MEMBERSHIP/ CERTIFICATION APPLICATION
The Certified Technicians
and Technologists
Association of Manitoba Inc. (CTTAM)
602 - 1661 Portage Avenue
Winnipeg, Manitoba R3J 3T7
Phone: 784-1088 Fax: 784-1084
For CERTIFICATION in the Engineering Technology discipline indicated:
CTTAM File No. ___________
CIVIL
ELECTRICAL
ELECTRONIC
MECHANICAL
OTHER (specify) _________________________________________________
PLEASE PRINT
Mr.
Mrs.
Miss
Ms.
Name:
Surname
Given Names
Birth Date:
Your Name as Desired on Certificate:
ADDRESS:
City:
PLACE OF EMPLOYMENT:
BUS. ADDRESS:
City:
Preferred mailing address:
Res. Phone:
E-mail:
Bus. Phone:
E-mail:
Postal Code:
Postal Code:
Residence … Business
Preferred e-mail address:
Residence … Business
Are you now or have you been a member of another applied science/engineering technology Association in a province of Canada? YES NO
If yes, please indicate: Where
Citizenship:
Canadian
When
Classification
Permanent Resident
PROFESSIONAL REFERENCES:
Provide the names, full mailing addresses, professional designations and business affiliations of at least three persons (preferably C.E.T.,
A.Sc.T., C.Tech., or P.Eng.) who have a good knowledge of your character, capabilities and technical work experience in Canada. Unless selfemployed, one reference should be your current and immediate supervisor. CTTAM will contact these persons on your behalf and request the
completion of professional reference questionnaires. All information is strictly confidential between the reference and the Association.
1.
2.
3.
Name
Prof. Designation
Full Mailing Address including Postal Code
Business Name
Name
Prof. Designation
Full Mailing Address including Postal Code
Business Name
Name
Prof. Designation
Full Mailing Address including Postal Code
Business Name
APPLICANT'S AGREEMENT: I hereby acknowledge that:
1. The information contained on this form (including the reverse side and any attachments hereto) is true and correct, to the best of my
knowledge.
2. The Certification Board reserves the right to certify as they find me qualified, and in no way does this application represent a request for a
specific classification. Also, the Certificate is the property of CTTAM and shall be returned to the Association if my membership ceases for
any reason.
3. The Association has the right to publish my name and classification.
4. I will abide by the Code of Ethics of this Association, if accepted into membership.
Date:
Regular Signature:
Complete Parts A, B and C, each starting on a separate sheet of paper.
Note: Applicants with less than 2 years of work experience or with only work experience outside Canada do not submit references and
complete only Parts A and B. These applicants may be eligible for Associate status until they meet certification requirements.
PART A: ACADEMIC DOCUMENTATION:
¾ Submit a chronological list of all schooling to date using the following categories:
1. Post Secondary Education – List using the following headings:
School Name, Location, Dates in attendance (from/to), Diploma/Certificate achieved
2.
¾
¾
¾
Continuing Professional Development & Part-time Education – List using the following headings:
School Name, Location, Subject/Name of Course, Dates (from/to), Hours of instruction, Supervised Exams (Yes/No)
Submit copies of all diplomas or certificates and an original or notarized copy of transcript of marks. Please make photocopies of
all of your academic documents to submit with your application. Original documents will be returned.
Foreign language documents MUST be accompanied by a notarized English translation.
Graduates of foreign and non-accredited programs should submit a detailed syllabus or course outline obtained from your educational
institute. If you do not have a syllabus, discuss this matter with the CTTAM Registrar.
PART B: WORK HISTORY:
For certified membership, the Certification Board requires a minimum of two years of acceptable technical experience. Applicants with
foreign technical work experience must acquire a minimum of twelve months of technical work experience in Canada to be considered for
certification.
¾
¾
Provide a chronological listing of all past technical work experience that includes: Dates of employment (month/year), Job Title,
Company Name, Location, Job Description, Detailed Technical Experience, responsibilities and/or achievements.
For graduates of technology programs that included co-op work experience, indicate which jobs were co-op positions. Co-op work
experience can be assigned a maximum of six months work experience towards the total requirement of 24 months.
PART C: DETAILED CURRENT JOB DESCRIPTION & AFFIDAVIT
¾ Submit a DETAILED JOB DESCRIPTION of your present position using the following headings:
1. Job Title, Department, Company, Location, Supervisor's Title & Name, Date of Appointment.
2. Describe the various functions of the job in order of importance.
Indicate the percentage of total time spent on each function.
3. Specify how you influence or direct the work of others, indicating the numbers and qualifications of people involved.
4. Describe the manner in which your work is assigned and evaluated.
5. Describe examples of projects with which you are typically involved and/or relevant information on equipment used, test
procedures, etc.
¾ Ensure that each page of your job description and the affidavit below are signed by your immediate supervisor.
AFFIDAVIT
From personal knowledge, I do state that the attached Detailed Job Description is a fair and accurate statement of the applicant's present duties
and responsibilities. (Each page of the job description must be signed by the immediate supervisor.)
Name: _________________________________________________ Signature: _________________________________________
Please Print
Position: _______________________________________________ Telephone: ________________________________________
PLEASE ENSURE THAT YOU HAVE ENCLOSED THE FOLLOWING with the Application Form:
□ Original transcripts/diplomas/notarized translations
If applicable,
□ Photocopies of all academic documents
□ Part C- Detailed current signed job description
□ Part B – Work History
□ Signed affidavit on Page 2 of application form
□ Application Fee - $140.00 (non-refundable) – includes Professional Practice Exam (PPE) Study Guide fee
If possible, submit your application in person to the CTTAM office. Original documents will be immediately returned and applicants will
receive the PPE Study Guide. Applicants with the minimum of 2 years of work experience should register to write the PPE.
It is the applicant's responsibility to ensure that all required information is provided. The review of your qualifications will be based solely
on the information submitted. To complete the certification process, you must pass the Professional Practice Exam.
On acceptance to CTTAM, you will be invoiced annual dues.