JIB UK PHMES SMARTCARD CSCS Registration Application

Transcription

1 JIB UK PHMES SMARTCARD CSCS Registration Application Return to: JIB PMES. Lovell House, Sandpiper Court, Phoenix Business Park, Eaton Socon, St Neots, Cambs. PE19 8EP or to pmes.org.uk 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 address: Please provide your membership number if you are a UNITE THE UNION member as you may be entitled to a free card: Card Details: Cost Sections required Plumber Blue , 2, 3, 3a & 4 Plumber Gold , 2, 3, 3a & 5 Heating Fitter Blue , 2, 3, 3a & 6 Heating Fitter Gold , 2, 3, 3a & 7 Mechanical Pipe Fitter Blue , 2, 3, 3a & 8 Mechanical Pipe Fitter Gold , 2, 3, 3a & 9 Gas Service Fitter Blue , 2, 3, 3a & 10 Gas Service Engineer Gold , 2, 3, 3a & 11 Plumbing Related Occupations (Gas) White , 2, 3, 3a & 12 Plumbing Related Occupations White , 2, 3, 3a & 13 Labourer Green , 2, 3, 3a & 14 Plumbing Apprentice/Trainee Red , 2, 3, 3a & 15 Supervisor Gold , 2, 3, 3a & 16 Manager Black , 2, 3, 3a & 17 Site Visitor Yellow , 2, 3, 3a & 18 Card Renewal a & 19 Adult Trainee Red , 2, 3, 3a & 20 Please make cheques/postal orders payable to JIB PMES 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 FAST TRACK OPTION For an additional payment of (plus standard card fee) you can request your application to be 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 box to fast track your application

2 Section 2 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) or NVQ Diploma 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. 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: pmes.org Section 3 Declaration SECTION 3: Applicants 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 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 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 form, all documentation will be returned. * I agree and accept that the JIB PMES bear 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

3 Section 3A Credit/Debit card payment authorisation I hereby authorise the JIB PMES to charge the required fee (plus applicable handling charge) to my credit/debit card as detailed below. Card Type Debit Credit Card number Expiry Date Security code (last 3 digits from the back of the card) Cardholder s address Cardholder s signature Cardholders contact telephone number: address: ALTERNATIVE METHODS OF PAYMENT BACS: Please call the JIB PMES on to make a BACS payment CHEQUE OR POSTAL ORDER MADE PAYABLE TO JIB PMES Note 1: 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. Note 2: Invoices will not be provided before or after payment. Note 3: Receipts must be requested at the time of application. Note 4: All details on this page will be destroyed following successful payment.

4 Section 15 Apprentice/Trainee (Plumbing, Heating Fitter, Gas Fitter or Mechanical Pipefitter) Name: National Insurance Number: Section 15a: This section MUST be completed. Please indicate the National/Scottish Vocational/NVQ Diploma Qualification you are undertaking. Note If you are only studying the 6129/6035 City & Guilds technical certificate and are not continuing to the NVQ qualification you are not entitled to this card. Name of qualification: Level 2 NVQ Diploma Level 3 NVQ Diploma NVQ/SVQ or NVQ Diploma Registration Number (this is issued by your college) Start Date of NVQ Diploma/NVQ/SVQ D D M M Y Y Y Y SECTION 15b: To be completed by College/Training Centre Tutor/Lecturer If you are claiming a 2 year NVQ exemption from the Health, Safety and Environment test, the following must be completed by your tutor/lecturer: (note: exemption is for a maximum of 2 years from the above date) I certify that the applicant named above has successfully completed the appropriate NVQ Diploma/NVQ unit(s) providing exemption from the Plumbing and Gas Health, Safety and Environment test. Signed (by tutor/lecturer) Date D D M M Y Y Y Y Tutor/Lecturer Name Name of College/Training Centre Please note this section is double sided. Section 15a and 15c must be completed.

5 Section 15 (cont.) Apprentice/Trainee (Plumbing, Heating Fitter, Gas Fitter or Mechanical Pipefitter) SECTION 15c: To be completed by Employer of Apprentice or Trainee EMPLOYER S DETAILS AND ENDORSEMENT The Apprentice/Trainee shall undertake recognised training or pursue accreditation of learning and/or experience with a view to achieving a Level 2 or Level 3 NVQ Diploma or NVQ/SVQ in Plumbing, Heating Fitting or Mechanical Pipefitting. By endorsing this application for a JIB PMES CSCS Card as an Apprentice/Trainee, I confirm that the applicant and the employer have entered into an individual partnership arrangement to ensure the applicant has every opportunity to undergo periodic assessment of his knowledge and experience, and gather evidence to prove his normal day to day working experience. I certify that the applicant named above has been employed by this company since D D M M Y Y Y Y Employer s Signature Date D D M M Y Y Y Y Signatory s Name Position in Company Company Name: Address: Postcode: Telephone number: Address: Please make sure you have completed sections 15a,15c and where applicable, section 15b.

6 Section 15 Guidance Notes UK PHMES CSCS Registration Card for Plumbing/Heating/Gas Fitting & Mechanical Pipefitting Apprentices/Trainees i. The Red Apprentice/Trainee card is available for new entrant trainees as follows: ii. iii. iv. Those without prior experience who are registered for an NVQ Diploma or NVQ/SVQ Level 2 or 3 (but who have not yet achieved the qualification) and are employed in the plumbing and mechanical engineering services industry. Adult Trainees who do not have directly relevant industry experience, but who have experience of similar work in other industrial sectors, which their employer believes suits them for training for employment in the plumbing sector and who are registered for an NVQ Diploma or NVQ/SVQ Level 2 or 3 (but who have not yet achieved the qualification) It acts as an identification card during on site training periods. It shows that the cardholder is registered on an NVQ Diploma or NVQ/SVQ appropriate to his/her occupation, but has not yet completed. Before an Apprentice/Trainee card can be issued the applicant must provide one of the following: Confirmation of completing the appropriate health and safety units from the NVQ Diploma or NVQ/SVQ Complete the CITB Health, Safety and Environment test for operatives Complete a CITB approved one day safety course (contact JIB PMES if you are unsure if a course is approved) v. Apprentice /Trainee cards are valid for up to five years, or until the card holder is eligible for a Blue or Gold Card relevant to their occupation. Please note students registered on C&G 6129/6035 (VRQ) technical certificate or other equivalent courses who are not continuing their training to obtain a full qualification are not eligible for this card. Plumbing and Heating Fitter apprentices engaged through JTL Managing Agency should contact JTL directly.