AUTOMOTIVE SERVICE TECHNICIAN 1
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
STATUTORY DECLARATION
OF WORK EXPERIENCE
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
customerservice@itabc.ca
To qualify to challenge certification in this trade or be granted authority to supervise and sign-off on apprentices in this trade, individuals
must have:


worked a minimum of 2,250 hours performing the tasks listed in Section E, and
experience performing at least 70% of the job tasks listed in Section E
Holders of a Certificate of Qualification (C of Q) in Heavy Duty Equipment Technician (Heavy Duty Equipment Mechanic) or
Truck and Transport Mechanic (Commercial Transport Vehicle Mechanic) will be eligible to challenge this certification or
receive Supervision and Sign-off Authority with a credit of 1500 work-based hours of directly related work experience.
A Statutory Declaration of Work Experience is used to declare work experience for periods during which you were self-employed or a
previous employer is unavailable to complete an Employer Declaration. Please note that unless your work experience hours were
gained through self-employment, Certification Challenge and Supervision and Sign-Off Authority applications will not be accepted if
they are only accompanied by a Statutory Declaration. Non-self-employed applicants must provide an Employer Declaration from at
least one employer who can verify work experience. For more information, see Instructions for Certification Challenge or
Supervision and Sign-off Authority.
The information provided on this form is used to assess and to validate your work experience in this trade. This form must be
completed in front of, and signed by, a Commissioner of Oaths, Notary Public, or Lawyer. It can be also be notarized at any Service BC
office, or at ITA Customer Service.
A.
Applicant Name
Legal First Name:
B.
Legal Middle Name(s):
Legal Last Name:
Supervisor or Self-Employment Contact Information
Enter the contact information for the Supervisor at your previous employer who is unavailable to complete an Employer Declaration, or
for your own business if you are self-employed.
Name of Organization/Employer/Business:
Suite Number:
Supervisor’s Position/Title:
Street Number and Name:
City:
Province:
Telephone Number:
(
Supervisor Name:
Postal Code:
Email Address:
Business Registration Number:
(Self-Employment only)
)
Page 1 of 6
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician 1 - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN 1
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
STATUTORY DECLARATION
OF WORK EXPERIENCE
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
customerservice@itabc.ca
C.
Employment or Self-Employment Information of Applicant
Enter the dates and number of hours for this period of employment or self-employment. Combine multiple periods of self-employment
on one form, but separate periods of employment with different employers on separate forms.
Dates of Employment (MM/DD/YYYY):
From:
Total Number Hours of Automotive Service Technician 1 Experience
Accumulated in that Period:
To:
Job Title of Applicant:
D.
Reason for Statutory Declaration
Indicate why a Statutory Declaration is required for this period of employment:
Applicant was self-employed
Employer will not complete Employer Declaration
Employer is no longer in business
Employment records are not available
Applicants must attempt to contact current or previous employers to request an Employer Declaration. If you have been unable to
obtain an Employer Declaration for any portion of your non-self-employed work experience, indicate the steps you have taken to try to
obtain it. If sufficient evidence of steps taken is not provided, the application may not be approved.
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 2 of 6
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician 1 - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN 1
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
STATUTORY DECLARATION
OF WORK EXPERIENCE
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
customerservice@itabc.ca
E.
Statutory Declaration of Job Task Performance
By checking “Yes” or “No” in the Declaration Response column, indicate whether or not you have performed the job tasks listed below. Cross out any
job tasks you did not perform during the period indicated in Section C.
Job Tasks
Declaration
Response
Workplace Safety
Is this candidate able to perform his/her duties in a safe and conscientious manner?
Yes:
No:
Yes:
Does this candidate hold a WHMIS ticket obtained by your shop?
No:
Employability Skills
Does this candidate demonstrate knowledge of the shop management structure?
Yes:
No:
Does this candidate demonstrate the ability to interpret work orders, perform repairs and provide descriptions of repairs?
Tools and Equipment
Is the candidate able to use, maintain, and store hand tools and measuring instruments in a competent manner?
Is the candidate able to use, maintain, and store power tools and fasteners in a competent manner?
Is the candidate able to use, navigate, troubleshoot, and perform repairs on a vehicle using reference materials in an
appropriate manner?
General Automotive Maintenance
Is the candidate competent in selecting lubricants and fluids?
Yes:
No:
Yes:
No:
Yes:
No:
Yes:
No:
Yes:
No:
Is the candidate competent in identifying replacement items such as: belts, hoses, exterior lamps, body trim and hardware?
Yes:
No:
Yes:
Is the candidate competent in servicing tires and wheels?
No:
Yes:
Is the candidate competent in servicing non-friction bearings, spindles and hubs?
No:
General Automotive Practices
Is the candidate capable of performing basic diagnostic procedures such as: confirming complaint searching probable causes
and providing a repair plan?
Is the candidate competent in demonstrating welding safety such as: start-up and shut-down of Oxy/Acetylene torches and MIG
welder procedures?
Basic Electrical Systems
Is the candidate competent in describing principles of electricity such as Ohms Law and circuitry?
Yes:
No:
Yes:
No:
Yes:
No:
Yes:
Is the candidate competent in using electrical test equipment?
No:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 3 of 6
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician 1 - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN 1
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
STATUTORY DECLARATION
OF WORK EXPERIENCE
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
customerservice@itabc.ca
Declaration
Response
Job Tasks
Yes:
Is the candidate competent in servicing 12 volt wiring systems and batteries?
No:
Is the candidate competent in using scan tools for decoding, recording and erasing diagnostic trouble codes?
Brake Systems
Is the candidate competent in servicing brake tubing, fittings and brake hydraulic systems?
No:
Yes:
No:
Is the candidate competent in servicing drum and disc brake systems and inspecting power assist systems?
Yes:
No:
Yes:
Is the candidate competent in servicing anti-lock brake systems?
No:
Steering Systems
Is the candidate competent in servicing steering gears such as: adjusting steering boxes and racks?
Yes:
No:
Yes:
Is the candidate competent in servicing passenger restraint systems?
No:
Yes:
Is the candidate competent in inspecting steering columns?
No:
Yes:
Is the candidate competent in servicing steering linkage and performing wheel alignments?
No:
Yes:
Is the candidate competent in servicing power steering systems?
No:
Suspension Systems
Is the candidate competent in identifying frame types?
Yes:
No:
Yes:
Is the candidate competent in identifying suspension components and geometry?
No:
Yes:
Is the candidate competent in servicing suspension systems?
No:
Yes:
Is the candidate competent in identifying electronic suspension systems?
F.
Yes:
No:
Confirmation of Prerequisite Credentials or Certificates
For some trades, evidence that the applicant has earned prerequisite credentials or certificates is required before the individual is
permitted to challenge certification or receive Supervision and Sign-Off Authority. For those trades, you must prove you have the
required prerequisite credentials.
There are no prerequisite credentials or certificates for this trade.
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 4 of 6
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician 1 - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN 1
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
STATUTORY DECLARATION
OF WORK EXPERIENCE
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
customerservice@itabc.ca
G.
Applicant Signature
I certify that the information I have provided is accurate. (Note: Collection and protection of personal information on this form is in
accordance with the provisions of the Freedom of Information and Protection of Privacy Act.)
Applicant Name (please print):
H.
Applicant Signature:
Date: (MM/DD/YYYY)
Declaration of Official
This section must be completed by a Commissioner for Oaths, a Notary Public, or a Lawyer. It may also be completed by any Service
BC Office or ITA Customer Service.
Name of Organization, Employer or Business for which this Statutory Declaration was prepared:
Official’s Last Name:
Official’s First Name:
Occupation:
Commissioner of Oaths
Notary Public
Lawyer
Address:
Telephone Number:
Declared before me on Date: (MM/DD/YYYY)
Signed at: (City, Province)
Signature of Official:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 5 of 6
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician 1 - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN 1
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
STATUTORY DECLARATION
OF WORK EXPERIENCE
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
customerservice@itabc.ca
I.
References
References must accompany all Statutory Declarations. Include with your completed Statutory Declaration the names and contact
information of three individuals who can verify your self-declared work experience in this trade. This may include suppliers (maximum
one), former employees (maximum one), contractors, or regular, long-term clients (maximum one).
Each individual listed will be contacted by the Industry Training Organization (ITO) responsible for this trade or ITA to verify the
information provided on your application.
1.
Reference
Legal Last Name of Reference:
Legal First Name of Reference:
Organization/Business Name:
Position/Title:
Business Phone Number:
Reference Cell Number:
Relationship to Applicant:
Email Address:
2.
Reference
Legal Last Name of Reference:
Legal First Name of Reference:
Organization/Business Name:
Position/Title:
Business Phone Number:
Reference Cell Number:
Relationship to Applicant:
Email Address:
3.
Reference
Legal Last Name of Reference:
Legal First Name of Reference:
Organization/Business Name:
Position/Title:
Business Phone Number:
Reference Cell Number:
Relationship to Applicant:
Email Address:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 6 of 6
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician 1 - SD December 2012
www.itabc.ca
December 2012