St Neots, Cambs. PE19 8EP or to:

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1 JIB UK-PHMES SMARTCARD CSCS Registration Application Gas Service Engineer Gold card Return to: JIB-PMES. Lovell House, Sandpiper Court, Phoenix Business Park, Eaton Socon, St Neots, Cambs. PE19 8EP or to: Section 1 Your details Title: (Mr, Mrs, etc.) First name: Surname: Home Address: Postcode: Date of birth: NI Number: Home Tel. No. Mobile Tel. No. Colour Photo This photo will be electronically scanned. Please ensure a passport-style photo fits inside the red box. Failure to do so will result in your application being rejected. If posting, please write your national insurance number on the back. address: Please provide your membership number if you are a UNITE THE UNION member as you may be entitled to a free card:. Section 2 Card type and cost Costs (Tick which type of application you are making) Card Details Standard application Fast track application Gas Service Engineer Gold (For L3 qualified operatives) FAST TRACK OPTION With standard applications it can take up to 28 days from the receipt of all required documentation for your card to arrive. For an additional payment of (plus standard card fee) you can request your application to be fast tracked. When an application is fast tracked, we aim for you to receive your card within 4 working days. We require a completed application form, all supporting documentation and cleared payment by credit/debit card, postal order, or BACS transfer (cheques are not acceptable). Please tick the above box to fast track your application. 1

2 Section 3 Health, Safety and Environment Training 1. NVQ/SVQ Exemption (applicable for blue/gold cards) If you have obtained a relevant Level 2 or Level 3 National Vocational Qualification (NVQ/SVQ); NVQ Diploma or applicable Diploma qualification within the past two years, tick this box and include a copy of your completion certificate with your application. Please Note: C&G 6129 or 6035 VRQ certificates are NOT acceptable. Those providing a NARIC equivalence report are NOT entitled to any NVQ/SVQ exemption The exemption period is for a maximum of 2 years from the date on the completion certificate. 2. CITB Health, Safety and Environment (HS&E) Test If you have passed the CITB HS&E test within the past 2 years please tick this box and ensure you send a copy of your test pass letter with this application. 3. CITB Supervisors + CITB Managers and Professionals HS&E Test (applicable for Supervisors/Managers cards) If you have passed either the CITB Supervisors or the CITB Managers and Professionals HS&E Test within the last 2 years please tick this box and ensure you send a copy of your test pass letter with this application. 4. Other applicable Health and Safety Tests If you have passed any other acceptable Health and Safety tests/courses within the last 2 years please ensure you send a copy of your test/course certificate with this application. Failure to provide a copy of your H&S test pass could result in your application form being returned. For a list of acceptable tests, please visit our website: Section 4 Declaration Applicant Declaration By signing the below declaration I certify that the details on this application form are correct and complete to the best of my knowledge. I understand and agree that the information on this application form will be used by the JIB-PMES and its related companies for the purpose of processing my JIB UK-PHMES card application. This may include passing on information to employers, labour agencies or training providers; and for this purpose, the data provided may be entered onto a secure database accessible via a website in accordance with the Data Protection Act I understand that my personal data will be retained by the JIB-PMES and processed in accordance with the requirements of the JIB-PMES Privacy Statement (which can be accessed on the JIB-PMES website: and the JIB-PMES Privacy Policy. I also agree that the information contained in this application form may be used by the JIB-PMES and its related companies in relation to the provision of other services associated with my employment in the plumbing and mechanical engineering services industry, and that information from this application may be held on a database by the JIB-PMES in accordance with the Data Protection Act 2018 and the JIB-PMES Privacy Policy. Important Information: * If your application has been through the initial assessment stage and you decide to withdraw your application an administration fee will be deducted from the refund of your fee. Maximum timescale for refunds is 6 months. * The card remains the property of the JIB-PMES and can be withdrawn at any time. * If all the relevant documentation is not enclosed with the application, the form and all supporting documentation will be returned. * I agree that the JIB-PMES accepts no responsibility or liability for my Registration Card should it be lost in the post. Signed: Date: D D M M Y Y Y Y 2

3 Section 5 Credit/Debit card payment authorisation (do not complete if submitting form by ) Please tick to confirm application type and fee: Standard Fast track I hereby authorise the JIB-PMES to charge to the credit/debit card as detailed below. If you have selected fast track, please ensure that the fast track box on page 1 is also ticked. Card type: Debit Credit Card number: Expiry Date: Security code: (last 3 digits from the back of the card) Cardholder address: Cardholder signature: Cardholder contact telephone number: Cardholder address: ALTERNATIVE METHODS OF PAYMENT BACS: Please phone the JIB-PMES on for instructions POSTAL ORDER: Made payable to JIB-PMES CHEQUE: Made payable to JIB-PMES (Standard applications only) Notes: 1.) If you wish to pay by Credit/Debit card authorisation YOU MUST post this application to us. PLEASE DO NOT a completed Section 5 to us. If you want to your application to us, YOU MUST choose one of the alternative payment methods and leave Section 5 blank. 2.) If we are unable to obtain payment from the above details the application will be rejected without further attempts to contact the cardholder. If you do not wish to complete the card details above please use one of the other methods of payment. Applications without payment will not be processed. 3.) Invoices will not be provided before or after payment. 4.) Receipts must be requested at the time of application. 5.) All details on this page will be destroyed following successful payment. 3

4 Section 6 Gas Service Engineer Gold Card (For guidance notes see reverse) Plumber Gold Card Name: National Insurance Number: Gas Service Engineer Gold Card Minimum qualification - Gas Utilisation Installation Diploma (City & Guilds 6014), NVQ/SVQ Level 3 or City & Guilds Advanced Craft Certificate (See guidance notes). Gas Service Engineer gold cards are also available to those who complete the Gas Engineering Apprenticeship Standard. Please tick against qualifications obtained. L3 NVQ/SVQ, L3 NVQ Diploma or Gas SCOTVEC Modules Gas Engineering Apprenticeship Utilisation L3 Diploma Standard City & Guilds Advanced Craft (Pre ) NARIC Equivalence Report Please ensure you send copies of all your completion certificate with this application. Employment Details Please provide details of your current employer or a company you have worked for (not a domestic client). If you are selfemployed we will accept a company you have sub-contracted for. Your own company details are not acceptable. Contact person (must be a senior member of staff/director): Company Name Address: Postcode: Telephone number: Address: Gas Safe Licence number Note - applications will be returned if a valid Gas Safe Licence number is not provided Please note that checks will be made with the contact person to ensure that details included on this form are accurate and that you are, or have been employed in the PHMES sector. 4

5 Section 7 Guidance Notes Gas Service Engineer UK-PHMES CSCS Registration Card (Gold) i. A gold UK-PHMES CSCS Registration Card is issued to those who have achieved any of the following NVQ/SVQ, NVQ Diploma, Diploma or equivalent City & Guilds Certificates: City & Guilds Final Certificate in Gas Fitting City & Guilds Gas Equip. Fault Diagnosis & Rectification City & Guilds Level 3 Cert. for Service Engineers (GAS) City & Guilds Final Cert in Gas Fitting City & Guilds Licentiateship Gas Services City & Guilds Level NVQ Gas Services Installation & Maintenance City & Guilds Level NVQ Domestic Natural Gas Installation & Maintenance (ACS) City & Guilds Level NVQ in Gas Emergency Service Operations (ACS) City & Guilds Level NVQ in Gas Installation and Maintenance City & Guilds Level NVQ in Gas Service Installation & Maintenance City & Guilds Level NVQ Domestic Natural Gas Maintenance City & Guilds Level Diploma in Gas Utilisation & Maintenance EAL Level Diploma in Gas Utilisation Installation A gold UK-PHMES CSCS Registration Card is also issued to those who achieve the Gas Engineering Apprenticeship Standard. For those who achieve the Apprenticeship Standard, the grade they achieve (i.e. Pass, Merit or Distinction) will also appear on the reverse of the card. ii. iii. iv. UK-PHMES CSCS Registration Cards issued on this basis are valid for up to five years, and may be renewed after that period (subject to renewal rules). This route of entry is permanently open. Those who have achieved their NVQ Diploma or NVQ/SVQ less than two years before applying for their UK-PHMES CSCS Registration Card do not need any further health and safety training/testing to obtain the card, until the card needs renewing. The exemption period is for a maximum of 2 years. v. To obtain a Gas Service Engineer UK-PHMES CSCS Registration Card (Gold), applicants must provide the following: A correctly completed application form plus appropriate fee. A copy of the Level 3 NVQ Diploma, Level 3 NVQ/SVQ Diploma or Gas Engineering Apprenticeship Standard Completion Certificate or City & Guilds Advanced Craft Certificate. Evidence of completing appropriate Health, Safety and Environment training. Evidence of working within the Plumbing and Mechanical Services industry. 5