ML22312A435

Exam Form 1.3-1

ML22312A435
Person / Time
Site:	Hope Creek
Issue date:	10/03/2022
From:	Office of Nuclear Reactor Regulation
To:	Public Service Enterprise Group
References
Download: ML22312A435 (1)

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 8/8-15/2022 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 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

en I To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered N

0 during the week(s) of 8/8-15/2022. From the date that I entered into this security agreement until the completion of examination administration, I did

-u not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically Ol noted below and authorized by the NRC.

(Cl CD

(,.) _. PRINTED NAME JOB TITLE/RESPONSIBILITY DATE SIGNATURE (2) DATE NOTE

0

..... Cf -,s--22.

(,.) 1. Paul Breidenbach Exam Author

2. Steve Dennis Exam Author t:::t--1.r--2..L

a /-z:z_/zz_ -

. '). )_

J-

NOTES:

ES -201, Page 31 of 32 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 8/8-15/2022 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 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

CJ)

I To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered N 0

_,_ during the week(s) of 8/8-15/2022. From the date that I entered into this security agreement until the completion of examination administration, I did

""CJ not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically Q) noted below and authorized by the NRC.

co Cl)

(.,.) _,_ PRINTED NAME JOB TITLE/RESPONSIBILITY SIGNATURE (1)

0

(.,.)

-_,_ /\\/Co

3. "T. C.&,~'-4\\~0 \\ \\..trl '-RAP 4. c m1NhdltH 141>1 1,n1ive.1et 5. c. '?:-"'~ e,Es z., ~

6. B; n Ch e&J -s:,." 1ctw ~, **.,OU"""

7. :l"~ l\\6\\t..$"1UI> c,es J 8. ::fo!>\\-l tv\\e5S 5~l\\fl OFF.AA!u,~ s MNJA6eL 9. ~ /./jJn,, *L~,-z;_ ~T/kzllfl'/:t=

10. >-/\\1\\v:::,-t~

11. :J. C~fJC~ A/Co

12. -------

13. -------

14. -------

15. -------

NOTES :

ES-201, Page 31 of 32