Application for Construction Occupation Licence Individual 
Electrician
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 Electricians licence to provide electrical 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 by Access Canberra then Access Canberra cannot process your application. The personal information you provide may be disclosed to the other areas of ACT Government 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 http://www.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 Electrician licence
Have you previously or do you currently hold an ACT Electrician licence?

 Yes — licence number				 expiry date				

 No — proceed to Section C – Occupation class and functions.

Section C — Occupation class and functions
An electrician is an entity that provides, has provided or proposes to provide electrical wiring services. Electrical wiring services are the doing or supervising of electrical wiring work. 

What class of electrical licence are you applying for?

 Unrestricted 	— licence authorises electrical wiring work without supervision and can supervise electrical wiring work undertaken by others. 

 Electrotechnology Systems Permit 	— permit authorises wiring work under supervision and incidental electrical work. This class of licence is used for applicants who need to undertake further training in order to become fully qualified for an unrestricted licence. 
*Please note this permit is to be used while an individual undertakes further studies to obtain an Unrestricted Licence. This permit will only be renewed in limited circumstances. 

 Restricted - Electrotechnology Systems 
Assembly and Servicing Electrical Fitting 	— licence authorises incidental wiring work in relation to electrical fitting disconnection and reconnection work.

 Restricted - Electrotechnology Systems 
Mechanical Fitting	 — licence authorises incidental wiring work in relation to mechanical fitting disconnection and reconnection work.

 Restricted - Electrotechnology systems 
Plumbing and Gas fitting 		— a licence authorises incidental wiring work in relation to plumbing and gas fitting disconnection and reconnection work.

 Restricted - Electrotechnology Systems 
Refrigeration and Air Conditioning 	— licence authorises incidental wiring work in relation to refrigeration and air conditioning disconnection and reconnection work

 Restricted - Electrotechnology Systems 
Type B Gas Appliances 		— licence authorises incidental wiring work in relation to disconnection and reconnection of type B gas appliances. 

 Electrotechnology Systems Restricted Permit* 	— permit authorises incidental wiring work under the supervision of a licensee with the appropriate licence for the work (see licence categories above). The permit is then issued in one of the following categories. This permit may be issued in conjunction with a practical experience log book. 
*Please note this permit is to be used while an individual undertakes further studies to obtain a Restricted Licence. This permit will only be renewed in limited circumstances. 

Please indicate which category of Restricted Permit you are applying for:

 Electrotechnology systems assembly and servicing electrical fitting

 Electrotechnology systems mechanical fitting

 Electrotechnology systems plumbing and gas fitting

 Electrotechnology systems refrigeration and air conditioning

 Electrotechnology systems type B gas appliances

Section C — Evidence of qualifications/eligibility — Unrestricted Electrician 
Complete this section only if you are applying for an Unrestricted Electrician. 

Qualification:	provide evidence of successful completion of one of the following Certificate III qualifications in Electrotechnology Electrician issued within five (5) years prior to making the application:

                                                UEE30811
                                                UEE30807
                                                UEE30806
                                                UTE31199

                                                The acceptable qualification (referenced above) must contain one of the following units of competency that has not been obtained through Recognition of Prior Learning (RPL):

                                                UEENEEG105A
                                                UEENEEG005B
                                                UEENEEG005A 
                                                NUE 505A 
                                                NUE 505B 

 Yes — please attach certified copies.

 No — please note that you may not be eligible for a licence.
Section C — Evidence of qualifications/eligibility — Unrestricted Permit Electrotechnology Systems 
Complete this section only if you are applying for an Unrestricted Permit Electrotechnology Systems.  

Option One (Australian qualifications more than five years old):

Qualification:	provide evidence of successful completion of a Certificate III in Electrotechnology Electrician issued more than five (5) years prior to application; or a Trade Certificate for Electrical Mechanic/Fitter issued by an RTO.

 Yes — please attach a certified copy.

 No — please note that you may not be eligible for the permit.

Requirement:	provide evidence of enrolment with a registered training organisation to obtain a Certificate III in Electrotechnology Electrician acceptable for obtaining an Unrestricted Electrician’s Licence.

 Yes — please attach a copy of enrolment papers

 No — please note that you may not be eligible for the permit.

Requirement:	Applicants must have a supervisor who is adequately licensed as an unrestricted electrician to supervise the work performed under the permit.

 Yes — please provide the details of the licensed electrical supervisor below and a statement from your supervisor.

 No — please note that you may not be eligible for a licence.
Licensee Name					Licence Number	 				
Option Two (overseas qualifications):

Qualification:	provide evidence of successful completion of a qualification that has been assessed by an RTO as requiring additional units of competency to be completed for it to become equivalent to the qualification acceptable for obtaining an Unrestricted Electrician’s Licence.  Completion of these additional units of competency is referred to as “gap training”, and cannot exceed 18 months of part time study. 

 Yes — please attach a certified copy.

 No — please note that you may not be eligible for the permit.

Requirement:	provide a statement from an RTO confirming enrolment in gap training and listing the units of competency required to achieve a Certificate III in Electrotechnology Electrician.

 Yes — please attach a copy of enrolment papers

 No — please note that you may not be eligible for the permit.

Requirement:	Applicants must have a supervisor who is adequately licensed as an unrestricted electrician to supervise the work performed under the permit.

 Yes — please provide the details of the licensed electrical supervisor below and a statement from your supervisor.

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

Section C — Evidence of qualifications/eligibility — Restricted Licence:
                      Electrotechnology Assembly and Servicing Electrical Fitting 
Complete this section only if you are applying for a Restricted Electrical Licence for Electrotechnology Assembly and Servicing Electrical Fitting. 

Option One:

Qualification:	a Certificate III in Electrical Fitting UEE33011 issued within five (5) years prior to application.

 Yes — please attach a certified copy.

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

Option Two (all qualifications must be met):

Qualification: 	provide evidence of completion of one of the following qualifications:

                                                a qualification as per option one (above) that was issued  more than five (5) years prior to application; or
                                                a Certificate III in Electrotechnology Assembly and Servicing (UTE30104, UTE30199); or
                                                a trade certificate in electrical fitting.

 Yes — please attach certified copies of the qualification.

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

Qualification:              Provide evidence of completion of one of the following units of competency in disconnect/reconnect issued within five (5) years prior to application: 

                                                UEENEEP010A - Disconnect/reconnect appliances connected to low voltage installation wiring.
                                                UEENEEP012A - Disconnect/reconnect composite appliances connected to low voltage installation wiring.
                                                UEENEEP014A - Disconnect/reconnect water heaters connected to low voltage installation wiring.
                                                UEENEEP015A - Disconnect/reconnect motors connected to low voltage installation wiring.
                                                UEENEEP001A - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.
                                               UEENEEP001B - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.

 Yes — please attach certified copies of the transcript showing completion of unit of competency.

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

Qualification:              Provide evidence of completion of one of the following units of competency in locate/rectify faults within five (5) years prior to application:

 	UEENEEP016A - Locate and Rectify Faults in Low Voltage Appliances; 
 	UEENEEP017A - Locate and rectify faults in low voltage composite appliances using set procedures; 
 	UEENEEP018A - Locate and rectify faults in low voltage control devices using set procedures; 
 	UEENEEP019A - Locate and rectify faults in low voltage water heaters using set procedures; 
 	UEENEEP020A - Locate and rectify faults in low voltage motors using set procedures; 
 	UEENEEP007B - Locate and rectify faults in electrical low voltage equipment following prescribed procedures; or,
 	UEENEEP007A - Locate and rectify faults in electrical low voltage equipment following prescribed procedures.

 Yes — please attach certified copies of the transcript showing completion of unit of competency.

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

Requirement: 	please provide a statement from your employer, or from yourself if self-employed, stating the principal trade to which the incidental electrical work applies, and the need for the restricted electrical licence in that trade.  

 Yes — please attach the letter.

 No — please note that you may not be eligible for the licence.
Section C — Evidence of qualifications/eligibility — Restricted Licence:
                      Electrotechnology Systems Mechanical Fitting 
Complete this section only if you are applying for a Restricted Electrical Licence for Electrotechnology Systems Mechanical Fitting. 

Qualifications: 	have successfully completed one of the following qualifications:

 	a trade certificate in the mechanical (services) trades; or
 	a Certificate III in Data and Voice Communications, (UEE30411, UEE30407, UEE30406, UEE30699); or
  	a Certificate III in Electronics and Communications, (UEE30911, UEE30910, UEE30906, UEE30907); or,
  	an equivalent trade certificate.

 Yes — please attach certified copies of the qualification and unit of competency.

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

Qualification:                	Provide evidence of successful completion of one of the following units of competency in disconnect/reconnect issued within five (5) years prior to application: 

                                                UEENEEP010A - Disconnect/reconnect appliances connected to low voltage installation wiring.
                                                UEENEEP012A - Disconnect/reconnect composite appliances connected to low voltage installation wiring.
                                                UEENEEP014A - Disconnect/reconnect water heaters connected to low voltage installation wiring.
                                                UEENEEP015A - Disconnect/reconnect motors connected to low voltage installation wiring.
                                                UEENEEP001A - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply. 
                                                UEENEEP001B - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.
	
 Yes — please attach certified copies of the qualification and unit of competency.

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

Qualification:              Provide evidence of completion of one of the following units of competency in locate/rectify faults within five (5) years prior to application:

 	UEENEEP016A - Locate and Rectify Faults in Low Voltage Appliances; 
 	UEENEEP017A - Locate and rectify faults in low voltage composite appliances using set procedures; 
 	UEENEEP018A - Locate and rectify faults in low voltage control devices using set procedures; 
 	UEENEEP019A - Locate and rectify faults in low voltage water heaters using set procedures; 
 	UEENEEP020A - Locate and rectify faults in low voltage motors using set procedures; 
 	UEENEEP007B - Locate and rectify faults in electrical low voltage equipment following prescribed procedures; or,
 	UEENEEP007A - Locate and rectify faults in electrical low voltage equipment following prescribed procedures.

 Yes — please attach certified copies of the transcript showing completion of unit of competency.

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

Requirement: 	please provide a statement from your employer, or from yourself if self-employed, stating the principal trade to which the incidental electrical work applies, and the need for the restricted electrical licence in that trade.  

 Yes — please attach the letter.

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

Section C — Evidence of qualifications/eligibility — Restricted Licence:
                      Electrotechnology Systems Plumbing and Gasfitting 
Complete this section only if you are applying for a Restricted Electrical Licence for Electrotechnology Systems Plumbing and Gasfitting. 

Requirement: 	hold an ACT (COLA) licence in the occupation of plumber or gasfitter (excluding journeyperson) 

 Yes — please provide your plumber and gasfitter licence details below.

 No — please note that you may not be eligible for a licence.
Licensee Number					Licence Expiry 				

Qualification:	provide evidence of successful completion of one of the following units of competency in disconnect/reconnect issued within five (5) years prior to making the application:

                                                UEENEEP010A - Disconnect/reconnect appliances connected to low voltage installation wiring.
                                                UEENEEP012A - Disconnect/reconnect composite appliances connected to low voltage installation wiring.
                                                UEENEEP014A - Disconnect/reconnect water heaters connected to low voltage installation wiring.
                                                UEENEEP015A - Disconnect/reconnect motors connected to low voltage installation wiring.
                                                UEENEEP001A - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.
                                                UEENEEP001B - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.

 Yes — please attach a certified copy of the unit of competency.

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

Qualification:              Provide evidence of completion of one of the following units of competency in locate/rectify faults within five (5) years prior to application:

 	UEENEEP016A - Locate and Rectify Faults in Low Voltage Appliances; 
 	UEENEEP017A - Locate and rectify faults in low voltage composite appliances using set procedures; 
 	UEENEEP018A - Locate and rectify faults in low voltage control devices using set procedures; 
 	UEENEEP019A - Locate and rectify faults in low voltage water heaters using set procedures; 
 	UEENEEP020A - Locate and rectify faults in low voltage motors using set procedures; 
 	UEENEEP007B - Locate and rectify faults in electrical low voltage equipment following prescribed procedures; or,
 	UEENEEP007A - Locate and rectify faults in electrical low voltage equipment following prescribed procedures.

 Yes — please attach certified copies of the transcript showing completion of unit of competency.

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

Requirement: 	please provide a statement from your employer, or from yourself if self-employed, stating the principal trade to which the incidental electrical work applies, and the need for the restricted electrical licence in that trade.  

 Yes — please attach the letter.

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

Section C — Evidence of qualifications/eligibility — Restricted Licence:
                      Electrotechnology Systems Refrigeration and Air Conditioning
Complete this section only if you are applying for a Restricted Electrical Licence for Electrotechnology Systems Refrigeration and Air Conditioning.  

Option One:

Qualification:	provide evidence of successful completion of a Certificate III in refrigeration and air conditioning UEE32211, UEE31307 or UEE31306 issued within five (5) years prior to application.

 Yes — please attach a certified copy.

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

Option Two (all qualifications must be met):

Qualification:	provide evidence of successful completion of Certificate III in Air-conditioning and Refrigeration UTE30999;

                                                OR

                                                provide evidence of successful completion of a trade qualification in refrigeration and/or air conditioning issued more than five (5) years prior to application;

 Yes — please attach a certified copy of the qualification and unit of competency.

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

Qualification:	provide evidence of successful completion of one of the following units of competency in disconnect/reconnect issued within five (5) years prior to making the application:

                                                UEENEEP010A - Disconnect/reconnect appliances connected to low voltage installation wiring.
                                                UEENEEP012A - Disconnect/reconnect composite appliances connected to low voltage installation wiring.
                                                UEENEEP014A - Disconnect/reconnect water heaters connected to low voltage installation wiring.
                                                UEENEEP015A - Disconnect/reconnect motors connected to low voltage installation wiring.
                                                UEENEEP001A - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.
                                                UEENEEP001B - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.

 Yes — please attach a certified copy of the unit of competency.

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

Qualification:              Provide evidence of completion of one of the following units of competency in locate/rectify faults within five (5) years prior to application:

 	UEENEEP016A - Locate and Rectify Faults in Low Voltage Appliances; 
 	UEENEEP017A - Locate and rectify faults in low voltage composite appliances using set procedures; 
 	UEENEEP018A - Locate and rectify faults in low voltage control devices using set procedures; 
 	UEENEEP019A - Locate and rectify faults in low voltage water heaters using set procedures; 
 	UEENEEP020A - Locate and rectify faults in low voltage motors using set procedures; 
 	UEENEEP007B - Locate and rectify faults in electrical low voltage equipment following prescribed procedures; or,
 	UEENEEP007A - Locate and rectify faults in electrical low voltage equipment following prescribed procedures.

 Yes — please attach certified copies of the transcript showing completion of unit of competency.

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

Requirement: 	please provide a statement from your employer, or from yourself if self-employed, stating the principal trade to which the incidental electrical work applies, and the need for the restricted electrical licence in that trade.  

 Yes — please attach the letter.

 No — please note that you may not be eligible for the licence.
Section C — Evidence of qualifications/eligibility — Restricted Licence:
                      Electrotechnology Systems Type B Gas Appliances
Complete this section only if you are applying for a Restricted Electrical Licence for Electrotechnology Systems Type B Gas Appliances. 

Requirement:	hold a construction occupation licence as an Unrestricted Type B or Restricted Type B – Level 1 Gas Appliance Worker. 

 Yes – please provide details:

 No — please note that you may not be eligible for the licence.
Licence Number					 

Qualification: 	provide evidence of successful completion of the unit of competency UEENEEP016A Locate and Rectify Faults in Low Voltage Appliances.

 Yes — please attach a certified copy of the qualification.

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

Qualification: 	provide evidence of successful completion of one of the following units of competency in disconnect/reconnect issued within five (5) years prior to application: 

                                                UEENEEP010A - Disconnect/reconnect appliances connected to low voltage installation wiring.
                                                UEENEEP012A - Disconnect/reconnect composite appliances connected to low voltage installation wiring.
                                                UEENEEP014A - Disconnect/reconnect water heaters connected to low voltage installation wiring.
                                                UEENEEP015A - Disconnect/reconnect motors connected to low voltage installation wiring.
                                                UEENEEP001A - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.
                                                UEENEEP001B - Disconnect/reconnect fixed wired electrical equipment connected to a Low Voltage supply.

 Yes — please attach a certified copy of the qualification and unit of competency.

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

Requirement: 	please provide a statement from your employer, or from yourself if self-employed, stating the principal trade to which the incidental electrical work applies, and the need for the restricted electrical licence in that trade.  

 Yes — please attach the letter.

 No — please note that you may not be eligible for the licence.
 Section C — Evidence of qualifications/eligibility — Restricted Permit Electrotechnology Systems 
Complete this section only if you are applying for a Restricted Permit Electrotechnology Systems.  

Qualification:	provide evidence of current enrolment in one of the following units of competency:

 	UEENEEP010A - Disconnect/reconnect appliances connected to low voltage installation wiring;
 	UEENEEP012A - Disconnect/reconnect composite appliances connected to low voltage installation wiring;
 	UEENEEP014A - Disconnect/reconnect water heaters connected to low voltage installation wiring;
 	UEENEEP015A - Disconnect/reconnect motors connected to low voltage installation wiring.

 Yes — please attach a copy of enrolment papers. 

 No — please note that you may not be eligible for the permit.

Qualification:               	Provide evidence of current enrolment of one of the following units of competency in locate/rectify faults within five (5) years prior to application:

 	UEENEEP016A - Locate and Rectify Faults in Low Voltage Appliances; 
 	UEENEEP017A - Locate and rectify faults in low voltage composite appliances using set procedures; 
 	UEENEEP018A - Locate and rectify faults in low voltage control devices using set procedures; 
 	UEENEEP019A - Locate and rectify faults in low voltage water heaters using set procedures; 
 	UEENEEP020A - Locate and rectify faults in low voltage motors using set procedures; 
 	UEENEEP007B - Locate and rectify faults in electrical low voltage equipment following prescribed procedures; or,
 	UEENEEP007A - Locate and rectify faults in electrical low voltage equipment following prescribed procedures.

 Yes — please attach a copy of enrolment papers. 

 No — please note that you may not be eligible for the permit.

For the type of restricted permit being applied for, do you have the following qualification (evidence must be attached to the application)?

Qualification for Assembly and Servicing Electrical Fitting	
 	
 	Certificate III in Electrical Fitting UEE33011 issued more than five (5) years prior to application;
	
	OR
	
	Certificate III in Electrotechnology Assembly and Servicing  (UTE30104 or UTE30199);

	OR

	Trade certificate in electrical fitting.

Qualification for Mechanical Fitting:  	

 	Trade certificate in the mechanical (services) trades;

 	OR

 	Certificate III in Data and Voice Communications (UEE30411, UEE30407, UEE30406 or UEE30699). 

Requirement for Plumbing and Gas Fitting:  	
 	
 	Current ACT licence (COLA) in the occupation of Plumber or Gasfitter excluding Journeyperson.

Qualification for Refrigeration and Air Conditioning: 	
 	
 	Trade qualification in refrigeration and air conditioning other than UEE32211, UEE31307 or UEE31306 issued over five (5) years prior to application.  

Requirement for Type B Gas Appliances:   	
 	
 	Current Accreditation for Type B Gas Appliances under the Gas Safety (Appliance Worker Accreditation Code). 

 Yes — please attach a certified copy of qualification certificate or a photocopy of licence. 

 No — please note that you may not be eligible for the permit.

Requirement: 	please provide a statement from your employer, or from yourself if self-employed, stating the principal trade to which the incidental electrical work applies, and the need for the restricted electrical permit in that trade.  This letter must include the name and licence number of the person who will be supervising your work.  Please also provide their details below.

 Yes — please attach the letter.

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

Company					
Section D — Evidence 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. 

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

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

 Yes – please attach details and official documentation of bankruptcy/insolvency     		  No

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 E — Licence History Declarations

1.	Have you previously held an electricians 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 electrician, in Australia or overseas, currently suspended or cancelled?  

 Yes — you must attach details     							 No 

3.	Have you previously had an electrician 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 should notify the Construction Occupations Registrar if my electrician licence is cancelled, refused or suspended in Australia or overseas. 

 I have read and understand the above statement. 

5.	Has your electrician 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 electrical 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 electrical work I may perform under my electrician licence must comply with all relevant legislation, codes and standards.

 I have read and understand the above statement.

Please note: Electrical 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 F — 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 Environment and Planning Directorate 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 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 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 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 for one year is $231.00 or for three years the licence term fee is $520.00.
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