Declaration of Experience

As you are enrolled in an assessment only course you must complete this form and submit before your course date.

Course Date*
DD slash MM slash YYYY
Course:*
eg: Excavator
Name*
First Last
Phone*
You must indicate your operating experience.*
Machine Make and Model/Type Job Details (Eg, trenches, bulk material moving, demolition, road works, warehousing) Approximate Dates Approximate Hours

More lines can be added by using the + at the end of the row.
Total Hours
Total Days
Total Years
Attachments
List the attachements that you have used when operating the above machines.
If found that this is not a true reflection of your operating experience you will have to undertake training at further expense. This could mean having to reschedule training for another date.*
I agree that this is a true reflection of my operating experience.
If found that this is not a true reflection of your operating experience you will have to undertake training at further expense. This could mean having to reschedule training for another date.

Machine Make and Model/Type	Job Details (Eg, trenches, bulk material moving, demolition, road works, warehousing)	Approximate Dates	Approximate Hours