CITY OF LOS ANGELES

SUPPLEMENTAL FORM

ENGINEERING ASSOCIATE - CAMPUS EXAMS

Emmanuel Bautista-Dizon
_________________________________ __________________________
(Do Not Complete Until Requested)
(Print name) (Social Security Number)
X
1. Do you have an EIT certification number or a PE registration number? No Yes

If yes, list EIT # ____________ __ or PE # _________________________

2a. If you have graduated with a four-year degree in Engineering, enter the name of school, type of
degree earned and major, and graduation date below:
Cal Poly Pomona Electrical Engineering July/2018
____
(Name of school) (Degree earned & Major) (Graduation date: Month/Year)

2b. If you have not graduated, enter the name of school that you are currently attending, your major,
and your anticipated graduation date below:

____
(Name of school) (Major) (Anticipated graduation date:
Month/Year)

3. Check ONLY ONE box next to the exam you are interviewing for. Then list the appropriate
semester or quarter units you have completed in engineering in the chart provided on the next
page. (If you have an EIT certification # or a PE registration # listed above, do not complete
this section.)

Civil Engineering Associate (Code No. 7246): 24 semester or 36 quarter units of core
courses completed in civil engineering
✔ Electrical Engineering Associate (Class No. 7525): 24 semester or 36 quarter units of core
courses completed in electrical engineering
Environmental Engineering Associate (Class No. 7871): 12 semester or 18 quarter units of
core courses completed in environmental engineering
Mechanical Engineering Associate (Class No 7554): 24 semester or 36 quarter units of
core courses completed in mechanical engineering
Street Lighting Engineering Associate (Class No. 7527): 24 semester or 36 quarter units of
core courses completed in electrical or civil engineering
Structural Engineering Associate (Class No. 7957): 12 semester or 18 quarter units of core
courses completed in structural engineering
Transportation Engineering Associate (Class No. 7280): 9 semester units or 12 quarter
units of transportation engineering, civil engineering and/or computer science courses

Rev. 08/11/16 page 1 of 2

 Credit Earned
(Specify # of Units) Grade Received
School Course Title Semester Quarter (or write:
units units “in progress”)
Cal Poly Pomona Network Analysis I 3 B+

Cal Poly Pomona Network Analysis II 3 B+

Cal Poly Pomona Electrical Devices and Circuits 4 C

Cal Poly Pomona Independent Study - Transfomer Vids 2 A

Cal Poly Pomona Team Project III 1 B+

Cal Poly Pomona C for Engineers 3 B

Cal Poly Pomona Digital Signal Processing I 3 A-

Cal Poly Pomona Electromagnetic Fields 4 A-

Cal Poly Pomona Intro to Microcontrollers 3 B-

Cal Poly Pomona Discrete Time Sig/Sys 4 A-

Cal Poly Pomona Instrumentation Systems 3 B

Cal Poly Pomona Control Systems engineering 4 B

Cal Poly Pomona Advanced Control Systems 3 B-

40
TOTAL UNITS
You may take this interview only once every 365 days from the date you were last added to the eligible list
or when you were interviewed, whichever date is more recent. If you have been added to this exam’s
eligible list in a campus environment with any City of Los Angeles department or DWP, a special
recruitment event, or during an open filing period in the Personnel Department or have interviewed for this
position within the last 12 months, you may not file for this examination at this time.

I do hereby attest, under penalty of disqualification, that I have not taken the interview or have not been
added to the eligible list in a campus environment with any City of Los Angeles department or DWP, a
special recruitment event, or during an open filing period.

_____________________________________
(Do Not Complete Until Requested) __________________________
(Do Not Complete Until Requested)
(Signature) (Date)

I do hereby attest, under penalty of disqualification, that all information supplied above is true and
accurately reflects my transcript record.

_____________________________________
(Do Not Complete Until Requested) __________________________
(Do Not Complete Until Requested)
(Signature) (Date)

Rev. 08/11/16 page 2 of 2