AUTOMOTIVE SERVICE TECHNICIAN
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
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 9,000 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 military certificate in Vehicle Technician MT #411, and who are QL 5or higher will be eligible to challenge this
certification.
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:
Province:
Postal Code:
Email Address:
Telephone Number:
C.
Supervisor’s Position/Title:
Street Number and Name:
City:
(
Supervisor Name:
Business Registration Number:
(Self-Employment only)
)
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 Experience
Accumulated in that Period:
To:
Job Title of Applicant:
Page 1 of 10
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
D.
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
customerservice@itabc.ca
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.
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.
Declaration
Response
Job Tasks
Block A – Task 1 Occupational Skills
Yes:
Able to use tools and equipment?
No:
Yes:
Able to maintain tools and equipment?
No:
Yes:
Able to use hoisting and lifting equipment?
No:
Yes:
Able to use PPE and safety equipment?
No:
Task 2 Perform common trade activities.
Yes:
Able to use technical information?
No:
Yes:
Able to estimate preliminary job cost?
No:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 2 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
customerservice@itabc.ca
Declaration
Response
Job Tasks
Yes:
Able to maintain safe work environment?
No:
Block B – Task 3 Engine and Engine Support Systems
Yes:
Able to diagnose engine systems?
No:
Able to diagnose cooling systems?
Yes:
No:
Yes:
Able to diagnose lubricating systems?
No:
Yes:
Able to diagnose base engine?
No:
Task 4 Repair engine systems
Yes:
Able to repair cooling systems?
No:
Able to repair lubricating systems?
Yes:
No:
Yes:
Able to repair base engine?
No:
Task 5 Diagnose engine support systems
Yes:
Able to diagnose fuel delivery systems?
No:
Able to diagnose ignition systems?
Yes:
No:
Yes:
Able to diagnose intake/exhaust systems?
No:
Yes:
Able to diagnose emission systems?
No:
Yes:
Able to diagnose accessory drive systems and mounts?
No:
Yes:
Able to diagnose diesel engine support systems?
No:
Task 6 Repair engine support systems
Yes:
Able to repair gasoline delivery systems?
No:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 3 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
customerservice@itabc.ca
Declaration
Response
Job Tasks
Yes:
Able to repair ignition systems?
No:
Yes:
Able to repair intake/exhaust systems?
No:
Yes:
Able to repair emission systems?
No:
Yes:
Able to repair accessory drive systems and mounts?
No:
Yes:
Able to repair diesel engine support systems?
No:
Block C – Task 7 Vehicle Management Systems
Yes:
Able to diagnose vehicle management systems?
No:
Able to read diagnostic trouble codes (DTCs)?
Yes:
No:
Yes:
Able to monitor parameters?
No:
Yes:
Able to interpret test results?
No:
Yes:
Able to test system circuitry and components?
No:
Task 8 Repair vehicle management systems.
Yes:
Able to update component software?
No:
Able to replace components?
Yes:
No:
Yes:
Able to verify vehicle management system repair?
No:
Block D –Task 9 Drive Line Systems
Yes:
Able to diagnose drive line systems?
No:
Yes:
Able to diagnose drive shafts and axles?
No:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 4 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
customerservice@itabc.ca
Declaration
Response
Job Tasks
Yes:
Able to diagnose automatic transmissions/transaxles?
No:
Yes:
Able to diagnose clutches?
No:
Yes:
Able to diagnose transfer cases?
No:
Yes:
Able to diagnose final drive assemblies?
No:
Task 10 Repair drive line systems.
Yes:
Able to repair drive shafts and axles?
No:
Able to repair manual transmissions/transaxles?
Yes:
No:
Yes:
Able to repair automatic transmissions/transaxles?
No:
Yes:
Able to repair clutches?
No:
Yes:
Able to repair final drive assemblies?
No:
Block E – Task 11 Electrical and Comfort Control Systems
Yes:
Able to diagnose electrical systems and components?
No:
Able to diagnose starting/charging systems and batteries?
Yes:
No:
Yes:
Able to diagnose basic wiring and electrical systems?
No:
Yes:
Able to diagnose lighting and wiper systems?
No:
Yes:
Able to diagnose entertainment systems?
No:
Yes:
Able to diagnose electrical options?
No:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 5 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
customerservice@itabc.ca
Declaration
Response
Job Tasks
Yes:
Able to diagnose instrumentation and information displays?
No:
Yes:
Able to diagnose electrical accessories?
No:
Task 12 Repairs electrical systems and components.
Yes:
Able to repair starting/charging systems and batteries?
No:
Able to repair basic wiring and electrical systems?
Yes:
No:
Yes:
Able to repair lighting and wiper systems?
No:
Yes:
Able to repair entertainment systems?
No:
Yes:
Able to repair electrical options?
No:
Yes:
Able to repair electrical accessories?
No:
Yes:
Able to install electrical accessories?
No:
Yes:
Able to repair instrumentation and information displays?
No:
Task 13 Diagnoses HVAC and comfort control systems.
Yes:
Able to diagnose air flow control systems?
No:
Able to diagnose refrigerant systems?
Yes:
No:
Yes:
Able to diagnose heating systems?
No:
Task 14 Repairs HVAC and comfort control systems.
Yes:
Able to repair air flow control systems?
No:
Yes:
Able to repair refrigerant systems?
No:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 6 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
customerservice@itabc.ca
Declaration
Response
Job Tasks
Yes:
Able to repair heating systems?
No:
Block F – Task 15 Steering and Suspension Braking, Control Systems, Tires, Hubs and Wheel Bearings
Yes:
Able to diagnose steering and suspension, and control systems?
No:
Able to diagnose braking and control systems?
Yes:
No:
Yes:
Able to diagnose tires, wheels, hubs and wheel bearings?
No:
Task 16 Repair steering and suspension, braking, control systems, tires, wheels, hubs and wheel bearings.
Yes:
Able to repair steering, suspension and control systems?
No:
Able to repair braking and control systems?
Yes:
No:
Yes:
Able to repair tires, wheels, hubs and wheel bearings?
No:
Task 17 Diagnose body components, trim and restraint systems.
Yes:
Able to diagnose restraint systems?
No:
Able to diagnose wind noise, rattles and water leaks?
Yes:
No:
Yes:
Able to diagnose interior and exterior components and trim?
No:
Yes:
Able to diagnose latches locks and movable glass?
No:
Task 18 Repair body components, trim, restraint systems and installed accessories.
Yes:
Able to repair restraint systems?
No:
Able to repair problems with wind noise, rattles and water leaks?
Yes:
No:
Yes:
Able to repair interior and exterior components and trim?
No:
Yes:
Able to repair latches locks and movable glass?
No:
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 7 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
AUTOMOTIVE SERVICE TECHNICIAN
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
customerservice@itabc.ca
Declaration
Response
Job Tasks
Yes:
Able to install interior and exterior accessories?
No:
Task 19 Diagnose hybrid and alternate fuel systems.
Yes:
Able to implement hybrid safety protocols?
No:
Able to diagnose hybrid systems?
Yes:
No:
Yes:
Able to diagnose alternate fuel systems?
No:
Task 20 Repair hybrid and alternate fuel systems.
Yes:
Able to repair hybrid and alternate fuel systems?
No:
F.
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.
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):
Applicant Signature:
Date: (MM/DD/YYYY)
Enter the applicant name (repeat on every page of this form).
Legal First Name:
Page 8 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
H.
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
customerservice@itabc.ca
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 9 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012
AUTOMOTIVE SERVICE TECHNICIAN
Tel: 778-328-8700
Fax: 778-328-8701
Toll Free: 1-866-660-6011
STATUTORY DECLARATION
OF WORK EXPERIENCE
I.
ITA Customer Service
800 – 8100 Granville Ave.
Richmond, BC V6Y 3T6
customerservice@itabc.ca
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 10 of 10
Legal Middle Name(s):
Legal Last Name:
The Industry Training Authority is an agency of the Government of British Columbia.
Automotive Service Technician - SD December 2012
www.itabc.ca
December 2012