APPLICATION CERTIFICATION CHALLENGE TIDAL ANGLING GUIDE

Transcription

1 APPLICATION CERTIFICATION CHALLENGE This form is used to apply to challenge trade certification. This application must be accompanied by at least one Employer Declaration or Statutory Declaration. For detailed instructions refer to Instructions for Certification Challenge. A. Personal Information Mandatory fields marked with an asterisk (*). All communication from ITA will be sent to the address provided. ITA Individual ID #:(leave blank for new registration) *Program (Trade): *Legal First Name: Legal Middle Name(s): *Legal Last Name: *Date of Birth : *Gender: Male Female *Born in Canada? Yes No Suite Number: *Mailing Address: *City: *Province: *Postal Code: *Phone Number: ( ) Do you identify yourself as an aboriginal person? Yes No Secondary Phone Number: ( ) * Address: If yes, please check one: First Nations Métis Inuit B. Scheduling My Exam Let us know when and where you want to write the exam, and if any special arrangements need to be made. Please DO NOT schedule my exam. Once my application is approved, I will contact ITA to request a time to write the exam. Please SCHEDULE MY EXAM upon approval of application. My earliest available date to write this exam is:. Note: Your exam will be scheduled as close to this date as possible. We cannot schedule exams more than 60 days in advance. If a practical assessment is also required for certification in your trade, further information will be provided when your application is approved. Additional Requirements I require exam accommodations for a physical, mental or learning disability, or require a translator or a translation dictionary. Click here to view our Exam Accommodations: ESL & Disability Options page I require a wheelchair accessible location to write the exam. Preferred Location to Write the Exam Burnaby Kamloops Nanaimo Surrey Chilliwack Kelowna Penticton Vernon Fort St. John Langley Prince George Victoria Other For a list of Service BC locations go to: Identification: Please check off the type of PHOTO identification you will be using on the day of your exam; you will be required to bring the same identification on the day of your exam. Your photo identification MUST BE VALID AND CURRENT on the day you write your exam; expired identification will not be accepted. Do not submit originals, photocopies or write the identification number of your identification on your application. Provincial Driver s License (issued by a Canadian Province or Territory) Provincial Identification Card (i.e. British Columbia Identification Card, Alberta Identification Card) * Canadian Permanent Residency Card BC Services Card Combination Driver s License and BC Services Card Canadian Certificate of Indian Status * Passport: Indicate Country of Origin; do not write identification number * Cards/Certificates without an expiry date will not be accepted Page 1 of 10 The Industry Training Authority is an agency of the Government of British Columbia. March 2016

2 APPLICATION CERTIFICATION CHALLENGE C. Work Experience in Trade To qualify to challenge a certification you must prove you have worked the required minimum number of hours in the trade and performed specific job tasks associated with the trade. In the table below, list the name of each employer you have worked for performing your trade, the dates you were employed, and the total number hours worked with each employer performing the job tasks listed on the Employer and Statutory Declaration of Work Experience forms. Name of Organization/Employer(s) Dates of Employment Hours Worked Total: D. Challenge Application Fee Payment If you are applying to challenge certification, an assessment fee of $120 must be paid when your application is submitted. If a practical assessment is required to challenge certification in your trade, additional fees are charged; further information will be provided when your application is approved. Payment of Assessment Fee made by: Credit card payment made online via the Payments & Fees page on the ITA Website Attach receipt or write Transaction number here: Cheque or money order (attached) Cash, credit or debit card, paid in person at ITA when application is submitted E. Signature Privacy Statement The Industry Training Authority is committed to protecting the privacy of any personal information you may provide when filing an application form with us. The Industry Training Authority will not use or share any personal information provided by the applicants except with the consent of the individual to whom the information relates or as otherwise authorized by the Freedom of Information and Protection of Privacy Act. Certification and authorization for collection, use and disclosure of personal information I certify that the information I have provided is accurate and I understand and agree that ITA reserves the right to verify the accuracy of such information. I agree to allow ITA, in accordance with the BC Freedom of Information and Protection of Privacy Act, to use and provide to others the personal information I have provided on this form, as well as any other information necessary, for the purpose of administering the apprenticeship training program I m seeking to challenge or receive Supervision and Sign-Off Authority for, including the application process, program delivery, evaluation and certification. I authorize ITA to provide my personal information for the previously stated purpose to apprenticeship officials in other jurisdictions, my present and future sponsors, educational institutions, private trainers and to other agencies, regulatory authorities and ministries of municipal, provincial and federal governments where the information is necessary for them to fulfill their legal responsibilities and/or manage apprenticeshiprelated programs. I also authorize ITA to make the status of my certification and apprenticeship publicly available. Applicant Name (Print): Applicant Signature: Date: Page 2 of 10 The Industry Training Authority is an agency of the Government of British Columbia. March 2016

3 EMPLOYER DECLARATION To qualify to challenge certification in this trade, individuals must have: worked a minimum of 750 hours performing the tasks listed in Section D, and prerequisites in Section E This form is used to declare work experience for periods of employment. The information provided is used to verify the applicant s work experience in this trade. This form must be completed by a direct supervisor of the applicant, who will be contacted by go2 or ITA. Note: An Employer Declaration of Work Experience form must be completed by each Employer listed on the applicant s completed Application form. A Statutory Declaration of Work Experience form must be completed for periods during which the applicant was self-employed or a previous employer is unavailable to complete an Employer Declaration. For more information, see Instructions for Certification Challenge A. Applicant Name Enter the name of the individual for whom this form is being completed. B. Supervisor Contact Information Enter the name and contact information for the person who directly supervised the applicant at this employer. Ensure the information given is current as the application will be denied if this person cannot be contacted by ITA. Name of Organization/Employer/Business: First and Last Name of Applicant s Direct Supervisor: Supervisor Position or Title: Suite Number: Street Number and Name: City: Province: Postal Code: Business Number: ( ) Mobile Phone Number: ( ) Supervisor Address: C. Employment Information of Applicant Dates of Applicant s Employment : Total Number Hours of Tidal Angling Guide Experience Accumulated in that Period: Job Title of Applicant: Vessel Type: Vessel Length: Areas Fished (check all that apply): Strait of Georgia Strait of Juan de Fuca Haida Gwaii North Coast/Hecate Strait Central Coast/Queen Charlotte Sound West Coast Vancouver Island North Vancouver Island /Johnstone Strait Other: Species Fished (check all that apply): Salmon Halibut Ling Cod Rockfish Crab Shrimp/Prawns Other: Page 3 of 10 The Industry Training Authority is an agency of the Government of British Columbia. May 2015

4 D. Skill Assessment EMPLOYER DECLARATION Please indicate how often the applicant has demonstrated the skills and knowledge in the areas listed below during their period of employment with you. Unit Details Frequently Occasionally Never TAG-1 Encounter situations requiring basic first aid Perform basic first aid procedures TAG-2 Respond to marine emergencies Use marine safety and survival equipment TAG-3 Operate non-pleasure small vessels Refuel non-pleasure small vessels TAG-4 Prepare voyage details and sailing plan Use navigational aids and equipment TAG-5 Operate VHF marine radio equipment Make distress calls and DSC alerts according to procedure TAG-6 Communicate with colleagues and customers in a variety of situations Communicate with supervisors and authorities according to protocol TAG-7 Work and interact effectively with others in the workplace Plan and manage time and tasks effectively TAG-8 Respond to conflict situations safely and professionally Resolve conflict situations encountered in day to day operations TAG-9 Use and share local tourism information in the workplace TAG-10 Follow maritime and tidal angling rules and regulations Inform and instruct others of applicable rules and regulations TAG-11 Apply and follow workplace safety policies and procedures Use and adjust safety and personal protective equipment (PPE) TAG-12 Interact appropriately with other coastal resource users while guiding Supervise the interactions of clients and colleagues with others TAG-13 Interact with the local environment according to protocols/regulations Supervise the interaction of others with the coastal environment Enter the Supervisor and Applicant names from Page 1 on every page of this form Supervisor First and Last Name: Applicant First and Last Name: Page 4 of 10 The Industry Training Authority is an agency of the Government of British Columbia. March 2016

5 EMPLOYER DECLARATION Unit Details Frequently Occasionally Never TAG-14 Act in an environmentally responsible and sustainable manner Instruct and inform others about environmentally responsible and sustainable behaviour TAG-15 Apply safe food, catch, and bait handling principles and procedures Identify and use cleaning and sanitizing products appropriately TAG-16 Use and maintain angling tools and equipment appropriately Select and match tools and equipment to angling conditions TAG-17 Supervise the catch, release and retention of fish by others Follow and enforce regulations and limits related to recreational fishing TAG-18 Plan and schedule trip activities subject to a variety of circumstances Respond to clients special needs and requests Maintain all necessary trip logs and records E. Confirmation of Prerequisite Credentials or Certificates Evidence that the applicant has earned prerequisite credentials or certificates is required before the individual is permitted to challenge certification. For those trades, a current or previous employer must verify that the applicant has the required prerequisite credentials. I have verified that the applicant has attained all the prerequisite credentials or certification required to be considered eligible to challenge in this trade. Marine Basic First Aid Copy of certificate attached Small Vessel Operator Proficiency (SVOP) Copy of certificate attached Marine Emergency Duties (MED) A3 Copy of certificate attached Restricted Operator s Certificate Maritime (ROC-M) Copy of certificate attached If you have other government issued certificates that exceed these certifications please contact go2 to confirm that they are acceptable substitutes F. Supervisor Signature I certify that the information I, as the current or former direct supervisor of the applicant, have provided is accurate. (Note: Collection and protection of personal information on this form is in accordance with the provisions of the Freedom of Information and Protection of Privacy Act.) Supervisor name (Please Print): Supervisor Signature: Date Signed: Enter the Supervisor and Applicant names from Page 1 on every page of this form Supervisor First and Last Name: Applicant First and Last Name: Page 5 of 10 The Industry Training Authority is an agency of the Government of British Columbia. March 2016

6 STATUTORY DECLARATION A Statutory Declaration of Work Experience is used to declare work experience for periods during which you were self-employed or a previous employer is unavailable to complete an Employer Declaration. Please note that unless your work experience hours were gained through self-employment, Certification Challenge applications will not be accepted if they are only accompanied by a Statutory Declaration. Non-self-employed applicants must provide an Employer Declaration from at least one employer who can verify work experience. For more information, see Instructions for Certification Challenge. The information provided on this form is used to assess and to validate your work experience in this trade. A. Applicant Name B. Supervisor or Self-Employment Contact Information Enter the contact information for the Supervisor at your previous employer who is unavailable to complete an Employer Declaration, or for your own business if you are self-employed. Name of Organization/Employer/Business: Supervisor Name: Supervisor s Position/Title: Suite Number: Street Number and Name: City: Province: Postal Code: Telephone Number: ( ) Address: Business Registration Number: (Self-Employment only) C. Employment or Self-Employment Information of Applicant Enter the dates and number of hours for this period of employment or self-employment. Combine multiple periods of self-employment on one form, but separate periods of employment with different employers on separate forms. Dates of Employment : Total Number Hours of Tidal Angling Guide Experience Accumulated in that Period: Job Title of Applicant: Vessel Type: Vessel Length: Areas Fished (check all that apply): Strait of Georgia Strait of Juan de Fuca Haida Gwaii North Coast/Hecate Strait Central Coast/Queen Charlotte Sound West Coast Vancouver Island North Vancouver Island /Johnstone Strait Other: Species Fished (check all that apply): Salmon Halibut Ling Cod Rockfish Crab Shrimp/Prawns Other: Page 6 of 10 The Industry Training Authority is an agency of the Government of British Columbia. May 2015

7 D. Reason for Statutory Declaration STATUTORY DECLARATION Indicate why a Statutory Declaration is required for this period of employment: Applicant was self-employed Employer is no longer in business Employer will not complete Employer Declaration Employment records are not available Applicants must attempt to contact current or previous employers to request an Employer Declaration. If you have been unable to obtain an Employer Declaration for any portion of your non-self-employed work experience, indicate the steps you have taken to try to obtain it. If sufficient evidence of steps taken is not provided, the application may not be approved. E. Skill Assessment Please indicate how often the applicant has demonstrated the skills and knowledge in the areas listed below during their period of employment with you. Unit Details Frequently Occasionally Never TAG-1 Encounter situations requiring basic first aid Perform basic first aid procedures TAG-2 Respond to marine emergencies Use marine safety and survival equipment TAG-3 Operate non-pleasure small vessels Refuel non-pleasure small vessels TAG-4 Prepare voyage details and sailing plan Use navigational aids and equipment TAG-5 Operate VHF marine radio equipment Make distress calls and DSC alerts according to procedure TAG-6 Communicate with colleagues and customers in a variety of situations Communicate with supervisors and authorities according to protocol TAG-7 Work and interact effectively with others in the workplace Plan and manage time and tasks effectively Enter the applicant name (repeat on every page of this form). Page 7 of 10 The Industry Training Authority is an agency of the Government of British Columbia. May 2015

8 STATUTORY DECLARATION Unit Details Frequently Occasionally Never TAG-8 Respond to conflict situations safely and professionally Resolve conflict situations encountered in day to day operations TAG-9 Use and share local tourism information in the workplace TAG-10 Follow maritime and tidal angling rules and regulations Inform and instruct others of applicable rules and regulations TAG-11 Apply and follow workplace safety policies and procedures Use and adjust safety and personal protective equipment (PPE) TAG-12 Interact appropriately with other coastal resource users while guiding Supervise the interactions of clients and colleagues with others TAG-13 Interact with the local environment according to protocols/regulations Supervise the interaction of others with the coastal environment TAG-14 Act in an environmentally responsible and sustainable manner Instruct and inform others about environmentally responsible and sustainable behaviour TAG-15 Apply safe food, catch, and bait handling principles and procedures Identify and use cleaning and sanitizing products appropriately TAG-16 Use and maintain angling tools and equipment appropriately Select and match tools and equipment to angling conditions TAG-17 Supervise the catch, release and retention of fish by others Follow and enforce regulations and limits related to recreational fishing TAG-18 Plan and schedule trip activities subject to a variety of circumstances Respond to clients special needs and requests Maintain all necessary trip logs and records Enter the applicant name (repeat on every page of this form). Page 8 of 10 The Industry Training Authority is an agency of the Government of British Columbia. May 2015

9 STATUTORY DECLARATION F. Confirmation of Prerequisite Credentials or Certificates Evidence that the applicant has earned prerequisite credentials or certificates is required before the individual is permitted to challenge certification. Marine Basic First Aid Copy of certificate attached Small Vessel Operator Proficiency (SVOP) Copy of certificate attached Marine Emergency Duties (MED) A3 Copy of certificate attached Restricted Operator s Certificate Maritime (ROC-M) Copy of certificate attached If you have other government issued certificates that exceed these certifications please contact go2 to confirm that they are acceptable substitutes. G. Applicant Signature I certify that the information I have provided is accurate. (Note: Collection and protection of personal information on this form is in accordance with the provisions of the Freedom of Information and Protection of Privacy Act.) Applicant Name (please print): Applicant Signature: Date: Enter the applicant name (repeat on every page of this form). Page 9 of 10 The Industry Training Authority is an agency of the Government of British Columbia. May 2015

10 I. References STATUTORY DECLARATION References must accompany all Statutory Declarations. Include with your completed Statutory Declaration the names and contact information of three individuals who can verify your self-declared work experience in this trade. This may include suppliers (maximum one), former employees (maximum one), contractors, or regular, long-term clients (maximum one). Each individual listed will be contacted by the Industry Training Organization (ITO) responsible for this trade or ITA to verify the information provided on your application. 1. Reference Legal Last Name of Reference: Legal First Name of Reference: Organization/Business Name: Position/Title: Business Phone Number: Reference Cell Number: Relationship to Applicant: Address: 2. Reference Legal Last Name of Reference: Legal First Name of Reference: Organization/Business Name: Position/Title: Business Phone Number: Reference Cell Number: Relationship to Applicant: Address: 3. Reference Legal Last Name of Reference: Legal First Name of Reference: Organization/Business Name: Position/Title: Business Phone Number: Reference Cell Number: Relationship to Applicant: Address: Enter the applicant name (repeat on every page of this form). Page 10 of 10 The Industry Training Authority is an agency of the Government of British Columbia. May 2015