ML23212A873

Form 1.3-1 Examination Security Checklist

ML23212A873
Person / Time
Site:	Fermi
Issue date:	07/31/2023
From:	NRC/RGN-III/DORS/OB
To:
Bryan Bergeon
Shared Package
ML22007A060	List: ML23200A255 ML23200A256 ML23200A257 ML23212A873 ML23213A030
References
Download: ML23212A873 (1)

Text

ILT 2023 Page 2 of; Form 1.3-1 Examination Security Agreement (1) Preexamination I acknowledge that I have acquired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of 619 & 6125, 2023 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 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 the completion of examination administration, except as specifically noted below or authorized by the NRC. 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, an enforcement action by the NRC against me or the facility licensee, or both. I will immediately report to facility licensee management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

(2) Postexamination 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 619 & 6/25, 2023. From the date that I entered into this examination 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 or authorized by the NRC.

Print Name Job Title Signature (1) Date Signature (2) Date Note

3. cs \O4 =4 tMm i ZIi

6. 29 3 1

8. ja J'~rj 10 .. iJ . ,)c2' t r

12. 24,4z 5 ,vx

13. a l t3 r _________ __ _____

NOTES: v r~a1>V# 5a £ ff 5~c, =

ILT 2023 Page1aI Form 1.3-1 Examination Security Agreement (1) Preexamination I acknowledge that I have acquired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of 619 & 6/25, 2023 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 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 the completion of examination administration, except as specifically noted below or authorized by the NRC. 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, an enforcement action by the NRC against me or the facility licensee, or both. I will immediately report to facility licensee management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

(2) Postexamination 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 6/19 & 6125, 2023. From the date that I entered into this examination 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 or authorized by the NRC.

Print Name Job Title Signature (1) Date Sigpature (2) Date Note

2. /'R,K S,,x __ _ _ _ _ __ _1~

5. -

6. G i z 27-2-3i

9. GG) TL___ L7'

10. 6-K/z[CK $- S vi z( Cl,;sc r -7?X3

12. 4,1C 5/RAPCA/ 2Ao

-(6-23 Dm'-t1 JIB 'A't S 1~

13. `c t t . cc 2, "Z-G- z3 Rkut-V C$n` 73)7-NOTES: