PROFESSIONAL QUALIFICATION REQUIREMENTS
   
 
EMERITUS STATUS
A person who is a Professional Engineer, Architect, Landscape Architect or Land Surveyor, Retired who applies to may be granted the use of the honorific title must be:
 
  1. Sixty-five (65) years of age
  2. Been a resident of Guam for at least five (5) years
  3. No disciplinary action against him
 
RETIRED STATUS
A person who has been duly licensed and registered as a Professional Engineer, Architect, Landscape Architect or Land Surveyor who applies to and may be granted by the Board to use the honorific title must be:
 
  1. Have been registered in Guam for at least five (5) years
  2. Chooses not to renew his license or registration
  3. Not participating in the preparation of construction documents, calculations, reports, expert testimony, and other aspects of professional services, with the exception of teaching or authoring of publications or articles.
 
 
 
 
 
East-West Business Center, Unit D-Suite 208
718 N. Marine Corps Drive
Upper Tumon, GU 96913
T: 671/646-3113; 646-3115
F: 671/649-9533
W: www.guam-peals.org
E: info@guam-peals.org
  APPLICATION - Retired or Emeritus Registration
 
Indicate the type of application you are making at this time: (application shall be for one profession only)
 Emeritus Status  
 Retired Status  
   
Last Registered with the Guam Board as a:
   
 Engineer - Branch:
 Architect
 Landscape Architect
 Land Surveyor
   
FOR BOARD USE ONLY:
 
 
I, , on this , day of 20 hereby submit my application
  Legal Name (Last, First, Middle)     Month   Year
 
for the above status. Enclosed is the applicable application fee of $120.00 payable to the: Treasurer of Guam. I have been registered with the Guam Board of Registration for Professional Engineers, Architects and Land Surveyor since
  My registration/certificate number is: . I further submit, as provided in the registration law, under oath, the following evidence of my qualifications:
     
  1. I am a retired not practicing my profession as: since
     
 
2. Residence Address (Include Apt. No., City, State and Zip Code):   Mailing Address (If different from residence address):
 
     
Telephone No. -Daytime ()   Email Address:
     
  3. I have been a residence of Guam since
     
 
 
     
  Select either yes or no and provide detailed explanation and supporting documents if applicable:
 
1. Has any license ever been suspended, revoked or otherwise subject to disciplinary action?  YES  NO
  If YES, explain the type of disciplinary action    
2. Are there any disciplinary actions pending against you?  YES  NO
  If YES, explain the type of disciplinary action    
3. Have you ever been convicted of a criminal offense (except minor traffic violations with less that a $500.00 fine)  YES  NO
  If YES, explain the type of conviction    
4. In the past 10 years, have you been convicted of a crime in which the conviction has not been annulled or expunged?  YES  NO
  If YES, explain the type of conviction    
         
 
   
  IMPORTANT: This application shall be submitted on the printed form of the Board, attested before a Notary Public, accompanied by an endorsed 2"x2-1/2" photograph of the applicant.
 
 
  The above photograph shall be an unmounted recognizable photo (size 2"x2 1/2" overall), not profile, not retouched, taken within thirty (30) days of submission of this application. Affix your signature and date on the lower right hand of the photo.
   
   
  AFFIDAVIT OF APPLICANT
   
  I, , certify that the statements, answers and representations made in this application and documents attached are true and correct. I understand that any misrepresentation is grounds for refusal or subsequent revocation of my registration.
   
   
   
 
DATE SIGNATURE
   
   
  SUBSCRIBED AND SWORN to before me this day of 20 .
   
   
 
 
  NOTARY PUBLIC
   
   
 
(SEAL) My commission expires: