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White Card (Construction Induction) Application Form

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64 views4 pages

White Card (Construction Induction) Application Form

Uploaded by

kaklrokz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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WorkSafe logo

Department of Justice
WorkSafe Tasmania
PO Box 56, Rosny Park,TAS 7018
Phone in Tasmania:1300 366 322
Phone outside Tasmania: 03 6166 4600
Email: [email protected]
Website www.worksafe.tas.gov.au
Service Tasmania Office use only
Product Code 291
Fee collected
Identification sighted
Declaration signed
Training Certificate & details on this form verified

Construction Induction Card Application Form


Please complete this form if you wish to apply for your construction induction card and you have completed your training in Tasmania.
You need to lodge this completed and signed application at a Service Tasmania outlet. When lodging you will need to bring:
Your certificate of training/statement of attainment issued by a Registered Training Organisation
Evidence of identity documents as per list below the form
Fee $12.46
This application must be made within 60 days after the issue of your training certificate. Failure to do so will require a written
declaration by the registered training organisation that you have successfully completed the general construction induction
training.
All fields are mandatory unless marked as optional.

Applicant details
Title

Mr

Surname

Lampkin

First name

Kalani

Middle name

Adrian Kenneth

Address (where card will be posted to)

1 milford street

Surburb

Lindisfarne

Post Code

7015

Phone (numbers only)

0499003295

Date of Birth (dd-mm-yyyy)

23-06-1997
:
Email

[email protected]

Training details
Registered Training Organisation (who provided the training)

EOT

Registered Training Organisation Number

40592

Training Certificate Number

OL2501211

Training Certificate Date (dd-mm-yyyy)

18-09-2023

Did you complete the training in Tasmania? Yes or No

Yes

How was the training completed?

Online

Declaration

I, the applicant, declare that the information contained in this application is true and correct and I consent to the making of enquiries,
and the exchange of information with, the authorities of any state or territory in matters relevant to this application; and the training was
completed in Tasmania.

Signature of applicant

Kalani Lampkin

Date (dd-mm-yyyy)

18-09-2023
:
Application information
You should complete this application form if you wish to apply for your construction induction card and you have completed your training in
Tasmania.
You need to lodge this application at a Service Tasmania outlet. When lodging this application you will need to bring:
The completed and signed application
Your certificate of training/statement of attainment issued by a Registered Training Organisation
Evidence of identity documents as per list below
Fee (see www.worksafe.tas.gov.au for current fees)

Ensure all details are completed on the application form. Failure to do this may result in your application not being processed.
This application must be made within 60 days after the issue of your training certificate. Failure to do so will require a written
declaration by the registered training organisation that you have successfully completed the general construction induction training.
At the time of lodgement your details and identification will be checked and your fee accepted. Your application will then be forwarded
to WorkSafe Tasmania for processing and your card will be sent to your nominated address. Ensure you keep your receipt as proof of
lodgement, until you receive your card.

Evidence of Identity requirements


Please provide at least:
one document from Category A plus two documents from Category B or
two documents from Category A plus one document from Category B

Documents category A
(All documents must be original and current)
Birth Certificate (not an extract)
Citizenship papers
Australian Passport/Visa
Overseas Passport/Visa
Australian Driver Licence
Australian Firearm Licence
Department of Immigration and Multicultural Affairs issued travel documents, including a Visa
Department of Immigration and Multicultural Affairs issued Certificate of Evidence of Residential Status

Documents category B
(All documents must be original and current)
Medicare Card
Plastic Bank or Credit Card, with signature Tertiary Student Identity card
Department of Veterans’ Affairs/Centrelink Pensioner Concession Card
Births Deaths and Marriages Change of Name/Marriage Certificate (to prove name change)
Security Guard/Crowd Controller Licence
Government issued Personal Photo ID Card

Personal Information Protection Statement


Personal information we collect from you for licensing purposes will be used by WorkSafe Tasmania for that purpose and may also be
used for related purposes permitted by the Work Health and Safety Act 2012 and associated laws. If you do not provide this information,
your application may not be processed or records not maintained properly. Your personal information may be disclosed to third parties
such as law enforcement agencies, courts and other government bodies authorised to collect it. This information will be managed in
accordance with the Personal Information Protection Act 2004 and you may access it on request to the Department of Justice (you may
be charged a fee).
:
:

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