Application for Construction Occupation Licence Individual 
Gasfitter
Construction Occupations (Licensing) Act 2004, s128 and s17	

This approved form is to be used for individuals applying under the Construction Occupations (Licensing) Act 2004 to the Construction Occupations Registrar for a gasfitter licence to provide gasfitting services in the ACT.  This application will not be considered unless it is complete and all supporting documentation provided.

All supporting documentation must:
•	be originals or certified true copies of original documents where relevant; and
•	be in English. If original documents are not in English, you must provide a certified copy of the original document and an official translation of the document.

For detailed information on eligibility criteria please refer to Gasfitters Licensing on the www.planning.act.gov.au website.  

Privacy Notice 
The personal information on this form is provided to the ACT Environment and Planning Directorate (EPD) to enable the processing of your application. If all or some of the personal information is not collected EPD cannot process your application. The personal information you provide may be disclosed to the other ACT Government Directorates, and third parties external to the ACT Government, as required by specific legislations administered by EPD. The Information Privacy Policy Annex contains information in regard to what information EPD collects and to whom it is disclosed. The policy also contains information about how you may access or seek to correct your personal information held by EPD, and how you may complain about an alleged breach of the Territory Privacy Principles. The EPD Information Privacy Policy can be found on the EPD website, under the “About Us” menu. 

Section A — Personal Details
Title 		 Surname 									 

Given Names							Date of Birth	    /	  /	

Business Address											 

Suburb 					State				Postcode 		

Residential Address										 

Suburb 					State				Postcode 		
	
Postal Address 											           

Suburb 					State				Postcode 		

Phone Number (Business Hours) 				Fax 					

Mobile Number* 				Email*							

*Please note that under s170 of the Construction (Occupations) Licensing Act 2004 it is a requirement to provide a valid mobile telephone number and email address. 

I understand that it is a requirement under law that should my licence be issued I must notify the Construction Occupations Registrar of any changes to my details within two weeks of the change?  

 I understand

Approved form AF2014‐139 approved by David Middlemiss, Construction Occupations Registrar on 7 November 2014 under
section 128 of the Construction Occupations (Licensing) Act 2004 and revokes AF2014-119.	

Section B — Existing licence
Have you previously or do you currently hold an ACT construction occupation licence?

 Yes — licence Number				 expiry date				

 No — proceed to Section C – Occupation class and functions.
Section C — Occupation class and functions
A gasfitter is an entity that provides, has provided or proposes to provide a gasfitting service.  A gasfitting service is the doing or supervision of gasfitting work.  For the definition of gasfitting work, see the Gas Safety Act 2000.  

What class of licence are you applying for?

 Advanced -	licence authorises gasfitting work, other than LPG (liquid phase) installation, without supervision.	

 General -	licence authorises gasfitting work for pressures below 21kPa pressure without supervision and gasfitting work for pressures above 21kPa pressure under the supervision of an Advanced Gasfitter. 

 Journeyperson Gasfitter -	licence authorises Gasfitting work under the general supervision of a licensee with an Advanced Gasfitters licence. 

 LPG Gasfitter (Vapour Phase) -	licence authorises LPG (vapour phase) installation without supervision.

 LPG Gasfitter (Liquid Phase) -	licence authorises LPG (liquid phase) installation without supervision.
	 
 Restricted Automotive (LPG) -	licence authorises LPG fuel installation on motor vehicles. 

 Restricted Automotive (NGV) -	licence authorises NGV fuel installation on motor vehicles.
  
 Restricted Automotive (LPG Forklifts)	-		licence authorises gasfitting for LPG forklifts. 
 
 Restricted Automotive (NGV Forklifts) -		licence authorises gasfitting for NGV forklifts.

Section D — Evidence of qualifications/eligibility — Advanced Gasfitter 
Complete this section only if you are applying for an advanced gasfitter licence. 

Requirement:	currently holds, or has held within 12 months prior to application, a general gasfitter licence for over 12 months.

Experience:	12 months experience in natural gas work for pressures above 21 kPa (totalling no less than 20 installations) while licensed as a general gasfitter under the supervision of an advanced gasfitter. 
	
 Yes — please provide details of the supervisor below and attach a copy of the list of installations signed off by the advanced gasfitter.
asfitter.

 No — please note that you may not be eligible for a licence.
Supervisor (Licensee) Name				Licence Number	 			
	
Section D — Evidence of qualifications/eligibility — General Gasfitter 
Complete this section only if you are applying for a General Gasfitter.  

Qualification:	provide evidence of completion, or partial completion, of one of the following Certificate IV qualifications in Plumbing and Services issued within five (5) years prior to making the application from a Registered Training Organisation:

•	CPC40912
•	CPC40911
•	CPC40909
•	CPC40908

 the Certificate IV, or partial Certificate IV, must include all the following units of competency, or their superseded equivalent:

•	BSBSMB401A - Establish legal and risk management requirements of small business
•	CPCCBC4012B - Read and interpret plans and specifications
•	CPCPCM4011A - Carry out work-based risk control processes
•	CPCPCM4012A - Estimate and cost work
•	CPCPGS4011C - Design and size consumer gas installations

 Yes — please attach a certified copy of the qualification or units of competency.

 No — please note that you may not be eligible for a licence.

Requirement:	currently holds, or has held within 12 months prior to application, a journeyperson gasfitter licence for over 12 months.
	
Experience:	12 months full-time experience in gasfitting while licensed as a journeyperson gasfitter under the supervision of a licensed advanced gasfitter or general gasfitter.

 Yes — please provide details of the supervisor below and attach a copy of the reference from the licensed advanced gasfitter or general gasfitter.

 No — please note that you may not be eligible for a licence.
Supervisor (Licensee) Name				Licence Number	 			

Section D — Evidence of qualifications/eligibility — Journeyperson Gasfitter
Complete this section only if you are applying for a journeyperson gasfitter licence.  

Qualification:	provide evidence of completion of one of the following Certificate III qualifications in Plumbing issued within five (5) years prior to making the application from a Registered Training Organisation:

•	CPC32408
•	CPC32411
•	CPC32412
•	CPC32413

and the Gas Services Stream and Roofing Stream were completed to attain this qualification.

 Yes — please attach a certified copy of the qualification including transcripts.

 No — please note that you may not be eligible for a licence.

Section D — Evidence of qualifications/eligibility — LPG Gasfitter (Vapour Phase) 
Complete this section only if you are applying for a LPG gasfitter (vapour phase) licence.  

Qualification:	provide evidence of completion of the following units of competency from the Certificate IV qualification in Plumbing and Services CPC40912 issued within five (5) years prior to making the application, or the superseded equivalent, from a Registered Training Organisation:

•	CPCPGS4011B - Design and size consumer gas installations
•	CPCPCM4011A - Carry out work-based risk control processes
•	CPCPCM4012A - Estimate and cost work
•	BSBSMB401A - Establish legal and risk management requirements of small business
•	CPCCBC4012B - Read and interpret plans and specifications

 Yes — please attach certified copies.

 No — please note that you may not be eligible for a licence.

Requirement:	currently holds, or has held within 12 months prior to application, a journeyperson gasfitter licence for over 12 months.
	
Experience:	12 months full-time experience in gasfitting work on LPG (vapour phase) installations while licensed as a journeyperson gasfitter under the supervision of a licensed LPG gasfitter (vapour phase) or licensed LPG gasfitter (liquid phase).

 Yes — please provide details of the supervisor below and attach a copy of the reference from the licensed LPG gasfitter (vapour phase) or licensed LPG gasfitter (liquid phase).

 No — please note that you may not be eligible for a licence.
Supervisor (Licensee) Name				Licence Number	 			

Section D — Evidence of qualifications/eligibility — LPG Gasfitter (Liquid Phase)
Complete this section only if you are applying for a LPG gasfitter (liquid phase) licence.  

Qualification:	provide evidence of completion of the unit of competency Install LPG storage of aggregate storage capacity exceeding 500 litres and less than 8KL with code BCPGS3005A; CPCPGS3005A; CPCPGS3035A or CPCPGS3060A issued within five (5) years prior to making the application from a Registered Training Organisation; 

 Yes — please attach a certified copy.

 No — please note that you may not be eligible for a licence.

Requirement:	holds an LPG gasfitter (vapour phase) licence.
	
Experience:	12 months full-time experience in gasfitting work on LPG (liquid phase) installations while licensed as a LPG gasfitter (vapour phase) under the supervision of a licensed LPG gasfitter (liquid phase).
	
 Yes — please provide details of the supervisor below and attach a copy of the reference from the licensed LPG gasfitter (liquid phase).

 No — please note that you may not be eligible for a licence.

Supervisor (Licensee) Name				Licence Number	 			
Section D — Evidence of qualifications/eligibility — Restricted Automotive – LPG
Complete this section only if you are applying for a restricted automotive – LPG licence.  

Qualification:	provide evidence of completion of a Certificate III in one of the following trades issued within five (5) years prior to making the application from a Registered Training Organisation:

•	Light Vehicle Mechanical
•	Heavy Vehicle Mechanical
•	Auto Electrical

 Yes — please attach a certified copy.

 No — please note that you may not be eligible for a licence.
Qualification:	provide evidence of successful completion of the following units of competency from the Certificate III in Automotive Alternative Fuel Technology AUR32012 issued within five (5) years prior to making the application from a Registered Training Organisation:

•	AURTTL3007 - Service LPG Fuel Systems
•	AURTTL3008 - Diagnose and Repair LPG Fuel Systems
•	AURTTL3009 - Install LPG Fuel Systems

 Yes — please attach certified copies.

 No — please note that you may not be eligible for a licence.

Section D — Evidence of qualifications/eligibility — Restricted Automotive – NGV 
Complete this section only if you are applying for a restricted automotive – NGV licence.  

Qualification:	provide evidence of completion of a Certificate III in one of the following trades issued within five (5) years prior to making the application from a Registered Training Organisation: 

•	Light Vehicle Mechanical
•	Heavy Vehicle Mechanical
•	Auto Electrical

 Yes — please attach a certified copy.

 No — please note that you may not be eligible for a licence.

Qualification: 	provide evidence of successful completion of the following units of competency from the Certificate III in Automotive Alternative Fuel Technology AUR32012 issued within five (5) years prior to making the application from a Registered Training Organisation:

•	AURTTL3001 - Service CNG Fuel Systems
•	AURTTL3002 - Diagnose and Repair CNG Fuel Systems
•	AURTTL3003 - Install CNG Fuel Systems

 Yes — please attach certified copies.

 No — please note that you may not be eligible for a licence.

Section D — Evidence of qualifications/eligibility — Restricted Automotive – LPG Forklifts
Complete this section only if you are applying for a restricted automotive – LPG forklifts licence.  

Qualification:	provide evidence of successful completion of a Certificate III in Forklift Technology issued within five (5) years prior to making the application from a Registered Training Organisation. 

 Yes — please attach a certified copy.

 No — please note that you may not be eligible for a licence.

Qualification:		provide evidence of successful completion of the following units of competency from the Certificate III in Automotive Alternative Fuel Technology AUR32012 issued within five (5) years prior to making the application from a Registered Training Organisation:

•	AURTTL3007 - Service LPG Fuel Systems
•	AURTTL3008 - Diagnose and Repair LPG Fuel Systems
•	AURTTL3009 - Install LPG Fuel Systems

 Yes — please attach certified copies.

 No — please note that you may not be eligible for a licence.

Section D — Evidence of qualifications/eligibility — Restricted Automotive – NGV Forklifts 
Complete this section only if you are applying for a restricted automotive – NGV forklifts licence.  

Qualification:	provide evidence of completion of a Certificate III in Forklift Technology issued within five (5) years prior to making the application from a Registered Training Organisation. 

 Yes — please attach a certified copy.

 No — please note that you may not be eligible for a licence.
Qualification:	provide evidence of completion of the following units of competency from the Certificate III in Automotive Alternative Fuel Technology AUR32012 issued within five (5) years prior to making the application from a Registered Training Organisation:

•	AURTTL3001 - Service CNG Fuel Systems
•	AURTTL3002 - Diagnose and Repair CNG Fuel Systems
•	AURTTL3003 - Install CNG Fuel Systems

 Yes — please attach certified copies.

 No — please note that you may not be eligible for a licence.

Section E — Evidence of Financial Resources (not applicable to journeyperson)
Evidence of financial resources is required to help demonstrate your ability to fulfil contractual obligations when providing construction services.  Failure to provide information below may result in your licence being refused. 

1.	Do you have access to financial resources adequate to complete works performed under the licence applied for?  

 Yes – please skip the next question.				

 No – complete next question.

2.	If ‘No’ to the above, do you wish to only operate as an employee under the licence applied for?

 Yes – I understand a condition may be imposed on the licence if issued.  

 No— if you do not wish to have a licence restricted to employee only, then you must ensure you have financial resources as requested above or you may be ineligible for a licence).

3.	Are you currently, or previously have been, deemed bankrupt or personally insolvent? 

 Yes – please attach details and official documentation of bankruptcy/insolvency.    		

 No.

4.	I understand that it is a requirement under law that should my licence be issued, I must notify the Construction Occupations Registrar should I become bankrupt or personally insolvent?  

 I have read and understand the above statement.

Section F — Licence History Declarations
1.	Have you previously held a gasfitter licence elsewhere in Australia or overseas? 

 Yes —provide details below of most recent licence/s (attach an additional page if required)   No

	State/Territory/Country ___________________________Expiry date:   ______/______/______  

2.	Is your licence as a  gasfitter, in Australia or overseas, currently suspended or cancelled?  

 Yes — you must attach details     							 No 

3.	Have you previously had a gasfitter licence cancelled, refused or suspended in Australia or overseas?      

 Yes — you must provide comprehensive details in an attachment to this application	 No

4.	I understand that I must notify the Construction Occupations Registrar if my gasfitter licence is cancelled, refused or suspended in Australia or overseas.  

 I have read and understand the above statement. 

5.	Has your gasfitter licence ever been subject to conditions, undertakings, limitations or restrictions in Australia or overseas?  

 Yes — you must provide comprehensive details in an attachment to this application	 No

6.	Are you disqualified under the Construction Occupations (Licensing) Act 2004, or a corresponding prior Act, from applying for licence, or being licensed, in a construction occupation? 

 Yes – you must provide comprehensive details in an attachment to this application	 No

7.	Have you ever been, or are you currently, the subject of complaints, occupational discipline, demerit activity or rectification orders whilst licensed under the Construction Occupations (Licensing) Act 2004, a corresponding prior Act, or the law of another jurisdiction in Australia or overseas, where those proceedings were not finalised?    

 Yes – you must provide comprehensive details in an attachment to this application	 No

8.	Have you been convicted or found guilty of a criminal offence* that involves fraud, dishonesty or violence and is punishable by imprisonment of 1 year or more? 

 Yes — you must provide comprehensive details in an attachment to this application 	 No
  and a recent criminal history check  (issued in the last three months)				
*Please note: Spent convictions under the Spent Convictions Act 2000 do not need to be included in this declaration

9.	I understand that it is a requirement under law that should my licence be issued I must notify the Construction Occupations Registrar if I am convicted of such an offence in the future.  

 I have read and understand the above statement.

10.	I understand that it is a requirement under law that should my licence be issued I must not perform any licensable gasfitting services that are outside the scope of what the licence authorises.  

 I have read and understand the above statement. 

11.	I understand that it is a requirement under law that should my licence be issued  I must give evidence to clients of the insurance I hold as a licensed individual in relation to any relevant licensable construction service I intend to undertake prior to providing the services. 

 I have read and understand the above statement.

12.	I understand that it is a requirement under law that should my licence be issued I must only advertise licensable construction services with my full name (as it appears on the licence) and my individual licence number.*  

 I have read and understand the above statement.

*Please note: It is an offence to advertise licensable construction services as an individual without including the above.

13.	I understand that it is a requirement under law that should I be granted a licence, all licensable gasfitting services I may perform under my gasfitter licence must comply with all relevant legislation, codes and standards. 

 I have read and understand the above statement.

Please note: Gasfitting work may be audited by the Construction Occupations Registrar in the ACT for compliance against the relevant laws. Individual licence holders identified performing non-compliant services may be subject to occupational discipline or other licensing action.

Section G — Consent and Application Declaration

I, ________________________________________________________________________________________,
 			Insert name, address and occupation of person making the declaration

make the following declaration:

1.	I declare:

a)	that I make this application to the Construction Occupations Registrar for a construction occupations licence and that all statements, and the documents/information provided in support of the application, are accurate, true and correct.

2.	 I authorise and consent:

a)	to the Construction Occupations Registrar and the Environment and Planning Directorate (EPD) to make enquiries of, and exchange information with, the relevant regulatory authorities of any Australian State or Territory, or other country, regarding my construction occupation licence and practice as an electrician or otherwise regarding matters relevant to this application.

b)	to receive information from the Construction Occupations Registrar relevant to my construction occupation licence or the construction industry electronically.

3.	I acknowledge:

a)	that the Construction Occupations Registrar and EPD may validate documents provided in support of this application or wish to confirm my identity.

b)	that failure to complete all relevant sections of this application and enclose all supporting documentation may result in this application not being accepted or additional fees being applied as per the statutory instrument authorising fees to be taken under the Construction Occupations (Licensing) Act 2004.

c)	that the Construction Occupations Registrar has the legal right to refuse my application if not satisfied that I am eligible to hold a licence or impose a condition on my  licence if it is deemed necessary or desirable to protect the public.

4.	Should I be issued with a construction occupations licence I undertake:

a)	to comply with the Construction Occupations (Licensing) Act 2004 (and it’s operational Acts) and the codes, standards and guidelines relevant to my construction occupation licence when providing, or offering to provide, a relevant construction service.

5.	 I believe that the statements (1 - 4) in this declaration are true and correct.

Signature of Applicant 							Date			

Section H — Payment Details
View the fees and charges booklet for licence applications for more information.

Upon lodgement of your application you will be required to pay an application assessment fee. This fee is non‑refundable. You will be provided with a notice of decision in relation to your application. If your application is approved a licence term fee will be payable prior to the issue of your licence. Please note that additional fees may apply if you submit an incomplete application without required supporting documents. 
Section I — Lodgement and Contact Information
Environment and Planning Directorate website www.planning.act.gov.au 

Customer Service Centre 
GPO Box 1908, Canberra City ACT 2601 
16 Challis Street, Dickson ACT 2602 
Business Hours: 8.30am to 4.30pm weekdays (excluding Public Holidays) 
Phone: (02) 6207 1923 

Email: epdcustomerservices@act.gov.au