Reference’s Comments & Recommendations on CSEP Application
Form 4A contains detailed instructions for guidance on preparing this reference form.
A few helpful hints for working with this form:
 The shaded areas in the form are for you to type or paste inputs, they will expand
to accommodate any length of text.
 The check boxes can be activated with a click of your left mouse button to check
or uncheck the box (i.e., insert (or remove) an “X” in the square boxes).
 The form is protected to prevent unauthorized modifications.
 Please submit this form when completed in its current Microsoft Word format; do
not convert it to any other format, such as PDF, for submittal. Forms not
submitted in the original Microsoft Word format will be returned to the
applicant.
Applicant’s Information
Applicant’s Name:
Family:
Mailing Address:
Number & Street:
City:
State or Province:
Zip or Postal Code:
Country:
Email Address:
Given:
Middle Initial:
Reference’s Information
Reference’s Name:
Family:
Given:
Middle Initial:
Mailing Address:
Number & Street:
City:
State or Province:
Zip or Postal Code:
Country:
Name of Present Organization:
Business or Professional Title:
Phone Number (if we may contact you there):
E-mail Address:
Do you currently have or have you ever had any level of INCOSE SEP certification?
Form 4B – CSEP Reference’s Comments & Reccomm
Revised 15 December 2011
Page 1 of 3
Yes
No
If yes, please indicate the current level, certification number, date attained, and expiration
date.
Associate Systems Engineering Professional (ASEP)
Certification Number
, Date Attained
, Expiration Date
Certified Systems Engineering Professional (CSEP)
Certification Number
, Date Attained
, Expiration Date
Expert Systems Engineering Professional (ESEP)
Certification Number
, Date Attained
, Expiration Date N/A
Are you an INCOSE Fellow? Yes
No
Describe your number of years and types of experience related to systems engineering.
Provide information about your own background and experience in systems engineering. This
will help the review team ascertain that you are a qualified reference. Please describe the type
and number of years of systems engineering work that you have done in addition to the
positions that you have held
Note: if you have indicated above that you are an INCOSE CSEP, ESEP, or Fellow, please
note that in this field. No other information is required.
Note: if you are commenting on the applicant’s additional general engineering experience
(not systems engineering), then please describe the qualifications you have for the type of
experience claimed.
(NOTE: The attached box for your inputs will expand to accommodate the information
you provide; the size of the empty box is not an indication that limited input is
expected.):
Reference’s Comments on Applicant
Please identify the time period in which you had personal knowledge of the applicant’s SE
experience:
From (Month/Year)
To (Month/Year)?
Your business connection with the applicant during that time period (e.g., co-worker,
immediate supervisor, higher-level manager):
Please describe the types of systems engineering functions and tasks the applicant has
performed, how well the applicant performed the functions/tasks, specific outcomes or work
products the applicant produced, for how long a period of time, and on what
products/services. Please describe the applicant’s experience over the total period that you
had personal knowledge of the applicant’s SE experience. Be specific and use as much space
Form 4B – CSEP Reference’s Comments & Reccomm
Revised 15 December 2011
Page 2 of 3
as you need.
(NOTE: The attached box for your inputs will expand to accommodate the information
you provide; the size of the empty box is not an indication that limited input is
expected.):
Reference’s Recommendation on Applicant
I recommend
do not recommend
this applicant for CSEP certification.
Reason for Recommendation:
Reference’s Signature:
Submittal.)
Date:
(Typed Name Is Accepted as Signature on Email
Form 4B – CSEP Reference’s Comments & Reccomm
Revised 15 December 2011
Page 3 of 3