ML22192A193

From kanterella
Jump to navigation Jump to search
2021 QC Ile ES-201-3 Security Agreement-Final
ML22192A193
Person / Time
Site: Quad Cities  Constellation icon.png
Issue date: 07/09/2021
From: Randy Baker
NRC/RGN-III/DRS/OLB
To:
Baker R
Shared Package
ML20139A015 List:
References
Download: ML22192A193 (4)
v • d • e


Text

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

1. Pre-examination I acknowledge that I have acquired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of A1 AV ~ i * \ v"1 ,..,~~s of 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 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 communicato r 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 t10.'-1 1. ,_ .lv>-.f "' lc,UFrom 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.

Ql cc (D PRINTED NAME JOB TITLE/RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE

(,J 0 1.,..:,;=:=:..:.:.~ ==:,.L.I!= ~ AuTllolt ,.f>,2.1

~ 2.,..:.::~ = ~.:.....:..= :!..-- M-.t,-"'

CW.rJc 4mdl>II t*Jrll

..... 3 ...la!oa~!YU!!IL. Jod..L.,111:1~~  :::z:;.T$A ~ r __

4-....u.:.i.:::=--""--IC.L..Jq. ~ /,,_lr/r . &:.1:1.&l

5. .:.tLI~ 7, Ha.ber-&,,-x. tvRe.-s:s o U 9si ~ . - :.o ~ Z ~~

!::mr:w.:~ t\,:t,t,, .L--

~ ft-: ~==

a~

y',u IM~

~ ~ ==~

\/.9. l:@ :o" 9.,..w::~=--.;....;::=....,,_....__ ~ iJ--+ 10 ...&...~~-i.:.=::. ...:....:J...~ t/i,... (,da t ,on

, .. 1:J, j.'1, ,,.

11.-='-'=---'C.1....L."',1---

~ -'<l=.-- '4~~--- ~l --

12 .....:.:.:===--.au.. JLJ..1""""'-

13. Go?D u...-c....\c
14. p~ ~,,

15.1'1~~

\/ i\ L.'l-o ~

VAI.IDA[lo AJ Ve.,\; ,:,A..,..-+-;.;,-' 'f/.w_/::i, .J...,j,c::;...4,

. z....J,~C..:: .,..---

1:Q *2/ ..:.Z:i4:~ ~~:::.___ t, *2j .,,

w~r;, __ --

l:x. ~1<<!1,¢-c dep r"C c S

  • S*Z 1....C.J."4:. ,fi'.3~~--- 6'-?S=?.1 - -

NOTES: .(..,-/1, v1' I lo-Mt ES-201 , Page 31 of 32

ES-201 Examination Securit~r eement Form ES-201-3

1. Pre-Exami~ tion I acknowledge tt,at I have acquired specialized knowledg~ about the U.S. Nuclear ~egulatory ~ommi~sion (NR~)

licensi~g examinations sche_dul~d for the week(s) of 1'11,;, 1\- )u*-' \"\ 'Loi...\ as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons whohave 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 administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicato r 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-Examioation 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 f /A-'I..,,, - ~ _,('. N 1~1..\ 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.

Q) cc CD PRINTED NAME JOB TITLE/RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE

1. H-.r,
'itM G";l'lttl"'\. v~L:J.. lv- /4: ~ 5/kJ/l/ c3/4 - ~ 6/lf/4 z;

...... 3. ,u,~

2. :[l*lo'"'.1)6 ~ <..

,.e,,,L,L d l i cld:o-c:

4, t ==

4. Tb.::tl~
5. G ru1 He-/4.-:J,;,I\
6. G
  • 13~

':f7Y Ol'ttoL a.lLdo,¥ 1/t1.l,dt-.1l, v ..... \ ~ 1 c l/_g,_l ik.to-r

~

57,o{t.1 -----,,.---- ,.,-,-------

~uet~ -~-..~--= c---'--- 6 5-1*-'I

~,1i .-z;1 - - -fl A 5-,-s-z,

~

~~ ~

7P1--

~

.ftr-71

~¥ tt~ ~-,_

7.-'¥',...._.,......,~.........- - -

8._,l!..l~-=~" -"',~::..i..:i.-

9. C!;>~

'1~

, ..I

10. A;?Q~ ltcs Tr~ rG\.;w_r-

\\M..,. ~

11. ,).\.~,...

}{::;

I 12 .*h,,.Mlt1rt-> e,~

13. A.wt
14. Dsv,d 6°~ha'h t-dt: /.JoJ,-.L._.

~; to*4rvc f os? ~t W

-z'( _ _

15 . ..JAy \.JA1:,,._, li'l'2-. S.~11&SJ:q'(2..

,IP/;

~ *. .*, kl

  • C J .Ylt;"1 ~ - (../,2/Jt., *-'-

NOTES:

ES-201 , Page 31 of 32

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

1. Pr~-Examination I acknowledge that I have ac;:quired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of ~\t>. I.\ \\ ~ ),,,., 1:: I'\ kl.\ 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 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 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 immediate ly report to facility management or the NRC's chief examiner any indications or suggestions that examination security may have been compromised.
2. Po_st-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 tl.c,.j 11 -~.,. ..... ~ 1~ 20-i,\ 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 administer ed these licensing examinations, except as specifically

~ noted below and authorized by the NRC.

!l)

<C CD PRINTED NAME JOB TITLE/RESPONSIBILITY DATE

(,.) DATE NOTE

1. I f!,0 5 4aMw 71NU1l 1f[D/L {>(l,.fif z; 2. T ba<<zs , /le.a,oc 1-t Simu/.,j""° t;_r-e. f

...... 3. ~t:u:s@.,p 1.:., c=; *-':::'*:::':..,--:\' !-4i'f

~;;;; ~~ (==

.~-4

~

Nlufp<d I

4. bMt(Dod ~iM 8t.,?' l' fl:!f.

6.;;;*

. ~~ ~e,

s. f,:

~"~

7. - ~ - ~"'~,r 8._ _ __ _ __

SiM.

f~: 00:r GM<< 2i.1PPo,.1' ~  : ~l;.> '!f!sj~,'

c _ _
9. _ _ _ _ _ __

10._ _ _ _ _ __

11._ _ _ _ _ __

12._ _ _ _ _ __

13._ _ _ _ _ __

14._ _ _ _ _ __

15. _ _ _ _ _ __

NOTES:

ES-201 , Page 31 of 32

ES-201 Examination Securitv Agreemen t ES-201-3

1. Pre-epminatiM I acknowledge that I have acquired s~lized knowledge about the U.S. Nuclear Regulatory Commission (NRC) ficenslng examinations sch duled for the week(s) of A1 A'l '!. I * ,\, "J '~1io-as of the date of my signature. I agree that I will not knowingly divulge any infonnation about these exa inations to any persons who have not been authorized by the.NRC's chief examiner. I understand that I am not to instruct, evaluate, or provide perform nee feedback to those appficants scheduled to be administered these licensing examinations from this date until completion of examination admln tration, except as specifically no~d below and authortzed by the NRC (e.g., acting as a simulator booth operator or communicator Is acceptable if the indMdual does not select the training content or provide direct or Indirect feedback). Furthermore, I am aware of the physical security measures and r ulrements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellati n of the examinations and/or an enforcement action against me or the facility licensee. I wtll immediately report to facility management or the NRC's hief examiner any Indications or suggestions that examination security may have been compromised.
2. Post-Exam fnatign

~ To the best of my knowledge. I did not divulge to any unauthorized persons any information concerning the NRC licensing examination I'> during the week(s) of . ti 1>.--1 "\.- l~:::( 1 2..:,1..lFrom the date that I entered into this security agreement until the completion of examination s admi lstered

~ not instruct, evaluate, or provide performance feedback to those applicant! who were adminl ration, I did administered these licensing examinations, except as s ecifically

, noted below and authorized by the NRC.

Q)

'fl

,.J i~

PRfNTEO NAME JOB TITLE/RESPONSIBILITY DATE SIGNATURE (2) DAYE - N~~

~&M id ~-~ --==~-- -- - t ~

H!tif
1/2f
5. l)avg....':T. ~ K .

6.~p lID-W*p_

a:::2::14J:::--~---=--=--=--=--=--=---=

~:::: .t~h 9,

10Qltrl? ~'~ <

Jlii t:k 1_

i

.. - * ~~ ~

1 h:¥fffe_. Q ** .,kT

-)1 .

I 0

~

NOTES: :j ES-201, Page 31 of 32

Retrieved from "https://kanterella.com/w/index.php?title=ML22192A193&oldid=3451117"