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
,
DECLARE THAT:
(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:
TYPE OF LOW VOLTAGE (LV) ELECTRICAL
WIRING WORK SUPERVISED:
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)
Industrial
(eg: factories, plants,
mills etc)
Commercial
(eg: office buildings,
shopping centres etc)
WORK SITUATION
(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
methods.
• 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.
PAGE 2
HB031
12-2019
