The purpose of this form is for individuals to outline their building work experience in accordance with the Construction Occupations (Licensing) (Mandatory Qualifications Declaration Schedule (the Schedule).  To be issued with a builders licence a requirement under this Schedule, for Class A, B and C Builders, is “not less than 2 years full time building work experience where 1 year full time building work experience was undertaken post the date the qualification was issued”. For a Class D Builder the requirement is “3 years full time building work experience”. The Schedule outlines what the Construction Occupations Registrar deems to be acceptable building work experience for the purposes of obtaining a licence. To view the Schedule please go to www.legislation.act.gov.au. 

This form is only for applicants whose building work experience was undertaken in the ACT. If you are relying on building work experience on interstate projects, you must complete the Applicant Statement — Building Work Experience — Interstate Experience form.

Please complete one form per project. 

Applicant Details

Title 		 Surname 			Given Names					 

Project Details
Block	Section	Suburb	

Building Code of Australia Class	Number of storeys	Project Description	

Time you actively worked on the project undertaking building work. To be expressed in hours. 	
Date
	Building Technology Hours
	Non-Building Technology Hours	Total Hours
	
to				

Your role on the project:	
What were you engaged to do on this project i.e. carpentry, site supervision etc.

	

	

	

	

Please specify and detail the building work experience that you undertook on the project:	
Attach additional pages as required. 

	

	

	

	

	

	

	

	

	

	

	

	

Verifier Details
Please provide the details of the person who verified this experience. 

Surname 					Given Name 					
 
Company Name (if applicable) 									                   

Verifiers licence number 										 

Applicant Signature 				Date 		/		/		

Verifier Signature 				Date 		/		/