Application for Construction Occupation Licence Individual
Plumber/Drainer/Gasfitter   – Journeyperson
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 Plumber, Drainer or Gasfitter licence to provide plumbing, draining and gasfitter services in the ACT under supervision.  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.  

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 AF2016‐50 approved by Ben Green, Deputy Construction Occupations Registrar on 27 June 2016 under
section 128 of the Construction Occupations (Licensing) Act 2004 and revokes AF2016-14.	
Section B — Existing Plumber Licence
Have you previously held or do you currently hold an ACT Plumber licence?

 Yes – licence number				Expiry date					 

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

If the licence expired within the last five years, do you wish to apply for the same licence again?

 Yes – proceed to Section F – Evidence of Financial Resources. 

 No – proceed to Section C — Occupation class and functions.
Section C — Occupation class and functions
What class of plumbing licence are you applying for?

 Journeyperson Plumber  	— licence authorises sanitary plumbing work under the supervision      of a licensee with sanitary plumbing licence. 

Journeyperson Fire Sprinkler Fitter	— licence authorises fire sprinkler work and work on a fire hydrant or fire hose connection point, under the supervision of a licensee with fire sprinkler fitter licence.

 Journeyperson Drainer                           —	licence authorises sanitary drainage work under supervision of licensee with an Advanced Sanitary Drainers licence

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

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

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:

 	BCP30103
 	CPC32408
 	CPC32411
 	CPC32412
 	CPC32413

  	and the Water Stream, Sanitary 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 — Journeyperson Fire Sprinkler Fitter
Complete this section only if you are applying for a Journeyperson Fire Sprinkler Fitter licence.   

Qualification:	provide evidence of successful completion of, or completion of an apprenticeship that includes, a Certificate III in Fire Protection CPC32813 issued within five (5) years prior to making the application.

 Yes — please attach a certified copy.

 No — please note that you may not be eligible for a licence.
Section D — Evidence of qualifications/eligibility — Journeyperson Drainer
Complete this section only if you are applying for a Journeyperson Drainer 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:

 	CPC32408
 	CPC32411
 	CPC32412
 	CPC32413

  	and the Drainage Stream was 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 — 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 by a Registered Training Organisation issued within five (5) years:

 	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 E — Licence History Declarations
1.	Have you previously held a Plumber, Drainer or 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 Plumber, Drainer or Gasfitter, in Australia or overseas, currently suspended or cancelled?  

 Yes — you must attach details     							 No 

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

 I have read and understand the above statement. 

5.	Has your Plumber, Drainer or 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 plumbing service 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 not perform any licensable draining service that is outside the scope of what the licence authorises.  

 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 not perform any licensable gasfitting service that is outside the scope of what the licence authorises.  

 I have read and understand the above statement. 

13.	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.

14.	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.

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

 I have read and understand the above statement.

Please note: Plumbing, Draining and 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 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 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 plumber 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 I — Payment Details
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.  
View the Access Canberra Website for licence application fee and charges.
Section J — 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 8096
Email: cwpl@act.gov.au