Referee'S Statement Page 2

Download a blank fillable Referee'S Statement in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Referee'S Statement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

5. Employer Details (Company, Partnership or Sole Trader)

Note: Fair Trading cannot accept this referee statement if the employer details are not completed.

Name of Employer

Address (Not PO Box)

Postcode

Contact Telephone Number

Mobile Number

(

)

Contractor Licence No.

Category of Work

Email address

6. Referee's Declaration

(name of Referee), the holder of Qualified Supervisor

Certificate / Contractor Licence Number

, DECLARE THAT:

The above named applicant was supervised by me. carrying out a wide range of building work for the time periods I have declared in the attached

'Applicant's On Site Building Experience' form. This work was whilst as an employee or as a sub-contractor, where they held an endorsed contractor licence

or held a qualified supervsior certificate and were the nominated supervisor for a contractor licence. The work was financially remunerated.

2. I certify that the applicant has demonstrated a level of knowledge and experience in a wide range of building work which would allow him/her to

competently perform the roles and responsibility of a licensed builder. This includes and is not limited to:

• Applying building codes and standards to the construction process in accordance with the Building Code of Australia.

• Dealing effectively with Sub-contractors, consumers and other parties

• Reading and interpreting plans and specifications

• Planning building or construction projects and work

• Organising site surveys and set-out procedures to building and construction projects.

• Applying structural principals to residential constructions

• Conducting on-site supervision of building and construction projects

• Applying legal requirements to building and construction projects

• Managing occupational health and safety in a building and construction workplace.

I understand further enquiries may be made of me in giving this referee statement and that any information obtained by Fair Trading may be made

available to the applicant.

I confirm that the attached 'Applicant's On Site Building Experience' form(s) covers ALL the building sites where I have supervised the applicant in

respect of a wide range of building construction work. I understand that Fair Trading may not accept any additional site work claimed by the applicant

that was under my supervision that is not included in the accompanying 'Applicant's On Site Building Experience' form(s).

A total of

‘Applicant's On Site Building Experience form(s) accompany this Referee Statement.

(insert number)

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 two 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 disciplinary action and/or the refusal of future applications not to renew my authority.

I have read and understood the information provided in Section 1 “Purpose of Referee’s Statement” and Section 2 “Responsibility of Person Making a

Referee Statement”.

8. 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 Fair Trading for these purposes.

Referee's Signature:

Date

7. Applicant's Declaration

have reviewed the referee statement and a total of

(name of Applicant)

(insert number)

'Applicant's On Site Building Experience' form(s) that accompany this Referee Statement. I am satisfied that these accurately reflect ALL of my experience and

employment history under the supervision of

(insert referee's name).

Applicant's Signature:

Date

HB030

PAGE 2

12-2015