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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 : 20
th
October 2011