Australian Government - Australian Maritime Safety Authority

AMSA forms

APPLICATION FOR APPROVED TRAINER ASSESSOR – AMSA 735
Exemption 38 – Marine Safety (Low complexity duties) Exemption 2017 (No. 2)
 
A. Organisation details
Organisation name
Registered business/trading name (if applicable):
Location:
RTO Code Number:
Contact person:
Contact number:
B. Nominated trainer assessor details
1. Provide details of the trainer assessor nominated for approval
Surname
Given names

Workplace address:
Street name and number
Town/suburb
State
Postcode
Country
Phone
Mobile
Email

  1. Do you currently work for a registered training organisation delivering MAR Maritime Training Package qualifications?

 
2. Provide details and a copy of your Marine Certificate/s of Competency (minimum Coxswain Grade 1 NC unrestricted) OR approved equivalent.
Certificate of Competency Issuing Authority Date of Issue Date of Expiry
Provide details that demonstrate equivalence

3. Provide a statement of experience in workplace training and assessment AND attach relevant qualifications
4. Provide details of a professional referee who supports your suitability to be an Australian Maritime Safety Authority approved trainor assessor
 
C. Nominated trainer assessor status
You must answer the following questions before consideration of this application may be undertaken by the National Regulator. Tick either Yes or No for each question below.
  1. Have you been convicted for offence(s) under the National Law?
  2. Have you had a certificate, issued under a law of the Commonwealth or a State or Territory, suspended, revoked or cancelled?
  3. Have you been found to be 'not a fit and proper person' under a law?
If the answer to any of the questions above is ‘Yes’, please provide further details (continue on a separate page if necessary).
D. Declaration and Consent
I declare that:
  • To the best of my knowledge the information provided by me in this application (and any attachments I have included with this application) is true and correct.
  • I consent to the Australian Maritime Safety Authority (AMSA), as the National Regulator, making all reasonable enquiries in order to verify that the information provided by me in the application (and any attachments I have included with this application) is true and correct.
  • I understand and acknowledge that AMSA, as the National Regulator, may ask that I provide any information or document that the National Regulator reasonably considers necessary for consideration of this application.
  • I understand and acknowledge that AMSA, as the National Regulator, may ask another person to provide any information or document that the National Regulator reasonably considers necessary for consideration of this application: and
  • I agree to demonstrate to AMSA, as may be required, that I continue to meet the Approved trainer assessor conditions in accordance with the Training and Assessment Criteria (AMSA 508).
Signature
Name
Date

Privacy Statement
The collection of information requested in this form is required or authorised by Schedule 1 of the Marine Safety (Domestic Commercial Vessel) National Law Act 2012 (the Act). It will be used for purposes related to the Act and may be provided to Commonwealth or State/Territory government agencies for the purposes of marine safety. Failure to provide the information may result in the transaction not being processed. To contact us, or for more information on how to access or correct your personal information, how to make a privacy complaint, or how your information may be used or disclosed for purposes beyond those described in this statement, visit www.amsa.gov.au/privacy.
How to lodge
Email applications can be sent to: scsadmin@amsa.gov.au

Postal applications should be addressed to:

Australian Maritime Safety Authority
Attention: Operations - Seafarer Certification
GPO Box 2181
Canberra ACT 2601
Australia
AMSA form: 735
Version: 1 7/18