QMS-BRS, TWG Form No.

17

Department of Public Works and Highways

ACCREDITATION OF DPWH MATERIALS ENGINEERS
APPLICATION FORM FOR WRITTEN EXAMINATION
________________________
Date of Examination

Application Number -

New Applicant / Not Yet Accredited

2" x 2" Photo

Upgrading Accreditation No.

Previously Accredited Contractors

Materials Engineer Accreditation No.

Name :
(Last) (First) (Middle Name)

Birthday : Sex : Civil Status :

Age : Nationality : TIN :

Office :
Region/District Office Address

Position Employee ID Number

Office Telephone Number Office Fax Number e-mail Address

PRC License Number : Valid Until :

Mailing Address : Zip Code

Home Address : Zip Code :

:
Home Telephone Number Cellphone Number/s

Education
(Limit to Tertiary Level Up)
Degree School Year Graduated

I certify to the correctness of the foregoing.

_______________________________
Signature over printed name

_________________________
Date
 INSTRUCTIONS

1. Fill-out (type or print) all the applicable spaces of the Application Form
legibly

2. Attach to this Application Form the following requirements:

a. Xeroxed copy of valid Professional Regulation Commission (PRC)

Identification Card as Civil Engineer (not expired and with
signature)
b. Xeroxed copy of latest Appointment
c. Two 2" x 2" recent photographs (one to be pasted in the
Application Form and the other is for Notice of Examination
Schedule)
d. One 1" x 1" photograph

3. Submit the Application Form and the requirements to:

The Chief
Quality Assurance and Hydrology Division
Any neatest Regional Office of the Department of Public Works and
Highways

4. Application forms must be received by the DPWH Regional Office at

least thirty (30) working days before the scheduled accreditation
examination.

5. Applicants shall obtain the Notice of Examination Schedule from the

DPWH Regional Office where the application was filed within one (1)
week before the scheduled examination. The notice shall confirm the
date, time and place of examination. This notice must be presented to the
DPWH examination proctor during the examination.

EXAMINATION COVERAGE

Construction materials specifications, sampling and testing procedures, test results

calculations/interpretation/evaluation, DPWH minimum testing requirements, materials
quality control terminologies/practices, duties and responsibilities of materials engineers,
and quality control implementation/documentation.