Application for Construction Occupation 
Licence Individual
Asbestos Removalist
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 an asbestos removalist licence to provide asbestos removal 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 Asbestos Removalists 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 AF2014‐156 approved by David Middlemiss, Construction Occupations Registrar on 7 November 2014 under
section 128 of the Construction Occupations (Licensing) Act 2004 and revokes AF2014-112.
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
An asbestos removalist, at the class A level, is an individual who provides an asbestos removal service.  An asbestos removal service is the doing or supervising of building work that involves all or any of the following:

•	handling (including disturbing) asbestos in buildings; and
•	removing and disposing of asbestos from buildings.

An asbestos removalist, at the class B level, is an individual who provides an asbestos removal service in relation to bonded asbestos only.  An asbestos removal service is the doing or supervising of building work that involves all or any of the following:

•	handling (including disturbing) bonded asbestos in buildings; and
•	removing and disposing of bonded asbestos from buildings.

What class of asbestos removalist licence are you applying for?
 Class A – licence authorises provision of an asbestos removal service.

 Class B – licence authorises provision of an asbestos removal service for bonded asbestos only. 
Section D — Evidence of qualifications/eligibility — Class A Asbestos Removalist 
Complete this section only if you are applying for a class A asbestos removalist

Qualification:	 successful completion of the Course in Asbestos Removal with the national 		accreditation number 80804ACT from a Registered Training Organisation; or

Qualification:	successful completion of both units of competency Remove Friable Asbestos with the unit number CPCCDE3015A and Supervise Asbestos Removal with the unit number CPCCBE4051A from a Registered Training Organisation.

 Yes — please attach a certified copy of the qualification.

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

Experience

Relevant experience means that you must demonstrate that you have undertaken a minimum of four years part time, or two years full time, relevant work experience from within the last five years in performing the range of work that a class A asbestos removalist licensee is authorised to do under the supervision of a licensed class A asbestos removalist.

 Yes — you must attach a signed resume and/or logbook detailing relevant asbestos removalist work experience for specific projects where you were performing the work.  You must include dates, site details and the type of asbestos removal work undertaken.  You must provide sufficient detail of your individual involvement in the asbestos removal work against each project.

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

Verification

Your experience must be verified through a written reference. 

 Yes — references must be from a Class A Asbestos Removalist that you have worked with on site.  Your   referees must attest to your skills, knowledge, experience and competence as an asbestos removalist relevant to the class of licence you are applying for.

 No —  please note that you may not be eligible for a licence. 
Section D — Evidence of qualifications/eligibility — Class B Asbestos Removalist
Complete this section only if you are applying for a class B asbestos removalist

Qualification:	 successful completion of the Course in Asbestos Removal with the national 	accreditation number 80804ACT; 

 OR

Qualification:	successful completion of both units of competency Remove Non-Friable Asbestos with the unit number CPCCDE3014A and Supervise Asbestos Removal with the unit number CPCCBC4051A.

 Yes — please attach a certified copy of the qualification.

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

Experience

Relevant experience means that you must demonstrate that you have undertaken a minimum of four years part time, or two years full time, relevant work experience from within the last five years in performing the range of work that a class B asbestos removalist licensee is authorised to do under the supervision of a licensed class B or class A asbestos removalist.

 Yes –   you must attach a signed resume and/or logbook detailing relevant asbestos removalist work experience for specific projects where you were performing the work. You must include dates, site details and the type of asbestos removal work undertaken. You must provide sufficient detail of your individual involvement in the asbestos removal work against each project.

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

Verification

Your experience must be verified through a written reference. 

 Yes — references must be from class A or B asbestos removalists that you have worked with on site.  Your referees must attest to your skills, knowledge, experience and competence as an asbestos removalist relevant to the class of licence you are applying for.

 No —  please note that you may not be eligible for a licence.
Section E — Evidence of Financial Resources
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 - please note that 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 an asbestos removalist 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 an asbestos removalist, in Australia or overseas, currently suspended or cancelled?  

 Yes — you must attach details     							 No 

3.	Have you previously had an asbestos removalist 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 asbestos removalist licence is cancelled, refused or suspended in Australia or overseas.  

 I have read and understand the above statement. 

5.	Has your asbestos removalist 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 asbestos removalist work that is 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 asbestos removalist services I may perform under my asbestos removalist licence must comply with all relevant legislation, codes and standards. 

 I have read and understand the above statement.

Please note: Asbestos removal services 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 information/documents provided in support of the application, is/are accurate, true and correct.

2.	 I authorise and consent:

a)	to the Construction Occupations Registrar and 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 asbestos removalist or otherwise regarding matters relevant to this application.

b)	to receiving 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 my construction occupation licence be issued 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 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