
| Month: |
{month1279} |
| Year: |
{year1280} |
| Month: |
{month1282} |
| Year: |
{year1283} |
| Does your personal duration on this project overlap your personal duration on any other projects submitted? |
{doesYour1284} |
| Were you 100% on this project ONLY for the duration of time listed? (i.e. 40 hours FTE) |
{wereYou1285} |
| If No, Please explain how your involvement over time varied. If your personal duration overlaps with your personal duration on any other project submitted, your project time across all projects cannot exceed 100% for a given month. |
{ifNo1286} |
| Indicate the project phases you had personal involvement with on this project, select all that apply. |
{indicateThe1287} |
| Q1. State the type of Project and a brief concise description of the project scope of work. Explain how and why this project qualifies as design-build experience. |
{q1State1292} |
| Q2. Please provide a description of the Team (Owner-Builder-Designer) organization and integration. Explain how your role fit into the organization (who did you work for, who was your client) and how your role was integrated in the overall design-build process (interaction with overall team). |
{q2Please1294} |
| Q3. Explain your hands on experience on the project by providing two project specific examples of how the project implemented DBIA®’s Best Practices, and/or Implementing Techniques and your unique role in that implementation. |
{q3Explain1295} |
| Applicant: |
{applicant} |
| Applying for: |
{applyingFor} |
| Status of Certification Workshop: |
{statusOf} |
| Education: |
{education930} |
| Functional Resume Uploaded? |
{functionalResume} |
| Transcripts Uploaded? |
{transcriptsUploaded} |
| |
| |
{typeA1296} |