Form GEO-637-001 "Geologist and/or Specialty License Application" - Washington

What Is Form GEO-637-001?

This is a legal form that was released by the Washington State Department of Licensing - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Washington State Department of Licensing;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form GEO-637-001 by clicking the link below or browse more documents and templates provided by the Washington State Department of Licensing.

ADVERTISEMENT
ADVERTISEMENT

Download Form GEO-637-001 "Geologist and/or Specialty License Application" - Washington

Download PDF

Fill PDF online

Rate (4.4 / 5) 80 votes
Geologist and/or Specialty
License Application
Use this application to apply for a geologist, engineering geologist, or hydrogeologist license.
Mail your application and fee to:
Mail all other supporting documents to:
Geologist Licensing Board
Geologist Licensing Board
Department of Licensing
Department of Licensing
PO Box 35001
PO Box 9012
Seattle WA 98124-3401
Olympia WA 98507-9012
Geologist license requirements
To be licensed in Washington as a geologist, you must:
• Have a degree from an accredited college or university in geological sciences or a related degree as approved by the Board. Your
degree must include 24 semester or 36 quarter hours of upper division geology courses or course work educationally equivalent in
content and rigor as approved by the Board. For more detail on required course work, visit dol.wa.gov/business/geologist/
• Have at least 5 years of documented, verifiable professional geological experience. At least 3 years must be under the supervision of
a licensed geologist.
• Pass the National Association of State Boards of Geology (ASBOG ® ) Fundamental of Geology and Practice of Geology
examinations, or an examination the Board approves as equivalent.
• Be currently licensed in another state, if applying by reciprocity.
Specialty license requirements
To be licensed in Washington as an engineering geologist or hydrogeologist, you must:
• Be licensed as a geologist
• Have completed one of the following advanced studies pertinent to your chosen specialty.
• 18 semester or 27 quarter hours of graded academic course work
• 270 hours of seminars or workshops
• 540 hours of on-the-job training under the supervision of a geologist licensed in your chosen specialty, or others qualified to have
responsible charge, as determined by the Board
• Have at least 5 years of documented, verifiable experience in your chosen specialty, including at least 3 years under the supervision
of a geologist licensed in your chosen specialty, or others qualified to have responsible charge, as determined by the Board. If
applying for 2 specialties, you must have at least 5 years of documented, verifiable experience in each specialty.
• Pass exam for specialty. You can apply by reciprocity for specialty licenses if you have passed the applicable specialty exam and are
currently licensed in California as an engineering geologist or hydrogeologist or in Oregon as a Engineering Geologist.
Alternative experience credit
• One year of full-time graduate study in geology or a qualified related area counts as one year of experience, up to a maximum of 2
years.
• Geological research or teaching at the university or college level is credited year for year if, in the judgment of the Board, it is
comparable to experience obtained in the practice of geology or a specialty.
How to apply for a license
1. Submit a completed Geologist and Specialty License Application (sections 1 through 5) with a check or money order payable to the
Department of Licensing to our office.
2. Complete the Applicant Information section of the Employment and Experience Verification form send to each of the verifiers listed
on section 4 of this form. The person verifying will send the completed form directly to our office. Employment and Experience
Verification is not required if you are only applying for the Fundamentals of Geology Exam.
3. If you have only one Employment and Experience Verification, complete the Applicant portion of the Personal Reference form and
send to your reference to complete and submit to our office.
4. Request a certified copy of your transcript(s) be sent to our office. Only sealed transcripts sent directly from the issuing college
or university are accepted. Educational equivalents are subject to approval and must be documented by providing a course
syllabus, outline, or certificate of completion for non-academic courses.
5. After you are approved by the Board to take the ASBOG ® exams, you will receive a copy of the ASBOG ® National Examination
Candidate Request Form from our office. Complete the lower section of the form and send it with the exam fees directly to ASBOG ® .
Exam admission letters for approved candidates will be sent approximately one month prior to the date of the exam.
6. Specialty applicants only: Submit the List of Projects for the specialty(ies) you are applying for with your application. Also complete
the Applicant Information section of the Employment and Experience Verification form and send a copy of the List of Projects to each
of the verifiers listed. The person verifying will send the completed form directly to our office.
7. Reciprocity applicants only: Complete the Applicant section of the Geologist Licensing and/or Exam History Certification and send
to the state where you are currently licensed. They will complete the Certification Verification section and return the form to our office.
Questions?
Please feel free to contact us at (360) 664-1497 or by email to geologist@dol.wa.gov.
GEO-637-001 (R/10/18)WA Page 1 of 3
Geologist and/or Specialty
License Application
Use this application to apply for a geologist, engineering geologist, or hydrogeologist license.
Mail your application and fee to:
Mail all other supporting documents to:
Geologist Licensing Board
Geologist Licensing Board
Department of Licensing
Department of Licensing
PO Box 35001
PO Box 9012
Seattle WA 98124-3401
Olympia WA 98507-9012
Geologist license requirements
To be licensed in Washington as a geologist, you must:
• Have a degree from an accredited college or university in geological sciences or a related degree as approved by the Board. Your
degree must include 24 semester or 36 quarter hours of upper division geology courses or course work educationally equivalent in
content and rigor as approved by the Board. For more detail on required course work, visit dol.wa.gov/business/geologist/
• Have at least 5 years of documented, verifiable professional geological experience. At least 3 years must be under the supervision of
a licensed geologist.
• Pass the National Association of State Boards of Geology (ASBOG ® ) Fundamental of Geology and Practice of Geology
examinations, or an examination the Board approves as equivalent.
• Be currently licensed in another state, if applying by reciprocity.
Specialty license requirements
To be licensed in Washington as an engineering geologist or hydrogeologist, you must:
• Be licensed as a geologist
• Have completed one of the following advanced studies pertinent to your chosen specialty.
• 18 semester or 27 quarter hours of graded academic course work
• 270 hours of seminars or workshops
• 540 hours of on-the-job training under the supervision of a geologist licensed in your chosen specialty, or others qualified to have
responsible charge, as determined by the Board
• Have at least 5 years of documented, verifiable experience in your chosen specialty, including at least 3 years under the supervision
of a geologist licensed in your chosen specialty, or others qualified to have responsible charge, as determined by the Board. If
applying for 2 specialties, you must have at least 5 years of documented, verifiable experience in each specialty.
• Pass exam for specialty. You can apply by reciprocity for specialty licenses if you have passed the applicable specialty exam and are
currently licensed in California as an engineering geologist or hydrogeologist or in Oregon as a Engineering Geologist.
Alternative experience credit
• One year of full-time graduate study in geology or a qualified related area counts as one year of experience, up to a maximum of 2
years.
• Geological research or teaching at the university or college level is credited year for year if, in the judgment of the Board, it is
comparable to experience obtained in the practice of geology or a specialty.
How to apply for a license
1. Submit a completed Geologist and Specialty License Application (sections 1 through 5) with a check or money order payable to the
Department of Licensing to our office.
2. Complete the Applicant Information section of the Employment and Experience Verification form send to each of the verifiers listed
on section 4 of this form. The person verifying will send the completed form directly to our office. Employment and Experience
Verification is not required if you are only applying for the Fundamentals of Geology Exam.
3. If you have only one Employment and Experience Verification, complete the Applicant portion of the Personal Reference form and
send to your reference to complete and submit to our office.
4. Request a certified copy of your transcript(s) be sent to our office. Only sealed transcripts sent directly from the issuing college
or university are accepted. Educational equivalents are subject to approval and must be documented by providing a course
syllabus, outline, or certificate of completion for non-academic courses.
5. After you are approved by the Board to take the ASBOG ® exams, you will receive a copy of the ASBOG ® National Examination
Candidate Request Form from our office. Complete the lower section of the form and send it with the exam fees directly to ASBOG ® .
Exam admission letters for approved candidates will be sent approximately one month prior to the date of the exam.
6. Specialty applicants only: Submit the List of Projects for the specialty(ies) you are applying for with your application. Also complete
the Applicant Information section of the Employment and Experience Verification form and send a copy of the List of Projects to each
of the verifiers listed. The person verifying will send the completed form directly to our office.
7. Reciprocity applicants only: Complete the Applicant section of the Geologist Licensing and/or Exam History Certification and send
to the state where you are currently licensed. They will complete the Certification Verification section and return the form to our office.
Questions?
Please feel free to contact us at (360) 664-1497 or by email to geologist@dol.wa.gov.
GEO-637-001 (R/10/18)WA Page 1 of 3
Click here to START or CLEAR, then hit the TAB button
Geologist and/or Specialty
License Application
It is your responsibility to confirm that all required
documentation is received by the materials deadline.
Send this completed application with a check or money order, payable to the
Department of Licensing, for the fees shown below to:
Geologist Licensing Board, Department of Licensing,
PO Box 35001, Seattle WA 98124-3401
298-070-299-0040
All applicants must pay the application fee to take an exam.
*For a specialty license, you must have, or apply for, a Geologist license.
Application fees (check all that apply):
by exam, $100 fee
by reciprocity, $200 fee
Geologist
Engineering geologist*
by exam, $100 fee
by reciprocity, $150 fee
by exam, $100 fee
by reciprocity, $150 fee
Hydrogeologist*
Exam location and fees (check all that apply):
Location for exam:
West of Cascades
East of Cascades
Fundamentals of Geology for exam date
. Pay exam fee to ASBOG when approved to sit for the exam.
Practice of Geology for exam date
. Pay exam fee to ASBOG when approved to sit for the exam.
Engineering geologist* for exam date
. $300 fee payable to the Department of Licensing.
. $300 fee payable to the Department of Licensing.
Hydrogeologist* for exam date
Personal information
1
PRINT or TYPE Name (Last, First, Middle – will appear in the proper order on your wall certificate)
Former name (If applicable)
Street address
City
State
ZIP code
County
(Area code) Daytime telephone number
Area code) Home telephone number (optional)
Gender
Male
Female
Date of birth (mm/dd/yyyy)
Social Security number required* (or ITIN, Green Card, Canadian SIN)
Email
Exam state
License state
Date of original license
License number
If you are applying by reciprocity, indicate the
state where you passed an exam for licensure
State
Specialty
Year licensed
License number
If you are applying by reciprocity for a specialty license, indicate
the state where you passed a specialty exam for licensure
**All United States applicants are required by federal and state law to provide their Social Security number (SSN) for use in child support enforcement
programs (42 U.S.C. 666(a)(13) and RCW 74.20A.320). It may also be used for education loan repayment programs and identification of records with similar
names. Submission of your SSN is mandatory; failure to submit it will result in denial of your application.
2
Educational background (attach additional sheets if required)
2
Dates of attendance
Name of college, university, technical school
Location
From
To
Degree
Date of attendance
Applicable education and supplemental training
Location
From
To
Certificate/Degree etc.
Licensing and legal history
3
Answer the following
Answer the questions below. If you answer “Yes,” attach a detailed explanation.
In this state or any other jurisdiction, are you or have you:
1. Within the last 10 years, had any action (fine, suspension, revocation, censure, surrender, etc.)
taken against any professional or occupational license, certification, or permit held by you? . . . . . . . . .
Yes
No
2. Within the last 10 years, defaulted or been convicted of or entered a plea of no contest to a
gross misdemeanor or felony crime? (Don’t include traffic offenses.) . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
GEO-637-001 (R/10/18)WA Page 2 of 3
Qualifying experience – List in chronological order (most recent first)
4
Include only practical work experience performing activities involved in the practice of geology. A resumé alone is not enough.
Period of
Total hours
Full name and complete current address of employer,
employment
worked
Nature of service performed
including self employment and military service
(month/year)
per week
List types of projects, major duties
Verifier name and title
From
To
From
To
From
To
From
To
From
To
From
To
If additional space is required, please attach an 8 1/2" x 11" sheet.
5
Certification
Answer the following
1. Do you agree to abide by all the applicable laws and rules regarding the practice of geology and geology specialties? . . . . . . . . . . . . . . . . . . . .
Yes
No
2. Do you authorize any business associates (past and present) and any governmental agencies (local, state, or federal) to
release to the Department of Licensing any information, files, or records which may be required for a background investigation? . . . . . . . . . . . .
Yes
No
3. Do you understand that if you provide any false information in this application, we may deny, suspend, or revoke your license
to practice in Washington? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
When you have completed this form, please print it out and sign here.
Date and place
Applicant signature
GEO-637-001 (R/10/18)WA Page 3 of 3
Page of 3