SHENA - Workplace Safety and Health Auditor's Application Form

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Workplace Safety and Health Auditor's Application Form

APPLICANT'S DETAILS

APPLICATION TYPE*

New* Renewal*

DETAILS OF APPLICANT

Applicant's Name (as per IC / Passport)*

IC No. (For Brunei Citizen, Permanent Resident or Temporary Resident) / Passport No (Foreign Application)

Date of Birth*

Gender*

Male* Female*

Residential Address*

Mailing Address*

Contact No. (Mobile Number)*

Contact No. (Office Number)*

E-mail Address*

QUALIFICATION ACQUIRED

Highest Academic Qualification (Please state name of Course)*

Awarding Institution*

Issue Date*

LIST OF PREVIOUS EMPLOYMENT

Company	Job Position	Duration

SUPPORTING DOCUMENTS

Highest academic Qualifications*

Applicant Identity Card (IC) (for Brunei Citizen, Permanent Resident or Temporary Resident) / Passport No (for Foreign application)*

Curriculum Vitae (CV)*

Letter of Appointment/ Nomination of the individual appointed by the company as WSH Auditor*

Other supporting certificate*

Certificate of other relevant Workplace Safety and Health Certificate*

I declare that all particulars and information provided in this application and the documents attached hereto are true to the best of my knowledge and belief, and I understand that the Safety, Health and Environment National Authority (SHENA) reserves the right to reject this application if, at any stage, the information provided is false and incorrect. Should verification be required on any information provided in this application, I hereby authorise SHENA to carry out the necessary investigations.

Declaration of Applicant

I agree

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