Application for Motor Vehicle Repairer's Certificate by Anarbor

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									                           Motor Vehicle Industry Board




                                                                         Licensing Advice Line
                                                                         Metro: (08) 9282 4338
                                                                         Country: 1300 30 40 54
                                                                         Fax:
                                                                         (08) 9282 4363

                                                                         (8.30 – 5.00 Weekdays)
                                                                         (except for Public Holidays)


        Application for                                                  Department of Commerce
                                                                         - Consumer Protection Division -




         Motor Vehicle                                                   Motor Vehicle Industry Board

                                                                         Motor Vehicles Branch


      Repairer’s Certificate                                             Unit 4 / 321 Selby Street (REAR)
                                                                         OSBORNE PARK


                                                                         Head Office:
                                                                         Forrest Centre
                                                                         219 St Georges Terrace
                                                                         PERTH

 Refer to the ‘Information Booklet’ which accompanies this application   Postal
                       when completing this form.                        Locked Bag 14
                                                                         CLOISTERS SQUARE
                                                                         PERTH WA 6850




                                                                         ----------------------------------------------

                                                                         CERTIFICATE
                                                                         APPLICATION FEE
                                                                         $70.00
                                                                         See also page 2


                                                                         ----------------------------------------------




                                                                         Web Site:
                                                                         www.commerce.wa.gov.au/motorvehicles




Note: this application form expires on 30 June 2010.
PAGE 2




                                  GENERAL INFORMATION

1.   WHO NEEDS TO APPLY FOR A CERTIFICATE

     You will require a repairer’s certificate if you:

     •   DO REPAIR WORK UNSUPERVISED; or
     •   are an owner of a repair business and you do repair work or supervise the repair work of others; or
     •   are an individual who supervises the repair work of others; or
     •   are an individual repairer and your supervisor does not have a certificate for the same class of
         repair work that you do.

     In addition, as a certificated repairer you can only supervise repair work for the particular class of
     repairs for which you are qualified. You may apply for certification for more than one class of repair
     work if you hold the appropriate qualifications and these will be endorsed on your certificate.


2.   FALSE OR MISLEADING INFORMATION

     It is important to note that all the information in the application must be accurate. Any false or
     misleading information would be a contravention of the Motor Vehicle Repairers Act 2003, the Oaths,
     Affidavits and Statutory Declarations Act 2005 and/or Criminal Code Act Compilation Act 1913.


3.   PAYMENT *

     An application fee of $70.00 is payable at the time of lodging an application for a Motor Vehicle
     Repairer’s Certificate.

     The application fee is not refundable once your certificate / identification card has been issued.

     Cheques should be made payable to Department of Commerce. If paying by credit card, please
     complete the credit card payment details on the last page of this application form.

     ( * Fees payable for applications made in the period 1 July 2009 to 30 June 2010 )


4.   POLICE CLEARANCES

     One of the responsibilities of the Motor Vehicle Industry Board is to ensure that each applicant is ‘a fit
     person’ to hold a Motor Vehicle Repairer’s Certificate.

     All applicants are required to submit an original National Police Certificate that is no more than three
     months old with this application.


5.   PROOF OF IDENTITY

     Documentary evidence of the identity of all applicants must be provided. This evidence can be a copy
     of the person’s current photographic driver’s licence or the photographic and identification page of a
     current passport.

     This documentary evidence must be certified as a true copy, by one of the people listed on page 9 who
     are authorised to witness a statutory declaration.
                                                                                                PAGE 3




                                        INFORMATION REQUIRED

1.   NAME OF THE PERSON APPLYING FOR THE CERTIFICATE
     Name of Person applying

     …………………………                            …………………………..…….                      ……………………………………..
     Title (Mr, Mrs, Miss, Ms, Other)      First Name                           Family Name

                                                             Yes or No
     Have you been known by any other name?
     (such as name at birth, alias, previous married name)

     If ‘Yes’, give details:

     …………………………                            ………………………………...                      ……………………………………..
     Title (Mr, Mrs, Miss, Ms, Other)      First Name                           Family Name

     Reason for name change
     (such as deedpoll, alias, marriage, other)   …………………………………………………….………………

     If you have been known by other names, attach a page giving names and reason for change.

     Date of Birth                                              …………………………..…………

     Place of Birth (town/city and country)                     ……………………………..………

     How many years have you lived in Australia?                ………………………………….....

     If you have not lived in Australia continuously for the last 3 years, please see page 5.


2.   CONTACT DETAILS
     Residential Address (must be a street address)

     ……………………………………………………………………………………………………………..
     ……………………………………………………………………………………………………………..
     Postal Address (if different to above)

     ……………………………………………………………………………………………………………..
     Telephone Number ……………...……..…....…. Mobile Number ……….…………….…….………

     Facsimile Number ……………….…………..…. Email address ……….……………………………


3.   CURRENT EMPLOYER
     Name of employer

     ……………………………………………………………………………………………………………..
     Address of employer

     ……………………………………………………………………………………………………………..
     Telephone number of employer ……………...……..…....….
PAGE 4




                                         INFORMATION REQUIRED

4.   ‘FITNESS’ OF PERSON TO HOLD A REPAIRER’S CERTIFICATE

     To be eligible to obtain a Motor Vehicle Repairer’s Certificate, the Motor Vehicle Industry Board must
     be satisfied that you are a ‘fit person to hold a repairer’s certificate’.

            •      You are required to provide an original National Police Certificate that is no more than
                   three (3) months old at the time of application.
            •      If you have not lived in Australia continuously for the last three (3) years you will require both
                   the equivalent clearance from the country you previously lived in and the above police
                   clearance.

                Application for the National Police Certificate can be made at participating Australia Post outlets in Western
                Australia on provision of identification and payment of the fee.


     Please answer ‘Yes’ or ‘No’ to the following questions:

      Have / are you:                                                                                             Yes or No
      (a)        ever been convicted of, or found guilty of ANY offences, including convictions
                 which resulted in a suspended sentence?
                 (Include all offences which went to Court, including traffic offences)
      (b)        presently under a probation order, good behaviour bond, on parole, released on
                 licence or subject to periodic detention?
      (c)        ever been placed on a Community Based Order, Community Service Order, an
                 Intensive Supervision Order or any other order made by a court or tribunal?
      (d)        aware of any proceedings pending against you for an offence, including
                 proceedings by way of appeal or review?
      (e)        had any application for an occupational licence refused?
      (f)        had an occupational licence cancelled, suspended or disqualified?
      (g)        been subject to disciplinary action by a licensing authority?
      (h)        had any investigations or proceedings pending or current, which may result in
                 action being taken in relation to any occupational licence currently held?
      (i)        been known by another name?


     If the answer to any of the above questions was ‘Yes’, please provide full details below or on a
     separate attached sheet of paper.

     …………………………………………………………………………………………………………..

     …………………………………………………………………………………………………………..

     …………………………………………………………………………………………………………..

     …………………………………………………………………………………………………………..
                                                                                                         PAGE 5




                                      INFORMATION REQUIRED

5.   CLASSES OF REPAIR WORK

     There are 29 classes of repair work for which a Repairer’s Certificate can be granted.
     Refer to pages 8 to 12 of the Information Booklet for the list of the classes of repair work and
     their associated codes.
     (Eg. Air conditioning work [code = ACW] )


     Write in the table below the name and code of each type of Class(es) of Repair Work for which
     you are applying.

     Read pages 8 to 12 of the Information Booklet CAREFULLY before completing the following table.



     NOTE:       If you are certified to carry out Heavy Vehicle Work or Light Vehicle Work, then you will also
                 be qualified to carry out, or supervise, additional classes of repair work. (See page 10 of the
                 Information Booklet).


      Name of Class of Repair Work                                                              Code




     Attach additional pages if required.
PAGE 6




                                  INFORMATION REQUIRED

6.   QUALIFICATIONS AND TRAINING
                                                                                                     Yes or No
     Do you have an automotive trade or other relevant automotive mechanical
     qualification or Trade Certificate?

     If yes, please provide the following details.

      Name of Qualification / Trade Certificate (completed apprenticeship):                       Year Granted:




     If you are the holder of a relevant Australian recognised qualification (Certificate II or Certificate III) or a
     Trade Certificate for the class of repair work that you are applying for, you automatically qualify
     for certification (100 points) for that class of repair work. Please attach a certified copy of your
     educational qualifications and/or Trade Certificate.


7.   WORK EXPERIENCE

     Please state your work experience as an employee in the table below.

      Employer:                                            Class (Type) of Repair Work           Years Employed:
                                                                                                   (eg. 2000- 2005)




                                                                                                     Yes or No
     Are you a proprietor of a repair business and you do repair work or
     supervise repair work?

     If yes, please provide the following details.

      Name of Business:                                    Class (Type) of Repair Work           Years as Owner
                                                                                                  and Operator:
                                                                                                   (eg. 2000- 2005)




     Please attach a statement of service or other documents confirming your repair work
     experience as an employee or employer.
                                                                                                                  PAGE 7




                                   INFORMATION REQUIRED

8.   MEMBERSHIP OF RELEVANT INDUSTRY ASSOCIATION

                                                                                                               Yes or No
     Are you a current associate member or member of the Institute of Automotive
     Mechanical Engineers (IAME)?

     If yes, please provide the following details.

      When did you obtain membership?                                  Membership Number:

                                                                                                               Yes or No
     Are you a current member of the Society of Automotive Engineers (SAE)?

     If yes, please provide details the following details.

      When did you obtain membership?                                  Membership Number:

     Membership must be current and have been held for at least 24 months to qualify for points.

     Please attach a photocopy of your membership certificate and current membership card.


9.   REFERENCES AND TESTIMONIALS

     Please attach any references or testimonials that are less than 10 years old and support your
     application.


10. PROVISION OF PHOTOGRAPHS

     The Repairer’s Certificate will be issued as a wallet-sized identification card.

     To obtain your repairer’s certificate you will need to attach to your application two (2) identical
     photographs of yourself.
     The photographs must be:
     • passport size (44mm length x 35mm width);
     • a full front view of your head and shoulders; and
     • less than one month old at the time of submitting the application for a repairer’s certificate.

     Please write your name on the reverse side of your photographs prior to the witness signing them.

     An authorised witness must complete the ‘witness section’ of the declaration on page 9 and must also
     sign the reverse side of the photographs.

     Please note that the quality of the photographs provided will have a direct impact on the quality of the
     image that will appear on your identification card. Please ensure that the photographs you provide are
     clear with the image focused. Video camera, e-mailed or photocopied images will not be accepted.

     The Board may refuse to issue a certificate to you if:
     • the Board is not satisfied that the photograph is a current image;
     • the photograph is unclear; or
     • the photograph would not serve its purpose if it were included as part of the certificate.

     Photographs will remain the property of the Motor Vehicle Industry Board and will not be returned to applicants.

     Please attach to your application 2 identical photographs of yourself.
PAGE 8




                                  INFORMATION REQUIRED

11. AUTHORISATION TO THE MOTOR VEHICLE INDUSTRY BOARD

    In order to assist the Motor Vehicle Industry Board with assessment of this application, I give
    authorisation to the Board, or person(s) they direct, to make such further enquiries as it deems
    necessary, to obtain:

    (a)     verification of my qualifications from the training organisation, within Australia or New Zealand,
            that has granted the qualification;
    (b)     copies of any court transcript or records for proceedings to which I, or an associated entity, have
            been a party;
    (c)     copies of any decision in proceedings before any Board to which I, or an associated entity, have
            been a party;
    (d)     copies of any other document or file relating to another occupational licence that I have held or for
            which I, or an associated entity, have applied; and/or
    (e)     any other document or file that may be necessary to assist the Board with assessment of this
            application.

    I further agree to provide any additional information requested by the Board and acknowledge that the
    Board can use any or all of the information or documentation it receives pursuant to this authority for
    the purpose of assessing my application.


    Full Name:      ………………………………………………………………………….

    Signature:      ………………………………………………………………………….

    Date:           ………………………………………………………………………….




                                         *********************
                                                                                                                                         PAGE 9



                                         STATUTORY DECLARATION

WESTERN AUSTRALIA - OATHS, AFFIDAVITS AND STATUTORY DECLARATIONS ACT 2005
                        STATUTORY DECLARATION

I,   ……………………………………………………………………………………………………………..….….… (Full name)

of   ……………………………………………………………………………..…………………………….….……… (Address)

Occupation        …………………………………………………………….……………………………………………….……

sincerely declare that the statements and information provided in my application for a Motor Vehicle Repairer’s
Certificate are correct to the best of my knowledge and belief, and the photographs supplied with my application are a
true image of myself.

This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material
particular.

This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005

at ………………………………………………………..…….….....… (place)

…………………………….…………..……………..………..…...…. (date)

in the presence of -
                                                                                                  By ……………………………………..……….
                                                                                                      (Signature of person making the declaration)
……………………………………………….…………….…….……
          (Signature of authorised witness)

……………………………………………….…………….…....……
(Print name of authorised witness and qualification as such a witness * )


*Important This Declaration must be made before any of the following persons:-

Academic (post-secondary institution), Accountant, Architect, Australian Consular Officer, Australian Diplomatic Officer, Bailiff, Bank Manager,
Chartered Secretary, Chemist, Chiropractor, Company Auditor or Liquidator, Court Officer (Judge, Magistrate, Registrar or Clerk), Defence Force
Officer (Commissioned, Warrant or NCO with 5 years continuous service), Dentist, Doctor, Engineer, Industrial Organisation Secretary, Insurance
Broker, Justice of the Peace, Lawyer, Local Government CEO or Deputy CEO, Local Government Councillor, Loss Adjuster, Marriage Celebrant,
Member of Parliament (State or Commonwealth), Minister of Religion, Nurse, Optometrist, Patent Attorney, Physiotherapist, Podiatrist, Police
Officer, Post Officer Manager, Psychologist, Public Notary, Public Servant (State or Commonwealth), Real Estate Agent, Settlement Agent, Sheriff
or Deputy Sheriff, Surveyor, Teacher, Tribunal Officer, Veterinary Surgeon
OR Any person before whom, under the Statutory Declarations Act 1959 of the Commonwealth, a Statutory Declaration may be made.
PAGE 10




               CHECK COMPLETION AND PAYMENT DETAILS

      Please check:
          •   all questions that are relevant to your entity are complete
          •   all supporting documents are attached
          •   any further information is attached
          •   the correct fee is included
          •   an original National Police Certificate, as required, is attached
          •   the Statutory Declaration has been signed before an authorised person under the Oaths, Affidavits and
              Statutory Declarations Act 2005


      MOTOR VEHICLE REPAIRERS ACT 2003

      Copies of the Motor Vehicle Repairers Act 2003 and Regulations are available from the:
           State Law Publisher
           10 William Street
           Perth WA 6000
           Telephone: (08) 9321 7688

      The Act can also be viewed on the State Law Publishers website at www.slp.wa.gov.au




                   CERTIFICATE FEE AND PAYMENT DETAILS

APPLICATION FEE

An application fee of $70.00 is payable at the time of lodging an application for a Motor Vehicle Repairer’s
Certificate with the Motor Vehicle Industry Board.

The application fee is not refundable once your certificate / identification card has been issued.




LODGING YOUR APPLICATION

Your application can only be processed if all the relevant information and supporting documentation is provided.


You may lodge, and pay the fee for, your application:
   By post addressed to:                     In person at:                                In person at:
   The Licensing Officer                     Department of Commerce                       Department of Commerce
   Motor Vehicle Industry Board              - Consumer Protection Division -             - Consumer Protection Division -
   Locked Bag 14                             Unit 4 / 321 Selby Street (rear)             Ground Floor
   Cloisters Square                          OSBORNE PARK                                 219 St Georges Terrace
   PERTH WA 6850                                                                          PERTH




 If paying by credit card, please complete the
 credit card payment details on the next page.
                                                                                                                              PAGE 11




----------------------------------------------------------------------------------------------------------------------
CREDIT CARD PAYMENT DETAILS

         Application for Motor Vehicle Repairer’s Certificate

         For Credit Card Payment – applicant to complete

          Card Type             Visa              Mastercard                      (Only Visa and Mastercard accepted)


          Card Number


          Card Holder                                                                                                   Please print



          Expiry Date                                            Amount          $


          Signature / Authorisation                                                               Date


____________________________________________________________________________________________________________

                                       Motor Vehicle Repairer’s Certificate Application Form – July 2009




          ( Cashier – MR – Individ 1, Individ 2, Individ 3 )
Department of Commerce
Consumer Protection Division

								
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