The purpose of this form is to provide notification to the Construction Occupations Registrar where there is a training arrangement (however described) between a trainee’s relevant person and the trainee, and the construction service provided by the trainee is covered by the training arrangement.  

A trainee, however described (apprentice, trainee etc) is an individual providing a construction service under supervision and is also undertaking an accredited course that provides instruction in relation to the construction service being provided.

The trainee’s relevant person is defined as:
•	the trainee’s employer; or 
•	if the trainee does not have an employer, the provider of the accredited course that the trainee is undertaking.

This approved form is to be completed by the employer or the provider of an accredited course that the trainee is undertaking.  

This notification is only required in relation to the trainee, as described above, where they are providing one or more of the following construction services as defined under the Construction Occupations (Licensing) Act 2004:
•	Electrical wiring services;
•	Gasfitting services;
•	Plumbing services; or 
•	Sanitary drainage services.

Completion of Form

•	Employers that are an individual must complete section A, B & E
•	Employers that are a corporation or partnership must complete section A, B, C and E
•	Providers of the accredited course, where the trainee does not have an employer, must complete section A, D and E

Section A – Trainee Details 

Title _______ Surname _______________________________________________________________   

Given Names_______________________________________________________________________

Address___________________________________________________________________________

Suburb_______________________________ State_________________ Postcode_______________

Phone Number__________________________________________ Fax ________________________ 

Mobile Number _______________________ Email address__________________________________ 

Name of accredited course ___________________________________________________________

Course Code/Identification Number_____________________________________________________

Date Training arrangement commenced ______/______/______   

Date Training arrangement ends Date ______/______/______  

Section B – Employer Details (Individual, Corporation or Partnership)

Title _______ Surname _______________________________________________________________   

Given Names_______________________________________________________________________

Business Name (if applicable)__________________________________________________________

Business Address____________________________________________________________________

Suburb_______________________________ State_________________ Postcode_______________

Phone Number (Business Hours) _____________________________Fax _______________________ 

Mobile Number _______________________Email address__________________________________ 

Construction Occupations Licence Number (If applicable)____________________________________

Section C – Trainee’s Manager Details (Corporation or Partnership)

Title _______ Surname _______________________________________________________________   

Given Names_______________________________________________________________________

Phone Number (Business Hours) _____________________________Fax _______________________

Mobile Number _____________________________ Email address____________________________

Construction Occupations Licence Number (If applicable)____________________________________

Section D – Non Employer (Accredited Course Provider)

Provider Details 

Provider Name _____________________________________________________________________

Business Address____________________________________________________________________

Suburb____________________________________ State_______________ Postcode____________

Nominated Person for the trainee Details

Title ________ Surname ______________________________________________________________   

Phone Number (Business Hours) _____________________________Fax _______________________ 

Mobile Number ______________________Email address___________________________________ 

Section E – Acknowledgement

I believe that the statements in this notification are true in every particular.

Signature of Applicant ______________________________________________   Date ______/______/______  
__________________________________________________________________________________________

Lodgement and Contact Information
Environment and Sustainable Development Directorate: www.environment.act.gov.au 
Customer Service Centre 
GPO Box 1908, Canberra City 2601 
16 Challis Street, Dickson ACT 2602 
Business Hours: 8.30am to 4.30pm weekdays (excluding Public Holidays) 
Phone: (02) 6207 1923 (02) 6207 2622 TTY: (02) 6207 2622 
Email: actpla.customer.services@act.gov.au

__________________________________________________________________________________________

Privacy Notice 
Information you are asked to provide will be used to monitor training arrangements.  The lawful authority for the collection of this information is the Construction Occupations (Licensing) Act 2004. The information may be disclosed to other Regulatory Authorities and Government Agencies.   The Construction Occupations Registrar and ESDD are committed to ensuring the privacy and confidentiality of personal information held and will adhere to the National Privacy Principles under the Privacy Act 1988 (Cth) when collecting, using, disclosing, securing and providing access to private information.
__________________________________________________________________________________________