New Zealand Gazette – 1931 – No. 64

Page 2511

✨ Marine Department Application Form



SEPT. 3.]

THE NEW ZEALAND GAZETTE.

(3) Produce a certificate of service from the management
of such railway, giving details of his service, and showing
that the applicant has qualified as a stationary engine-driver
and has actually been employed in that capacity on such
railway.

SCHEDULE.

[Front.]
Marine Department. [Marine—376.
NEW ZEALAND.

APPLICATION FOR ENGINE-DRIVER'S CERTIFICATE.

(After completion, this form, together with other necessary papers and the prescribed fee,
is to be forwarded to the Secretary, Marine Department, Wellington. Before doing this the
applicant is requested to read the instructions printed on the back hereof.)

To be completed by Applicant.
(A)—Certificate required:
(B)—Name, &c., of Applicant.

(1) Christian Names in full. (2) Surname. (3) Address

Date of Birth. Place of Birth.

(4) Day. (5) Month. (6) Year. (7) Name of Place. (8) Country in which situated.

(C)—Particulars of Certificates held and of previous Failures.

If possessed of any Certificate, give Particulars. If failed previously for Certificate
now required, state here.

(9) Number. (10) Description and Class. (11) Date of Issue. (12) Place. (13) Date.

(D)—Statement of qualifying Service in which Proof is submitted herewith.

(14) Employer. (15) Address. (16) From (17) To (18) Capacity in which employed. (19) If driving or attending to Steam Plant, state here Particulars, including H.P. of Boilers and Number and Diameter of Cylinders of Engines.

(E)—Declaration by Applicant.
I hereby apply for the above-mentioned certificate, and declare that the
particulars contained in divisions (B), (C), and (D) of this form are correct and
true to the best of my knowledge and belief.
Signature of applicant:……………………………
Date:…………………. , 19………

For use by Department.
(F)—Certificate as to Receipt of Fee.
I certify that the fee of __ pounds __ shillings __ pence has
been received on Receipt No.
£ : s. : d.
………………………, Receiver.
Date:…………………. , 19………

(G)—Certificate of Examiner.

Date and Place of Examination. Passed or failed. Remarks.
(20) Date. (21) Place. (22) Working Questions


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✨ LLM interpretation of page content

🌾 Regulations for Examinations for Certificates under the Inspection of Machinery Act, 1928 (continued from previous page)

🌾 Primary Industries & Resources
31 August 1931
Examinations, Certificates, Inspection of Machinery Act, Regulations, Fees, Applications, Testimonials, Service, Nationality, Age, Medical Certificates, Replacement, Qualifications, Stationary Engineer, Engine-Driver, Winding-Engine Driver, Steam, Hydraulic, Competency, Practical Test, Oral Examination, Boilers, Engines, Defects, Signals, Mines, Safety

🚂 Application for Engine-Driver's Certificate

🚂 Transport & Communications
Marine Department, Engine-Driver's Certificate, Application Form, Service, Examination, Fees