ELECTRICAL W ORKERS

REGISTRATION BO ARD LIMITED CERTIFICATE APPLICATION

Please see the back of the form for additional information.

Please print clearly in black or blue pen and complete all required sections of the form.
EW Number

Personal details
Last Name Email

First Name Street Address

Middle Name

Date of Birth / / Postcode

Home Phone Work Mobile

What are you applying for

Electrician Electrical Appliance Serviceperson Line Mechanic Cable Jointer

Electrical Installer Electrical Engineer Electrical Service Technician

Information supporting the application

Safety Training – Specify what safety training you have done
Where (name of training provider) Date completed (Day/Month/Year)
Safe Working Practices / /

Testing / /

First Aid / /

CPR / /

Declaration
I declare the information I have given is correct and agree:
• to work within the limits as specified in Regulation 93 of the Electrical (Safety) Regulations 2010
and
Signature
• attempt examination(s)/practical assessment(s) relevant to the class of Registration to which
I am aspiring. Date / /

Payment for $91.00 licence fee

We do not accept purchase orders or cash or postal notes. I have made my payment by:

Credit card (Credit card information completed, see overleaf) NZ Cheque made out to “Electrical Workers Registration Board”

Please complete the following if your application is being paid for by your employer or another party.
Name / Company name

Address Postcode

Supervisor of Electrical Work Declaration

Supervisor’s Name:
I accept responsibility for the prescribed electrical work carried out by the above named applicant and ensure that: Supervision will be afforded in accordance with
supervision guidelines issued by the Electrical Workers Registration Board, and as a supervisor of electrical work I will certify on a certificate of compliance, and prescribed
electrical work that requires certification that is carried out under any provisional licence issued to the above named.

Registration No.

Signature of supervisor Date / /

VER 12/12/13 SAFETY | COMPETENCY | COMPLIANCE 1.9

 Limited Certificates
Limited certificates are issued to enable any person to assist in doing
any prescribed electrical work for people who have satisfied the training
and experience requirements for registration but are required to pass an
examination(s) and/or assessment.
Terms and conditions for the issuing of Limited Certificates
An applicant for registration who has had such an application assessed and is
required to pass an examination(s) and/or assessment for registration will be
issued with a limited certificate on satisfying;
(i) evidence that the applicant has satisfactorily completed instruction in
safe working practices, testing, basic first aid and cardio-pulmonary
resuscitation as approved by the Board, or will complete such instruction
within three months of the issue of any limited certificate;
(ii) a statement from a person, who holds a current practising licence that
authorises the person to supervise electrical work, which attests that the
trainee will be supervised in accordance with the Supervision Procedures
for Trainees issued by the Board and dated 31 March 2010;
(iii) an assurance that the applicant will work within the trainee limits as
specified in regulation 93 of the Electricity (Safety) Regulations 2010;
(iv) an assurance that examination(s)/practical assessment(s) relevant to the
class of registration to which the applicant is aspiring will be attempted
through the duration of any limited certificate that may be issued.
Duration of limited certificates
The duration for limited certificates for all registration classes is 1 year.
Renewal of limited certificates
Any application for the renewal of a limited certificate will be granted provided
the applicant has satisfied the Board that every attempt has been made to fulfil
the initial issuing requirements and any limited certificate would be subject to
cancellation if the Board was satisfied that the applicant;
(i) did not complete the safety training which is specified above; or
(ii) has not complied with supervision instructions which are specified in
paragraph (2)(iii) above; or
(iii) has repeatedly worked outside the limits of the limited certificate.

Limited Certificate
Most Limited Certificates are issued with limitations, which include one or more • not being able to test and certify wiring installation work unless such
of the following: testing and certification is done under supervision of a registered electrical
• limited to carrying out certain prescribed electrical work; inspector, or a registered electrician who is entitled to test and certify wiring
installation work.
• working on approved premises;
• being supervised by a supervisor of electrical work.
• working for an approved employer;
• not being able to supervise non registered persons;

Information about supervisors and employers

A supervisor of electrical work must be a registered person: • who holds a current practising licence.
• whose registration allows them to carry out prescribed electrical work they See www.ewrb.govt.nz for further details.
are supervising;
• who is competent to carry out the prescribed electrical work they are
supervising;

Checklist
Have you attached your:
fee of $91.00 any necessary certified copies of qualifications employer work experience reference(s) S/T

Please ensure supervisor details have been completed

Credit Card information

Type Full Name of Cardholder
MasterCard Visa Amex

Credit Card number Signature of Cardholder

Expiry Date Amount

/

Please return this form with payment to: Electrical Workers Registration Board,
PO Box 10156, Wellington 6143, New Zealand

For more help, call our helpline on 0800 661 000 between 8 am and 5 pm Monday to Friday
or email info@ewrb.govt.nz.

Privacy Notice: Any personal information submitted on this application will be kept and maintained by the Electrical Workers Licencing Group (“the EWLG”) in accordance with the New Zealand
Privacy Act 1993. Personal information submitted will be used by the EWLG for determining whether applications for registration as an electrical worker or practicing licences may be granted,
and for the maintenance and administration of the Electrical Workers Register. You may request access to see any information held about you and where that information is inaccurate, ask for it
to be corrected.