ML21361A029

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Pre Exam ES-201-3
ML21361A029
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: ML21361A029 (4)
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Text

SY~..., x.,.:r 2o-1 ES-201 Examination Security Agreement Form ES-201-3

1.

Pre-Examination I acknowledge that have acquire ~'il_alized knowledge about the U.S. Nuclear Regulatory Commission (NRG) licensing examinations scheduled for the week(s) of Z1 Z. - lo t~ 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 l 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 NRG (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 m

To the best of my know~ ge, I did no fifll.J.ge to any unauthorized persons any information concerning the NRC licensing examinations administered

.z, during the week(s) of 7j

~om 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

--u noted below and authorized by the NRC.

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JOB TITLE/RESPONSIBILITY AJJO SIGNATURE (1)

ES-201, Page 31 of 32 DATE SIGNATURE (2) 9/,, l'ltJ -----

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1t...r zc,-1 ES-201 Examination Security Agreement Fonn E!

1.

Pre-Examination I acknowledge that I ha~e acquired specialized knowledge about the U.S. Nuclear Regulatory Commission {NRC) licensing examinations schedul the week(s) of 1f,z,,z Y as of the date of my signature. I agree that I will not knowingly divulge any information about these examina1 any persons who have not 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 administra except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the indi does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requir (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation o examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC's chie*

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 administE N during the week(s) of ______. From the date that I entered into this security agreement until the completion of examination administrat

~ not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as speci1

'U noted below and authorized by the NRC.

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PRINTED NAME JOB TITLE/RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2)

DATE c.>....

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NOTES:

ES-201, Page 31 of 32

ES-201

1.

Pre-&amination Examination Security Agreement Fonn ES-201-3 I ad<nawledge~ave acquired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensmg examinations scheduled for the week(s) dJ

  • /0-17 ~ as of the date of my signature. I agree that I will not knowingly cflVUfge any infonnation about these examinations to any persons wtio have not been uthori%.ed by the NRC's chief examiner. I understand that I am not to instruct, evaluate. or provide performance faedback to lhose 8IJl)lcanta scheduled to be administered these licensing examinations from this date until completion of examination administration.

except aa spedfically 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 lhe training <:ontent or provide direct or indirect feedback). Furthennore, r am aware of the physical security measures and requiremencs (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result jn cancellation of the exaninations and/or an enforument action against me or the facility licensee. I will immediately report to facility management or the NRC's chief examiner any indications or suggesttons that examination security may have been comprormsed.

2.

Post-Examination m

To the best of my knowledge, I did not divulge to any unautllorized persons any infonnation concerning the NRC licensing exam,nations administered

"> during the week(s) of _____ From the date that I entered into this seany agreement unbl the completion of examination administration. I did

~ not in6truct. evaluale. or provide performance feedback to those applicants who were administered these licensing examinations. except as specifically

  • "lJ noted below and authorized by the NRC.

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PRINTED NAME JOB TITLEJRE~PONSIBIUTV

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4. ______ _

5., ______

6., ______

7., ______ _

8. ______
9. ______

10.. ______ _

11. ______
12. ______

13.. ______ _

14., ______ _

15.. ______ _

NOTES*

DATE SIGNATURE (2)

DATE NOTE

.st,Ji, __ _

ES-201, Page 31 of 32

ES-201 Examination Security Agreement Form ES-201-3

1.

Pre-Examination I acknowledge that h e a quired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of 2:7. 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 ill 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 ______. 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 "JI noted below and authorized by the NRC.

(C (I)

(,J PRINTED NAME

.... 1 Kevin Jacobs a *--------

w 2. _______ _

.... 3. _______ _

4. _______ _
5. _______ _
6. _______ _
7. _______ _
8. _______ _
9. _______
10. ______ _
11. ______ _
12. ______ _
13. ______ _
14. ______ _
15. ______ _

NOTES:

JOB TITLE/RESPONSIBILITY Analyst DATE SIGNATURE (2)

DATE NOTE 311012021 ES-201, Page 31 of 32

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