ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
LICENCE
APPLICATION TYPE
APPLICATION FOR REGISTRATION
FOR A RESTRICTED ELECTRICAL
WORKERS LICENCE
D
RESTRICTED
ELECTRICAL
D
    
ALLOCATED BY ESV
Fold
RETURN ADDRESS: LICENSING SECTION
ENERGY SAFE VICTORIA
PO BOX 262, COLLINS STREET WEST
VICTORIA
8007
Please complete this form in BLOCK LETTERS.
SURNAME OF APPLICANT:
GIVEN NAME(S):
RESIDENTIAL ADDRESS:
POSTCODE:
POSTAL ADDRESS: (IF SAME
AS ABOVE, WRITE 'AS ABOVE')
TELEPHONE NO:
AGE:
HOME:
FAX:
E-MAIL:
(
(
)
)
DATE OF BIRTH:
POSTCODE:
( )
BUS:
MOBILE:
/
/19
FOR IDENTIFICATION PURPOSES ONLY
ESV Use Only
RECOMMENDATION:
Employer/self employed letter
Qualification/ NREL 1 & 2/POO1B/POO7/Module/s Assessed
Evidence of Independent Practical Assessment on Equipment
Fault Finding, Training & Qualification Evidence
VBA/PIC/ARCTICK Evidence (front & back)
Classification
Type
1
Restrictions if any:
Date fee paid
/
/20
Fee Required
Date recommended:
/
/20
Recommended by:
Date approved:
/
/20
Approved by:
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$588.00
Last printed 02/07/15
Receipt:
Page 1 of 9
2
ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
1.
(a) Please provide details of your primary work (eg. plumber, gas fitter, mechanical fitter, refrigeration
mechanic etc.)
(b) Description of work you intend to carry out under the Restricted Electrical Worker’s Licence,
together with a description of the type of electrical equipment or component of the electrical equipment
for which you require the licence. Restricted electrical work allows for equipment or components only subject to
your primary work function. It does not allow the work of a Electrician. Work must be disconnect/reconnect only
for the purposes of repair, replacement or maintenance of such equipment.
Please tick ( ) appropriate box
2.
(a) Do you hold or have previously held a Victorian Electrical Worker’s Licence issued by Energy Safe Victoria (ESV)?
YES
if YES, complete section below
NO
Licence Class:
Date of Issue:
if NO, go to question 2 b)
Licence No.
Date of Expiry:
(b) Do you hold a current Electrical Worker’s Licence of any grade/class in other State or Territory of Australia
or New Zealand?
YES
if YES, complete section below
Type of Licence:
Issuing Authority:
Date of Issue:
NO
if NO, go to question 2 c)
Class:
Licence No:
Date of Expiry:
Copy of licence
card, front and back
to be attached
(c) Do you hold any trade licence/certificate?
YES
Licence Name:
Issuing Authority:
if YES, complete section below
NO
if NO, go to question 3
Licence No:
Date issued:
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Please attach evidence
ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
3.
Have you served as an apprentice in your trade?
Please note a licence cannot be issued if you are still serving an apprenticeship. If you have been trained as
an electrician or electrical fitter, a Restricted Electrical Licence cannot be issued.
YES
if YES, complete section below
NO
if NO, go to question 4
Please describe the nature of work in your apprenticeship (i.e. maintenance of gasfitting machinery etc.)
Please attach evidence
of the completion details
of apprenticeship
Name of Apprenticeship Employer:
Employer's Address:
Date commenced:
4.
Have you completed the equivalent course, which is now an equivalent to the current requirements? Known as units
NREL 1 and NREL 2 or POO1B and POO7?
YES
5.
(i)
Date completed:
if YES, please attach evidence
NO
if NO, go to question 5
Please provide details of present and past employment in your trade to support this application. You must
be either employed or self employed to make this application.
Name of Present Employer:
Employer's Address:
Describe Type of Work:
Period of Employment
(ii)
Please attach evidence of
completion
From:
/
/
To:
From:
/
/
To:
/
/
Name of Any Other Previous
Employer(s):
Employer's Address:
Describe Type of Work:
Period of Employment
(if insufficient space attach details)
/
/
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ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
6.
Have you ever been refused a Restricted Electrical Worker’s Licence in Victoria or elsewhere, been
disqualified from holding such a licence, or has any such licence held by you been cancelled or suspended
for any period of time?
YES
if YES, complete section below
NO
if NO, go to question 7
(a) Type of Licence and Issuing Authority :
Type of Licence:
Issuing Authority:
Class:
Lic. No.
(b) Date of refusal, or suspension and (if applicable) the period of suspension:
(c) Reason for refusal, cancellation or suspension:
7. Have you ever been subject to disciplinary action taken by ESV or other Regulatory Authority
relating to causes under section 34 or section 41 of the Electricity Safety Act 1998 or equivalent
causes?
YES
if YES, complete section below
NO
If NO, go to question 8
8. Have you ever been convicted for failing to comply with any part of the Electricity Safety Act 1998 or the
Electricity Safety (Installations) Regulations 2009?
YES
if YES, complete section below
NO
if NO, go to question 9
9. Have you ever been convicted of any offence involving fraud, dishonesty, drug trafficking or violence that
was punishable by imprisonment for 6 months or more?
YES
if YES, complete section below
NO
if NO, go to question 10
10. Have you ever had judgement against you in any proceedings relating to fraudulent conduct, negligence or
incompetence in connection with carrying out installation work?
YES
if YES, complete section below
NO
if NO, go to question 11
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ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
11. Do you have any physical disabilities that you believe would affect your ability to work safely as an electrical
installation worker?
YES
if YES, complete section below
12. Are you
NO
if NO, go to question 12
(tick appropriate box)
an employee
Go to (a) below
self-employed
Already licensed
Go to (b) below
Go to (a or b) below (include a copy of your
licence, front & back, licence must be valid)
(a) An applicant who is an employee must attach a detailed letter from their employer clearly stating
their requirement for the Restricted Electrical Worker’s Licence in order to undertake restricted
disconnect/reconnect of electrical equipment which is incidental to their primary function, which is
currently dated and signed by the employer, who is a person to support your technical competency.
(b) An applicant who is self-employed must attach a detailed written submission clearly stating their
requirement for the Restricted Electrical Worker’s Licence in order to undertake restricted
disconnect/reconnect of electrical equipment or components which are incidental to their primary
function.
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ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
UNITS OF COMPETENCY REQUIRED FOR ELIGIBILITY FOR THIS LICENCE TYPE
PLEASE SELECT WHAT UNITS YOU HAVE COMPLETED TO APPLY FOR A RESTRICTED ELECTRICAL LICENCE
Did you receive prior approval from ESV to undertake the units of competency (REL Course) with a view to
be licensed, prior to this application? (please circle)
YES
NO
Units of Competency Required
for Completion at your Local Training Provider
**For a Class 1 Licence Applicant,
both the Class 1 and Class 2
Units are required per classification**
Classifications
Class 1
To include Fault Finding
Class 2
Disconnect/Reconnect
Electronics
Instrumentation & Control Devices
UEENEEP017A
UEENEEP019A &
UEENEEP017A
UEENEEP017A
UEENEEP018A
UEENEEP012A
UEENEEP014A &
UEENEEP012A
UEENEEP012A
UEENEEP013A
Electrical Appliances (Domestic)
Motors
Composite Equipment
Control Devices
Hazardous Area Equipment
Neon Signs (Preassembled Signage)
Other Accepted
Other Accepted
UEENEEP016A
UEENEEP020A
UEENEEP017A
UEENEEP018A
UEENEEP017A
UEENEEP017A
P007 OR MEM18.46
-
UEENEEP010A
UEENEEP015A
UEENEEP012A
UEENEEP013A
UEENEEP021A
UEENEEP011A
P001B OR MEM 18.49
NREL 1 & 2
Refrigeration & Air Conditioning
Water Heaters & Gas Appliances
If you have previously completed fault finding training and are unable to provide such evidence you will have to arrange
for review of your competence at your local TAFE, and seek an additional letter which states the training package you have
undertaken, included fault finding at that time.
This review will result in either confirmed competence or the requirement of additional training, in line with the updated
regulatory requirements. Without fault finding evidence ESV will award Class 2 Only.
CLASSIFICATION ASSESSMENT
ESV determine your classification outcome as part of your application review. We advise that your primary
trade, qualifications and supporting documents determine what classification is most suitable for your primary work
function.
Completion of numerous units of competency as shown above, which do not align to your primary work function and
supporting qualification and training evidence, will not result in several classifications being awarded to you.
The most appropriate classification for the restricted scope of electrical work will apply.
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ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
DECLARATION BY APPLICANT
13. I declare that the information contained in this application or attached by me to the application is true and
correct to the best of my knowledge and that I have read the ESV Privacy Statement.
Signed by Applicant
Sign here
Date:
While every effort is made by ESV to forward renewals prior to their expiry date, it is still your responsibility to make
sure your Licence does not expire.
NOTE:

The Restricted Electrical Worker’s Licence, does not provide for the installation of electrical wiring work,
however it does entitles the holder to Restricted Electrical installation work of a class prescribed in
regulation 301(b) if the person is primarily engaged in a work function that(a) relates to a type of low voltage electrical equipment specified in Schedule 3: and
(b) involves electrical installation work that is incidental to the primary work function.
ESV PRIVACY STATEMENT
The Information Privacy Act 2000 requires Energy Safe Victoria (ESV) to tell you why we collect your personal information.
ESV collects information necessary to enable us to fulfil our functions under the Electricity Safety Act 1998, including the
monitoring of compliance with the Electricity Safety Act 1998 and the regulations made under that Act. We ask you to
provide your name, address and date of birth for identification purposes. Your address is also required so that we know
where to send your licence renewal form at the appropriate time.
ESV may need to disclose your personal information to third parties outside the organisation, such as contracted service
providers, mail houses/printers and other government organisations.
You are entitled to ask for access to the personal information that ESV holds about you.
If you have any queries, please contact ESV Privacy Officer on (03) 9203 9700.
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ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
APPLICATION COMPLETION CHECKLIST
EXPECTED TIMEFRAME:
AN APPLICATION IS SUBJECT TO ASSESSMENT FOR A PERIOD UP TO 10 WORKING DAYS,
IN ORDER TO PROCESS THE APPLICATION. THIS APPLIES IF ALL INFORMATION
FORWARDED IS CORRECT, IF NOT, FURTHER DELAYS IN PROCESSING WILL OCCUR AND
YOUR APPLICATION MAY BE RETURNED TO YOU.
Please
CHECK LIST
YES
Completed all details for Restricted Electrical Workers Licence.
Attached a copy of the Registration/Licence details from Interstate if applying
under Australian Mutual Recognition Act or if applying from New Zealand
under Trans Tasman Mutual Recognition Act.
(Refer to question 2(b))
Attached Certificate of Apprenticeship in your Trade to support your
application. (Refer to question 3)
Attached evidence of previously completed NREL 1, NREL 2, P001B and P007 –
Disconnect/Reconnect course. (Refer to question 4)
Attached a DETAILED letter from your employer or yourself if self employed
describing the type of electrical equipment stating the requirement for the
Restricted Electrical Worker’s Licence in order to perform electrical work
which is incidental to your primary function. (Refer to question 12)
Enclosed the fee for a Restricted Electrical Worker’s Licence
(cheque, money order or credit card details). Fee maybe subject to change
without notice.
Is application signed and dated? (Refer to question 13)
OR Attached any detailed information regarding employer provided training
or specific equipment training, relevant to the work you undertake? (training
completed on the job). Please note a period of employment DOES NOT
support this requirement.
Attached Qualifications or Training Certificates, relevant to the work you
undertake
Attached evidence of independent practical assessment and current
transcript and units of competency as approved by ESV via the course
approval process and/or completed with an RTO (see Units of Competency)
For Refrigeration, Air Conditioning, Plumbing, Gas Fitting (VBA Licence
or Registration (front & back) and ARCTICK Licence Copies required - please
refer to www.vba.vic.gov.au or www.arctick.org for further details
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box
NO
ENERGY SAFE VICTORIA – ELECTRICITY SAFETY (LICENSING & REGISTRATION) REGULATIONS 2010
LICENSING OF ELECTRICAL WORKERS SCHEDULE OF FEES
Application fee for the issue of a licence as an Restricted Electrical Workers Licence (5 years)
Licensing fees, Registration fees and Certificates of Electrical Safety are GST Exempt.
$588.00
HOW DO I PAY FOR MY APPLICATION?
MAIL



IN PERSON

Make cheque or money order payable to
Energy Safe Victoria
or
Pay with Credit Card - MasterCard or
Visa - please complete details below

Send application together with relevant
attachments along with either a cheque,
money order or credit card details to:
Present application together with relevant
attachments to:
For any
Licensing & Registration Enquiries
PHOTOCOPIES & SCANNED COPIES
ARE ACCEPTABLE
ESV website
www.esv.vic.gov.au
or email
licensing@esv.vic.gov.au
Office Hours – 8.30am to 4.30pm
(Monday to Friday)
A receipt will not be issued unless requested.
Mastercard
Freecall – 1800 815 721
Facsimile (03) 9686 2197
Licensing Section
Energy Safe Victoria
Level 5, Building 2
4 Riverside Quay
SOUTHBANK
Licensing Section
Energy Safe Victoria
PO Box 262
Collins Street West VICTORIA 8007
**

(i) Make cheque or money order payable to
Energy Safe Victoria
or

Pay with Credit Card - MasterCard or Visa
Visa
Expiry Date
Credit Card Number
Signature
Amount Paid
$588.00
Cardholder's Name (Block Letters)
Energy Safe Victoria
ABN 27 462 247 657
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