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TYPE OF APPLICATION (Please √)

Reference Registration No:

STEAM ENGINEER GRADE ONE

STEAM ENGINEER GRADE TWO

ICE GRADE ONE

ICE GRADE TWO

DREGDE MASTER

DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH Level 2,3 dan 4, Block D3, Complex D, T : 03 – 88865343

Federal Government Administrative Centre, F : 03 – 88892349

62530 W.P. Putrajaya Website : www.dosh.gov.my Email : jkkp@mohr.gov.my

APPLICATION FOR REGISTRATION OF STEAM ENGINEERS / ICE

GUIDANCE NOTES

(1) This form must be completed and submitted with the application letter to the Director General of the Department of Occupational Safety and Health at the above address.

(2) Please submit the following supporting documents :

(a) Application Form For Engineers / Chief Dredger (JKJ 25)

(b) A certified true copy of Identity Card.

(c) The letters original declaration from the employer that shows:-

I) Offer letter

ii) the daily tasks ; and

iii) machinery detailed in the custody of the applicant until now

(d) A certified true copy of Certificate Of Competency.

(e) The latest copy of Certificate of Boiler (Boiler CF) in the custody of applicant; and must be certified true copy for Steam Engineers.

(f) A certified true copy of Certificate of Approval Fuel Burning Equipment from Department

of Environment on the internal combustion engine which under custody of the applicant for Internal Combustion Engine Engineer

(g) 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

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PART ONE : APPLICANT INFORMATION

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 : 20th October 2011