6. Employment and Experience History
For General Building and Specialist Work ONLY.
You are not required to complete this section of the form if you are applying for Trade Work or Other building work.
Detail your practical experience. All General Building and Specialist Work applicants MUST include a complete employment history for the past 10 years
and up to current date, including where an individual has been previously licensed, self-employed or unemployed.
i. Please place an X in any of the following if you have ever:
Had other names or aliases that you have also been known as
If you have placed an X in the above, complete the “ ” .Additional Details Form 1
ii. Please place an X if you have ever had any of the following compliance matters arising from your activities related to carrying out of
residential building or specialist work by you as an individual or as a director of a company or as a member of a partnership:
Any complaints lodged
Any disciplinary action or proceedings including penalty notices, infringement notices, warnings or formal cautions.
Any disqualifications from holding a licence or applying for a new licence
Any previous licence/certificate suspension or cancellation
Any refusals of licence/certificate application
Any orders of a Tribunal or other Court Orders
Any paid or pending insurance claims against contracts entered into
If you have placed an X in any of the above, complete the “ ” . Additional Details Form 2
iii. Place an X if you have had:
Any criminal history within the last 10 years
This includes:
• Any recorded conviction for a criminal offence
• Being subject to a bond
• Any pending criminal charges
• Incarceration
• Being on parole or subject to any parole conditions
If you have placed an X in the above, complete the “ ” . Additional Details Form 3
iv. Please place an X if within the last 3 years you have been:
Declared bankrupt
Discharged from bankruptcy
Entered into arrangements with creditors or assigned your property to pay debts
If you have placed an X in any of the above, complete the “ ” . Additional Details Form 4
v. Please place an X if you:
Are or have been a director of a company that has experienced any insolvency issues
Ceased being a director of a company and within 12 months of the resignation, the company experienced any insolvency issues
Insolvency issues include:
• Being subject to a winding up order (including creditors' voluntary winding up and/or court ordered winding up)
• Having a controller appointed, or entered into other arrangements with creditors due to insolvency
• Placed in receivership or administration, or under official management
If you have placed an X in any of the above, complete the “ ” . Additional Details Form 5
vi. Please place an X if you are currently:
An involuntary, forensic or correctional patient within the meaning of the Mental Health Act 2007 (NSW)
A protected person within the meaning of the NSW Trustee and Guardian Act 2009 (NSW)
You should check online or call us on 13 32 30 to see if you need to provide fully completed Referee statements' from licensed supervisors for the
category you're applying for. If yes, they MUST also accompany this application.
Period of Employment
(DD/MM/YYYY)
Name and address of employer or contractor who engaged you
Type of work
PAGE 3
7. Declaration Questions
• You MUST read each of the questions below and mark an X against matters that you need to declare
• For any declared matters, you MUST provide full details on the relevant additional details forms(s) if applicable. If the required additional details
form(s) are not provided, your application will be considered incomplete and may be refused.
Have you read i. to vi. above and had nothing to declare? Then tick here to confirm that you do not need to provide any additional details
for assessment.
HB001
07-2020