ML21361A021

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Post Exam ES-201-3
ML21361A021
Person / Time
Site: Byron  Constellation icon.png
Issue date: 10/28/2021
From: Gregory Roach
NRC/RGN-III/DRS/OLB
To:
Roach G
Shared Package
ML21055A847 List:
References
Download: ML21361A021 (4)
v • d • e


Text

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SYR.oiv x~-r zo- I ES-201 Examination Securi~reement Form ES-201-3

1. Pre-Examination I acknowledge that have acquire ~Cii.alized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of Z '1 Z. - lb *'(ffl the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been thorized by the NRC's chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that vt-olation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC's chief examiner any indications or suggestions that examination security may have been compromised.
2. Post-Examination rn To the best of my know~ ge, I did no ~if}Age to any unauthorized persons any information concerning the NRC licensing examinations administered N during the week{s) of 7j - :tflfom the date that I entered into this security agreement until the completion of examination administration, I did

~ not instruct, evaluate, or provide pe r ance feedback to those applicants who were administered these licensing examinations, except as specifically

, noted below and authorized by the NRC.

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ES-201 Examination Secur~re ement Fonn ES

1. Pre-Examination examinations schedul, I acknowledge that I have acquired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing 1/'l-1/'Zf as of the date of my signature. I agree that I will not knowingly divulge any information about these examinat the week(s) of been authorized by the NRC's chief examiner. I understand that I am not to instruct, evaluate, or pr<Wide performanCE any persons who have not of examination administra feedback to those applicants scheduled to be administered these licensing examinations from this date until completion acting as a simulator booth operator or communicato r is acceptable if the indi except as specifically noted below and authorized by the NRC (e.g.,

provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requir does not select the training content or agreement may result in cancellation o (as documented in the facility licensee's procedures) and understand that violation of the conditions of this licensee. I will immediately report to facility managemen t or the NRC's chie examinations and/or an enforcement action against me or the facility examiner any indications or suggestions that examination security may have been compromised.

2. Post.Examination rn To the best of my kno d , I did no divulge to any unauthorized persons any information concerning the NRC licensing security agreement until the completion of examinations administ*

examination administrat r:., during the week(s) o ~~~:NJ~~ From the date that I entered into this feedback to those applicants who were administered these licensing examinations , except as speci

~ not instruct, evaluate, r p ovide e ormance

~ noted below and authorized by the NRC.

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(D C6art-tc-T h 1"-'011110114'. To "~llk*11( flluM1 t;*~,-n, A4~,c"11, ES-201, Page 31 of 32 a.-r. ~£'3£fllJ,T ')J ~ CD-.,P,f,v V

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1. Pre-Examinatjon I acf<na#tedge~ave acquired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of J , !q-r11J at of the date of my 519nature. 1 agree that I will not knowingly divulge any information about these exanmations to any persoms wm have not been uthorized by the NRC'a chief examiner. I understand that I am not to instruct, evaluale, or provide performance faedback to those applicants scheduled ID be administered these licensing examinations from this date until completion of examination administration.

except aa apec:ifically ncted below and authorized by the NRC (e.g., acting as a slmulator boolh operator Ot communicator is acceptable if the individual does net select the training content or p,ovide direct or indirect f9edback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures} and undemand that violation of the conditions of this agreement may l\lSult in cancelfation of the examinations and/or an enforcement action against me or the facility Ucensee. I will immediately repa1 to facility management or the NRC"s chief eminer any indication$ or suggestions tnat examination security may have been compromised.

2. Post-&amlnation m To the best of my k N duting the week(s) of ,

ge, I did at dMilge to any unauthorized persons any information concerning the NRC licensfng examinations admlniStered From the date that I entered Into this security agreement until the completion of examination adminis1ration, I did g not instruct. evaluate, er provide rr.iirtnnn:ance feedback to those applicants who were administered these licensing examinations, except as specifically

  • "1> noted below and authorized by the NRC.

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NOTES:

ES-201 , Page 31 of 32

0 ES-201 Examination Secur~reement Form ES-201-3

1. Pre-Examination I acknowledge that h ea quired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of 'Z7. Z as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have no been authorized by the NRC's chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC's chief examiner any indications or suggestions that examination security may have been compromised.
2. Post-Examination rn To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered N during the week(s) of q/?.l/-cc -19/15/q From the date that I entered into this security agreement until the completion of examination administration, I did

~ not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations. except as specifically

~ noted below and authorized by the NRC.

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(1) PRINTED NAME JOB TITLE/RESPONSIBILITY DATE SIGNATURE(2) f,ATE NOTE

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1. Kevin Jacobs z; 2. _ _ _ _ _ __

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NOTES: © C4WT~TltO 'J:""OIVJ°"-,.C.. To .ae....., ftzo.,.. 5rect14,-ry ~u, ,tflf,c,r, 4,/0it.l(f""' R£.tttrr1£/,.,7" ES-201, Page 31 of 32

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