DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH

Level
Level 1,
2, 3, 4 and
3 and 4, 5, Block
Block D4,
D3, Complex
Complex D,D, T : 03 – 8886 5343
Federal
Federal Government
Government Administrative
Administrative Centre,
Centre, F : 03 – 8886 5349
62530 W.P. Putrajaya
62530 W.P. Putrajaya Website : www.dosh.gov.my
Email : jkkp@mohr.gov.my

APPLICATION FOR REGISTRATION OF STEAM ENGINEERS / ICE

NOTA PANDUAN
1) This form must be completed and submitted with the application letter to the Director TYPE OF APPLICATION
(Please √)
General of the Department of Occupational Safety and Health at the above address.
Reference Registration No:

2) Please submit the following supporting documents:

a) Application Form for Engineers / Chief Dredger (JKJ 25). STEAM ENGINEER
b) A certified true copy of Identity Card. GRADE ONE

c) One (1) recent driving license photograph.

STEAM ENGINEER
d) The letters original declaration from the employer that shows:- GRADE TWO
i. Offer letter,
ii. the daily tasks ; and
ICE GRADE ONE
iii. Machinery detailed in the custody of the applicant until now.
e) A certified true copy of Certificate of Competency.
f) The latest copy of Certificate of Boiler (Boiler CF) in the custody of applicant; and must ICE GRADE TWO

be certified true copy for Steam Engineers.

g) A certified true copy of Certificate of Approval Fuel Burning Equipment from
DREGDE MASTER
Department of Environment on the internal combustion engine which under custody of
the applicant for Internal Combustion Engine Engineer.
h) A certified true copy of academic qualifications.

3) Please refer to Factories and Machinery (Certificates Of Competency-Examinations) Regulations, 1970 and Factories and
Machinery (Person In Charge) Regulations, 1970
PART ONE : APPLICANT INFORMATION Attach latest
photo
(Driving license
size)

1.1 Applicant Name:

1.2 Mailing Address:

1.3 Phone No.: 1.4 Fax No. :

1.5 Email:

1.6 Employer Name:

1.7 Address:

1.8 Phone No: 1.9 Fax No. :

1.10 Registration No. of Factory/Workplace:

PART TWO : CERTIFICATION OF APPLICANT

I certify that the information contained in this application is the truth. The Department may reject my application if the
information is incomplete and false.

Applicant Signature : ………………...……………………………………. Employer's stamp

Full Name : ………………...…………………………………………………..

Position : ………………...………………………………………………….

Date : ………………...…………………………………….

Date updated: 31 May 2013

 SECOND SCHEDULE (JKJ 25)

FACTORY AND MACHINERY ACT, 1967

FACTORIES AND MACHINERY (CERTIFICATES OF COMPETENCY – EXAMINATIONS)
REGULATIONS, 1970
Regulation 9(1)
APPLICATION FOR CERTIFICATE OF COMPETENCY AS ENGINEERS/DREDGEMASTERS

I (name in full) ……………………………………………………………..…………………K.P.P.N. No. ……………………..……………………………………..

(Capital letters)

Of (present address)………………………..…………………………………..………………………………………………………………………………………..

born at (place of birth) ……………………………….……………………………………..on (date of birth)…………………………………………..

hereby apply for examination/exemption from examination for:

• Second grade engineer’s certificate (steam boilers/internal combustion engines) Part A-Part B
• First grade engineer’s certificate (steam boilers/internal combustion engines) Part A-Part B
• Dredge master’s certificate (steam boilers/internal combustion engines) Part A-Part B-Part C
• Dredge master’s certificate (electric only) Part A-Part B-Part C

Name and addresses of firms with which you were Apprenticed as Date Period
in charge of steam boilers / internal combustion
from to month
dredge engines

Total period
Name and addresses of firms with which you were in charge of steam
boilers / internal combustion dredge engines

Total period
Details of academic training and qualifications, and certificates of
competency held

I am at present employed by …………………………………………………………………………………………….…………………………………..…………..

as ……………………………………..……………………………………………………………………………………………………..…………………………………………
I enclose original testimonials and copies thereof as evidence of the above statements.

Date: ………………………………………. (Signature) ………………….…………………………………………..

For office use only:

I certify that I have seen the original documents and the duplicates are true copies thereof.

…………………………………………………………..
Panel Members
* Strike out the words not applicable