CANADIAN ASSOCIATION OF

PETROLEUM LANDMEN

PSL® APPLICATION FORM

Application must be typed or printed and

mailed or delivered to the CAPL Office at:

350, 500 – 5 Avenue SW

Calgary, AB T2P 3L5

FOR STAFF USE ONLY

Date Form Received / Date all Verification Received
Applicant Fees Received / Date
Date Written Exam / Date of Negotiator Publication
Date Passed Exam
Re-write – Yes/No
Date
Segment Rewritten


CANADIAN ASSOCIATION OF PETROLEUM LANDMEN

PSL® APPLICATION FORM

(Application must be typewritten or printed)

1. PERSONAL DATA

Name:

(First) (Middle) (Last)

Address:

Postal Code: Home Phone:

Current Employer:

Business Address:

Business Phone: Your Title:

E-mail:

Where should mail be sent:

2. QUALIFICATIONS FOR CERTIFICATION

I request acceptance to the CAPL PSL® examination by virtue of my qualifications under section B as stated in the Professionalism Procedure:

i) ii) iii) iv)

3. EDUCATION / LICENCES

Permanent Land Agent Licence: Y N No.

Provincial Equivalent: Y N (Only applicable if primarily working outside of Alberta)

Provincial Equivalent: refers to a landman who has been working primarily in a province for a minimum of 12 months that may or may not have licensing requirements. If licensing is required the applicant will have to have an active permanent license for that jurisdiction.

Prov. of Primary Work:

Years of Experience as a Landman (CAPL By Laws Article 3.1(i)):

Post Secondary Education:

Name and address of College or University:

Area of Study:

Degree/Diploma Received:

Additional Education:

(Attach additional page if required)

Request for Exemption of Mandatory course other than Ethics and Fiduciary duties Y N

(If yes please explain and confirm that resume covers all required experience)

Mandatory Courses:

Category / Course Name / Date Attended
Ethics
Fiduciary Duties
Field Services
Oil and Gas Law
Negotiations
Regulations
Contracts
Option 1
Option 2
Option 3
Option 4
Option 5

PLEASE NOTE: Six (6) of the above courses must be Approved CAPL Surface Courses

4. WORK EXPERIENCE - Attach Current Resume (Mandatory)

5. SPONSORS

Applicants for PSL® must have five (5) sponsors: all of whom must be either an Active, Life or a Senior member of CAPL; three (3) sponsors must hold either a P.Land® or PSL® designation or be an active Permanent Land Agent in Alberta or hold a provincial equivalent none of whom, at the time of application, are employed or retained as a consultant by a common employer. The sponsors will be required by the Certification Committee to describe on a separate form the applicant's experience and attest to his/her ethics. Sponsors must know the applicant personally and be willing to attest to the applicant's qualification, job experience, and ethical conduct. Sponsors may be required to answer other committee questions bearing upon applicant's qualifications, and should not be named unless willing to supply such information.

The names and addresses of the five (5) sponsors are required on this application form. Please be sure each sponsor is provided with a verification form with full instructions. Verification forms can be found on the CAPL website.

Sponsor 1

Name: / Company: / Designation:
P.Land® PSL®
Land Agent Lic. #
Address: / Phone/Fax: / Email:

Sponsor 2

Name: / Company: / Designation:
P.Land® PSL®
Land Agent Lic. #
Address: / Phone/Fax: / Email:

Sponsor 3

Name: / Company: / Designation:
P.Land ® PSL®
Land Agent Lic. #
Address: / Phone/Fax: / Email:

Sponsor 4

Name: / Company: / Designation:
P.Land ® PSL®
Land Agent Lic. #
Address: / Phone/Fax: / Email:

Sponsor 5

Name: / Company: / Designation:
P.Land ® PSL®
Land Agent Lic. #
Address: / Phone/Fax: / Email:

6. EXAM WEIGHTING

Pursuant to the Professionalism Procedure the PSL® Exam will be weighted as follows:

Section 2 – Oil & Gas Law: 20 questions

Section 3 – Freehold Oil & Gas Leases: 20 questions

Section 4 – Surface Land: 55 questions

Section 8 – Negotiations and Ethics plus Fiduciary Duties: 15 questions

Section 10 – Unconventional Gas & Oil Sands/Heavy Oil: 10 questions

Surface Regulations: 30 questions

TOTAL: 150 questions

To successfully complete the PSL® Exam, applicants must pass with an overall minimum grade of seventy percent (70%).

7. FEES

The current Fee Schedule can be found on the CAPL website.

IN MAKING APPLICATION:

I hereby authorize the CAPL Certification Committee to verify all information herein.

Furthermore, I certify that all statements in this application are true to the best of my knowledge and I understand that any misstatement of facts deemed material is grounds for denial of my application. I further agree that in the event Certification is not granted to me, or if granted and later withdrawn for ethical reasons, I will make no claim against the Canadian Association of Petroleum Landmen – it’s Board of Directors, any committee, or any individual member.


Furthermore, I pledge that if I attain the PSL® designation, I will endeavor to maintain a high degree of professional competence, and moral and professional integrity.

Date Signature of Applicant

Name:

Page 5 of 5

Updated April 2013

PSL® APPLICATION FORM