Application for Construction Occupation Licence Individual
Works Assessor
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 works assessor licence to provide works assessment 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.

Privacy Notice 
The personal information on this form is provided to Access Canberra of the ACT Government to enable the processing of your application. If all or some of the personal information is not collected, Access Canberra 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 Access Canberra. The Information Privacy Policy Annex contains information in regard to what information Access Canberra 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 Access Canberra, and how you may complain about an alleged breach of the Territory Privacy Principles. The Information Privacy Policy can be found on the http://cmd.act.gov.au/legal/privacy_statement.  

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
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 works assessor is an entity who provides, has provided or proposes to provide a works assessment service. 

A works assessment service is the doing of works assessment work. Works assessment work means:
(a)	undertaking an exemption assessment under the Planning and Development Act 2007; or
(b)	providing, including doing anything incidental to providing, a unit title assessment report under the Unit Titles Act 2001.

What class of Works Assessor licence are you applying for?
 Class A – 	 undertaking an exemption assessment under the Planning and Development Act 2007.
 Class B –  	undertaking an exemption assessment under the Planning and Development Act 2007, in relation to the following: 
(a)	 site work under the Building Act 2004 for a class 1 building or class 10 building or structure;
(b)	 development in relation to a class 1 building or class 10 building or structure, mentioned in the Planning and Development Regulation 2008, schedule 1, other than the following:
(i)	division 1.3.6; 
(ii)	section 1.102 and section 1.103; 
(iii)	section 1.105 to section 1.112

 Unit Title – providing, including doing anything incidental to providing, a unit titles assessment report under the Unit Titles Act 2001. 
Section D — Evidence of qualifications/eligibility – Class A Works Assessor 
Complete this section only if you are applying for a class A works assessor.

Requirement:	Certification as a Certified Practicing Planner by the Planning Institute of Australia 

 	or

 	Registration with the Institution of Engineers Australia in the area of ‘principal certifier-building (ACT)

 	or

 	Accreditation as a building surveyor by the Australian Institute of Building Surveyors. 

 Yes — please attach a certified copy of the certification, registration or accreditation.

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

Section D — Evidence of qualifications/eligibility – Class B Works Assessor
Complete this section only if you are applying for a class B works assessor.

Requirement:	Membership with the Planning Institute of Australia; or

 	or

 	Accreditation as an assistant building surveyor by the Australian Institute of Building Surveyors. 

 Yes — please attach a certified copy of the membership certificate or accreditation.

 No — please note that you may not be eligible for a licence.
Section D — Evidence of qualifications/eligibility – Unit Title Works Assessor   
Complete this section only if you are applying for a unit title works assessor.

Requirement:	Registration with the National Engineering Registration Board in the engineering practice of either Civil or Structural; 

 	or

 	Registration as an Architect with an Architect Board in any Australian jurisdiction; 

 	or

 	Registration as a Land Surveyor in any Australian jurisdiction; 

 	or

 	Registration as a Registered Landscape Architect with the Australian Institute of Landscape Architects; 

 	or

 	Is eligible for a class A or B Works Assessor – planning and development.

 Yes — please attach a certified copy of the registration.

 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— 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 works assessor 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 works assessor, in Australia or overseas, currently suspended or cancelled?  

 Yes — you must attach details     							 No 

3.	Have you previously had a works assessor 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 works assessor licence is cancelled, refused or suspended in Australia or overseas.  

 I have read and understand the above statement. 

5.	Has your works assessor 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 works assessment 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 works assessment services I may perform under my works assessor 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 Access Canberra 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 a Works Assessor 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 Access Canberra 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 occupation 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 G — Payment Details
Upon lodgement of your application you will be required to pay an application assessment fee. This fee is $223.00 and 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. The licence term fee last for the duration of your insurance and the fee is $231.00.
Section H — Lodgement and Contact Information
Access Canberra Environment Planning and Land Shopfront
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