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 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 Email 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 35.00 1, 2, 3, 3a & 4 Plumber Gold 35.00 1, 2, 3, 3a & 5 Heating Fitter Blue 35.00 1, 2, 3, 3a & 6 Heating Fitter Gold 35.00 1, 2, 3, 3a & 7 Mechanical Pipe Fitter Blue 35.00 1, 2, 3, 3a & 8 Mechanical Pipe Fitter Gold 35.00 1, 2, 3, 3a & 9 Gas Service Fitter Blue 35.00 1, 2, 3, 3a & 10 Gas Service Engineer Gold 35.00 1, 2, 3, 3a & 11 Plumbing Related Occupations (Gas) White 35.00 1, 2, 3, 3a & 12 Plumbing Related Occupations White 35.00 1, 2, 3, 3a & 13 Labourer Green 35.00 1, 2, 3, 3a & 14 Plumbing Apprentice/Trainee Red 20.00 1, 2, 3, 3a & 15 Supervisor Gold 35.00 1, 2, 3, 3a & 16 Manager Black 35.00 1, 2, 3, 3a & 17 Site Visitor Yellow 35.00 1, 2, 3, 3a & 18 Card Renewal 35.00 3a & 19 Adult Trainee Red 35.00 1, 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 55.00 (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. We recommend you send your application by Guaranteed/Recorded Delivery.
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. Make sure you have a UK qualification in Health and safety in the construction environment. A full list of accepted qualifications is in the guidance notes in section 14 of this application form. For a list of acceptable tests, please visit our website: www.jib-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 1998. 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 1998. 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
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. Do NOT complete this section if you are returning this form by email. 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: Email address: ALTERNATIVE METHODS OF PAYMENT BACS: Please call the JIB-PMES on 01480 476925 to make a BACS payment CHEQUE OR POSTAL ORDER MADE PAYABLE TO JIB-PMES *Please note you must NOT complete Section 3A with payment details if you EMAIL this Application* 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.
Section 14 Labourer Green Card (For guidance notes see next page) Name: National Insurance Number: The occupation Labourer will appear on your CSCS card. Employment Details Please provide details of your current employer or a company you have worked for (not a domestic client). If you are self - employed we will accept a company you have subcontracted for. Your own company details are not acceptable. Company Name Address Postcode Telephone Number Employers Signature: Name of signatory Position in Company IMPORTANT NOTE *From March 2017 anyone applying for a Green Labourer card (new application) must complete the Level 1 Award in Health and Safety in a Construction Environment or have completed an appropriate equivalent Health & Safety test or qualification. Examples of appropriate equivalent tests/qualifications are included in the Guidance Notes on the next page.
Section 14 Guidance Notes Labourer UK-PHMES CSCS Registration Card (Green) i. A Green JIB-PMES CSCS Card is issued to Labourers who pass the Level 1 Award in Health and Safety in a Construction Environment qualification (or equivalent, including completion of the CITB Health, Safety and Environment operative test) 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. To obtain a Labourer UK-PHMES CSCS Registration Card applicants must: Correctly complete an application form and supply the appropriate fee Pass the Level 1 Award in Health & Safety in a Construction Environment (including completion of the CITB Health, Safety and Environment operative test) or an equivalent qualification (see list below) IMPORTANT NOTE: CHANGES IN THE CRITERIA FOR THIS CARD WITH EFFECT FROM MARCH 2017 From March 2017 new green card applicants will have to complete a Level 1 Award in Health & Safety in a Construction Environment or an appropriate equivalent health & safety test/qualification. Evidence of the test must be provided with the application. The latest news and updates relating to this change will be available on the JIB-PMES website www.jib-pmes.org.uk. Note: Applicants who have completed the City and Guilds 6129 or 6035 Plumbing Studies qualifications (or BPEC/EAL equivalent) qualifications will not have to complete the L1 Award in Health and Safety in a Construction Environment qualification. They will still need to pass the CITB Operatives H,S&E test and provide copies of both qualification and test pass certificates with their applications. The following certificates/qualifications are also currently acceptable as alternatives to the L1 Award In Health and Safety in a Construction Environment qualification. If you have achieved one of these, Please include a copy of the certificate with your application. Please note that the achievement of one of the following qualifications only exempts applicants from having to do the L1 Award in Health and Safety in a Construction qualification. ALL APPLICANTS STILL NEED TO PASS THE CITB OPERATIVES H,S&E TEST. A valid Champion Groundworks Health and Safety Awareness in the Construction Industry A valid GNMA Level 1 Health and Safety in a Construction Environment Certificate A valid JTJ Introduction to Construction Course Certificate A valid One day Site Safety Plus Health and Safety Awareness Certificate A valid Priestman Associates, Principles of Construction Site Health and Safety Certificate DSA Health and Safety Awareness Course certificate ESP Foundation into Construction Course HABC Level 1 Award in Health and Safety for Construction IOSH Working Safely Royal Environmental Health Institute of Scotland (REHIS) Elementary Health and Safety Course Rushmoor Borough Council Health and Safety in Construction Environment L1 Safety Pass Alliance (SPA) Core Construction Course Note: Regardless of any evidence that is included with this card application, the only occupation that will be included on the reverse of the card will be Labourer.