1. Purpose of Referee’s Statement
An Electrical Contractor Licence (Q) or Qualified Supervisor Certificate is granted to persons who have proven ability to do or supervise the doing of electrical wiring work.
All applications for a licence (except those based on equivalent interstate or New Zealand authorities or, where previous licence holders reapplying for the
same class of licence previously held) must be accompanied by supporting statements from the applicant’s employer or supervisor verifying the applicant’s
experience in electrical wiring work in accordance with AS/NZS 3000:2018, including:
details of the electrical wiring work* performed (a minimum of 12 months),
experience in low voltage work, and
the time spent and experience on electrical wiring work.
* Electrical wiring work is defined by the Gas and Electricity (Consumer Safety) Act 2017 as the actual physical work of installing, repairing,
altering, removing or adding to an electrical installation or the supervising of that work.
Please note that only the holders of an electrical licence or supervisor certificate can supervise electrical wiring work.
2. Responsibility of Person Providing Referee’s Statement
The person providing this statement must have:
held a Qualified Supervisor Certificate (QSC) or Contractor Licence (Q) in electrical wiring work during the period of time of the stated experience, and
supervised the applicant carrying out electrical wiring work.
Your attention is also drawn to the penalties outlined in the Declaration that may be imposed on any person found to be providing false or misleading
3. Referee’s Details (Supervisor)
Surname of Referee Given Names (full legal name)
Date of Birth
/ /
Address (Not PO Box)
Contact Telephone Number Mobile Number
Contractor Licence (Q)/QSC
Contractor Licence
Category of Work
Category of Work
Email address
Email address
4. Employer Details (Company, Partnership or Sole Trader)
Name of Employer
Address (Not PO Box)
Contact Telephone Number Mobile Number
13 32 20
Note: Fair Trading cannot accept this referee statement if the employer details are not completed
In accordance with section 12 of the Licensing and Registration (Uniform Procedures) Act 2002 this
referee statement document and any supporting attachments are part of the application form
submitted by the applicant making application for an authority under the Home Building Act 1989.
Driver Licence Number
State of Issue
Expiry Date
/ /
In providing the above information I also declare that:
I understand that the provision of false or misleading information by me may result in proceedings being brought against me under the
Crimes Act, 1900 that could lead to imprisonment of up to 2 years and/or fines of up to $22,000.
I understand that the provision of false or misleading information may result in Fair Trading assessing me as not being a fit and proper
person under the Home Building Act, 1989 that could result in the refusal of future applications to renew my authority.
I have read and understand the information provided in Section 1 “Purpose of Referee’s Statement” and Section 2 “Responsibility of
Person Making a Referee Statement”.
I authorise Fair Trading to make the necessary enquiries with any organisation or individual to verify the information I have
provided on this form and any organisation or individual to disclose relevant information to NSW Fair Trading for these purposes.
/ /
Signature of Licensee (Q)/Qualified Supervisor Date Signed
Note to Applicant:
To further assist in assessing your practical experience, you may be required to provide evidence of your employment as outlined in this
Referee Statement such as group certificates or pay dockets. You may also include other supporting documentation including your Profile Report,
Employer Statements or any other information you wish to be considered. Where this information is not provided, a written and signed statement
as to the reasons why the evidence of your employment is not available, may be requested.
5. Declaration
I, (name of Referee as shown on licence), the holder
of Qualified Supervisor Certificate / Contractor Licence (Q), Number
(full legal name of applicant) was supervised by me
between the following dates (DD/MM/YYYY): to during which time the applicant was employed
full-time / part time and the applicant held the position of
and I also declare that under my supervision, the applicant demonstrated competence in electrical wiring work and had (insert number
of months) hands on electrical wiring work experience in the following electrical wiring areas in accordance with AS/NZS 3000:2018:
PLEASE NOTE that applicants MUST have experience in ALL types of
low voltage electrical wiring work listed below.
Single dwellings
Multiple dwellings
(eg: flats, units,
townhouses etc)
(eg: factories, plants,
mills etc)
(eg: office buildings,
shopping centres etc)
(please tick one or more boxes in the columns below
for each type of LV electrical wiring)
• Installation of cable support and cable mechanical protection
• Design, installation and termination of low voltage power lighting
and control circuit wiring.
• Design, installation and termination of low voltage power lighting
and control circuit wiring.
• Installation of electrical apparatus and equipment.
• Fault finding, maintenance and repair of LV wiring systems and
electrical equipment.
Test and verify compliance of LV electrical wiring systems and
electrical equipment.
- Must include metallic conduit, non-metallic conduit, supporting cable
clips/ties, cable trays/trunking and underground systems.
- Must include consumer mains, sub-mains and final sub-circuits.
- Must include switchboards and circuit protection devices, heating,
cooling, lighting and power apparatus, electric motors and/or
transformers and controls.
- Must include LV power and control circuit wiring and electrical
apparatus and equipment.
- Must include mandatory testing of insulation resistance,
earth continuity/resistance, polarity and earth fault - loop impedance
as well as load and leakage current tests.
- Must include protective earth systems including MEN wiring systems.