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Career Episode Title:

Dates of Career Episode:

Competency
Element
Claimed

Signature of Candidate:
Candidates Verifier/s Details
Name:__________________________________________________________________________
Phone/ email: ___________________________________________________________________
Position: _______________________________________________________________________
Relationship to Candidate: ________________________________________________________
Engineering Qualifications: (or Engineers Australia Membership Number)___________________
I verify that the above narrative is a true account of the candidates own work
Signature:______________________________________________________________________

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