WORK HISTORY SUMMARY (FORM CA04)

List your engineering work history in chronological order with the most recent first. Applicants for Continued Registration Assessment only need to record their work history since their last competence assessment. Continue on another page and attach to this form if needed.

Name of Applicant: Ref No 1.

Position Title End Start mm/yy mm/yy

Membership Number or date of birth:

Name of Organisation

Key responsibilities, activities undertaken, major achievements and/or projects. These should relate to your practice area description.

Present / Start /

2.

End / Start /

3.

End / Start /

4.

End / Start /

Form CA04

Work History Summary (V2.2 - 31 May 2010)

Page 1 of 2

Name of Applicant: Ref No 5.

Position Title End Start mm/yy mm/yy

Membership Number or date of birth:

Name of Organisation

Key responsibilities, activities undertaken, major achievements and/or projects. These should relate to your practice area description.

Present / Start /

6.

End / Start /

7.

End / Start /

8.

End / Start /

Form CA04

Work History Summary (V2.2 - 31 May 2010)

Page 2 of 2