The Ohio 4011 D form is the application required for the renewal of dual professional engineer (P.E.) and professional surveyor (P.S.) licenses in Ohio for the 2012-2013 period. It is essential to complete this form accurately and submit it by the deadline to maintain your licensure. For a smoother renewal process, consider filling out the form online by clicking the button below.
The Ohio 4011 D form serves as a critical document for professional engineers and surveyors seeking to renew their dual P.E. (Professional Engineer) and P.S. (Professional Surveyor) licenses for the 2012-2013 period. This application must be completed accurately and submitted by the specified deadline to ensure continued licensure. Applicants are reminded that they can expedite the renewal process by utilizing the online platform available at www.peps.ohio.gov. It is essential to note that the form is not intended for reinstatement purposes; those needing to reinstate their licenses should contact the Board directly for guidance. To qualify for renewal, applicants must confirm they have completed the required 15 hours of continuing professional development, as outlined in section 4733.151 of the Ohio Revised Code. The form also includes sections for name and address changes, which require appropriate legal documentation. Additionally, applicants must disclose any felony convictions or other legal issues that may affect their registration status. A signature certifying the accuracy of the information provided is required, along with the appropriate renewal fee. Failure to comply with these stipulations may result in delays or denial of the renewal application.
OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS BOARD USE ONLY
4011-D
2012-2013 Ohio Dual P.e., P.S. License
renewal Application
reMINDer! For faster license renewal, renew online at www.peps.ohio.gov.
DO NOt SUBMIt application if continuing professional development require- ments are not complete in accordance with section 4733.151 of the Ohio R.C.
NAMe AND ADDreSS reQUIreD
NAME
P.e. AND P.S. NUMBerS reQUIreD
PE–
PS–
ADDRESS
$80.00 DUe NOW
AMOUNT DUE After 12/31/2011: $120.00
CITY
STATE ZIP CODE
Make your check or money order payable in U.S.
funds to treasurer, State of Ohio.
►
NAMe cHANGe AND/Or cHANGe Of ADDreSS ONLy
NAME CHANGE reQUIreS LeGAL DOcUMeNtAtION
STATE
ZIP CODE
OHIO COUNTY reQUIreD If OHIO ADDreSS
I do not plan to renew at this time.
IMPOrtANt — DO NOt USe tHIS
fOrM fOr reINStAteMeNt!
this application cANNOt be used for reinstatement of a professional license. It is to be used for 2012-2013
P.E., P.S. renewals only. Email the Board, at pes.board@ pes.ohio.gov, for reinstatement instructions.
DO NOt SUBMIt copies of continuing professional development information with this application.
yeS NO I certify that I have completed 15 continuing professional development hours in accordance with section 4733.151
of the Ohio Revised Code –Or– I’m exempt from this requirement because I was granted initial registration during calendar year 2011.
If you answered NO to this question, DO NOt submit this renewal application.
FOR MORE INFORMATION REGARDING THE CPD REQUIREMENT, CPD AUDIT, AND DOWNLOADING CPD ACTIVITY LOGS, VISIT OUR WEBSITE AT www.peps.ohio.gov.
yeS NO Since your last renewal have you been convicted of or pleaded guilty to any felony or crime involving moral turpitude or had your registration revoked, voluntarily surrendered or suspended by another jurisdiction? If yeS, please give date, type of conviction, court of conviction, case number, and explanation.
ATTACH SEPARATE SHEET IF NEEDED
I certIfy that this is a properly completed and accurate license renewal application which I am submitting to the state of Ohio’s State Board of Registration for Professional Engineers and Surveyors. I have not omitted any requested information. I
understand that my renewal is contingent upon satisfactory completion of all requirements. I further understand that any person who knowingly makes false statements on the renewal application is guilty of falsiication under section 4733.20 of the Ohio
Revised Code, and subject to penalties under law.
Applicant Signature
2012-2013 DUAL Pe PS LIceNSe reNeWAL
STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS
50 W BROAD ST STE 1820 COLUMBUS OH 43215-5905
Date Signed
Make check or money order payable in U.S. funds to treasurer, State of Ohio. Cash is not accepted. for credit card payment, renew online. Send completed, signed, and dated application and fee; postmarked no later than 12/31/2011; to the Board address at left.
PES 4011-D (Rev. 10/2011) 1020
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Completing the Ohio 4011 D form is an important step for professionals looking to renew their licenses. After filling out the form, ensure that you submit it along with the appropriate fee before the deadline. Follow these steps carefully to ensure your application is processed smoothly.
The Ohio 4011 D form is specifically designed for the renewal of Dual Professional Engineer (P.E.) and Professional Surveyor (P.S.) licenses in Ohio. It serves as an application to ensure that licensed professionals maintain their credentials and comply with state regulations.
For timely renewal, the fee is $80. However, if the application is submitted after December 31, 2011, the fee increases to $120. It is important to note that payments must be made in U.S. funds via check or money order, payable to the Treasurer, State of Ohio. Cash payments are not accepted.
Applicants must complete 15 hours of continuing professional development in accordance with section 4733.151 of the Ohio Revised Code. If an applicant was granted initial registration during the calendar year 2011, they may be exempt from this requirement. It is essential to certify that these hours have been completed when submitting the form.
No, the Ohio 4011 D form is not intended for license reinstatement. If you need to reinstate your license, you should contact the Board directly at [email protected] for specific instructions on how to proceed.
If you have a name change, you will need to provide legal documentation to support this change. For an address change, simply fill in the new address on the form. Ensure that you provide complete and accurate information to avoid any issues with your renewal.
If you do not meet the renewal requirements, such as failing to complete the necessary continuing professional development hours, you should not submit the renewal application. Doing so could result in penalties, including the possibility of having your license not renewed. It’s best to ensure all requirements are fulfilled before submitting your application.
Failing to complete the continuing professional development requirements. Applicants must ensure they have met the 15-hour requirement before submitting the form.
Not providing legal documentation for name changes. If an applicant has changed their name, they must attach the necessary legal documents to support this change.
Incorrectly filling out the license numbers. It's crucial to accurately enter both the P.E. and P.S. numbers to avoid processing delays.
Submitting the application without payment. The correct fee must accompany the application. Applications submitted without payment will not be processed.
Using the form for reinstatement purposes. This application is specifically for renewal only, and applicants should not use it if they need to reinstate a license.
Omitting required information. Every section of the application must be filled out completely. Incomplete applications may be rejected.
The Ohio 4011 D form is a crucial document for renewing professional engineering and surveying licenses in Ohio. Along with this form, several other documents are commonly utilized in the renewal process. Below is a list of these forms and their brief descriptions.
Each of these documents plays a vital role in ensuring a smooth renewal process for professional engineers and surveyors in Ohio. It is important to gather all necessary paperwork promptly to avoid delays in license renewal.
The Ohio 4011 D form is similar to the Texas Professional Engineer License Renewal Application. Both documents serve as official requests for the renewal of professional engineering licenses. They require the applicant to provide personal information, including name, address, and license numbers. Additionally, both forms stipulate the necessity of completing continuing education requirements to qualify for renewal. The Texas application also includes a certification section, where applicants affirm their compliance with all renewal prerequisites, mirroring the Ohio form's emphasis on accuracy and honesty in the renewal process.
Another comparable document is the California Professional Engineer License Renewal Application. Like the Ohio 4011 D form, this application necessitates that engineers confirm their completion of continuing education hours. Both forms require applicants to disclose any legal issues that may affect their professional standing, such as felony convictions or license suspensions. Furthermore, both documents provide clear instructions for submitting the application and associated fees, ensuring a structured renewal process.
The Florida Professional Engineer License Renewal Application shares similarities with the Ohio 4011 D form as well. Both documents require a renewal fee and emphasize the importance of fulfilling continuing education requirements. The Florida application also asks for personal information and any updates regarding the applicant's legal status. This parallel highlights the common regulatory framework governing professional engineers across states, ensuring that all applicants maintain a standard of competence and ethical conduct.
The New York Professional Engineer License Renewal Application is another document akin to the Ohio 4011 D form. Both applications demand personal details, including the engineer's license number and contact information. They also require a declaration of completed continuing education credits, reinforcing the commitment to ongoing professional development. Additionally, the New York form includes questions regarding any criminal history, similar to the inquiries found in the Ohio application, ensuring that all applicants meet the necessary moral and legal standards for licensure.
The Illinois Professional Engineer License Renewal Application is comparable to the Ohio 4011 D form in several respects. Both documents require engineers to provide their license number and personal information. They also mandate the completion of continuing education hours as a prerequisite for renewal. Furthermore, both applications include a section where applicants must certify the accuracy of their submissions, underscoring the importance of integrity in the renewal process.
Lastly, the Pennsylvania Professional Engineer License Renewal Application resembles the Ohio 4011 D form. Both forms require applicants to verify their continuing education compliance and disclose any legal issues that may impact their licensure. They also request personal information, such as name and address, and emphasize the submission of accurate and complete information. This similarity illustrates the shared regulatory expectations among states for maintaining professional engineering standards.
When filling out the Ohio 4011 D form, it is essential to follow specific guidelines to ensure a smooth renewal process. Below is a list of actions to take and avoid.
By adhering to these guidelines, you can help ensure that your renewal application is processed efficiently and without unnecessary delays.
Understanding the Ohio 4011 D form is crucial for professionals seeking to renew their licenses. However, several misconceptions can lead to confusion. Here are seven common misunderstandings:
Being aware of these misconceptions can help ensure a smoother renewal process for your professional license in Ohio.
Here are key takeaways regarding the Ohio 4011 D form for dual P.E. and P.S. license renewal:
Be sure to send your completed application, along with payment, to the specified Board address by the deadline.