ML22146A075
| ML22146A075 | |
| Person / Time | |
|---|---|
| Site: | Perry  |
| Issue date: | 07/31/2017 |
| From: | Randy Baker NRC/RGN-III/DRS/OLB |
| To: | |
| Baker R | |
| Shared Package | |
| ML17142A148 | List: |
| References | |
| Download: ML22146A075 (1) | |
Text
ILO NRC Exam 2017_{SRO-U Retest)
ES-201 Examination Security Agreement Form ES-201-3
- 1. Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 7/17/1 7 as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons w ho have not been authorized by the NRC chief examiner. I understand that I am not to instruct, ev aluate, or provide performance feed back to those appl icants sc heduled to be adm inistered these licensing exam inations 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 chief examiner any indications or suggestions that examination security may have been compromised .
- 2. Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of _ _ _ _ _ _ _ . From the date that I entered into this security agreement until the completion of examination adm inistration, I dicf 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.
PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE __ (1) , , DATE SIGNATURE (2) DATE NOTE
- 1. f2S T0,,.J1/2:S ( Uc,(_/] t';,.~.,_ l"'Mll r:-:c,.,,,.,. 401-ru,,.. s!dn
=::=::;;:::;:=;'l'f""7.'-=-:;"';:.;,-:: : - : : - - - - - . .
2.
-::::::- seo 1>--'fr~.Jc. ,.,.z ....,4~~~( . . . .~4'~~2==---- ,;;/ff/tJ
- 3. tci<--( J/f--4 1~v1':{we r - ~ ~ ~~ ~ :;;:=:.....__ _ .s/;t!t? _________
4.
5.
- 6. --;sa1/2 No,,Y-'f \
- 7. - )0 1-b.,) L Fto~£R.S StMufok ~
~-:-~ c~
S 'R o Ss.>ff6 (f: ~ ¢,IJ!!,~ ~ ~~ ~ ~~ _ s/~ft 7 _ _ _ _ _ _ _ __
-~ ~
---~
- =I~ 1/4- ~r4f (o H 7_ _ _ _ __
- 8. , -:vJ I fc <? t{.,tp~/,/"' ,5'4-2J = ~1(5/// - - - - - - - - -
.S/l-.c.J ~ (,,,-15*(7 _ _ _ _ _ _ _ __
- 9. 'JVi::vi M & X
- I 10.
11.
12.
13.
14.
15.
NOTES:
Sheet I of - - FENOC Facsimile