SECTION A - Your Details - please complete this section
SECTION B - Occupation & Card Details - please complete this section SECTION C - Employer Declaration - a current or previous employer must complete this section Title Surname Forename Home Address Postcode ATTACH PHOTOGRAPH HERE CSCS Occupation Title: Your occupation must be one as listed on the CSCS website: www.cscs.uk.com/occs as titles vary e.g. The CSCS occupation title for a groundworker is a General Construction Operative Please tick one box from section 1 and one box from section 2 N.B - Don't forget to attach any necessary evidence - see overleaf. By completing and signing the declaration below, I certify that: The applicant meets the requirements for the CSCS card they are applying for (www.cscs.uk.com) The applicant has 1 years site experience in the last 3 years (basic level card only) Grade: A B Code: Duplicate New Renewal N/SVQ level 2 or 3 Approved Apprenticeship Experienced Worker (Temporary Card - see reverse) Industry Accreditation Employer Apprenticeship Form number: CSCS/CR/01/10 E-mail address: Employer name: Address: Postcode Date Signature: Print name: Telephone number: Levy Registration Number (if known): Please see reverse of form for further information on your application. a different address, which is: Postcode A4 I confirm to the best of my knowledge the information above is correct and I agree to comply with the CSCS Scheme rules as laid out in the CSCS Scheme booklet. I understand and agree that the information on this form will be used by ConstructionSkills for the purposes of administering the CSCS Scheme, this may include passing on information to Employers or Training Providers and for this purpose, your data may be entered onto a secure database accessible via a website. Please note that all application fees are non-refundable. If your application is incomplete you will be given 90 days to resolve any issues. Any applications returned after 90 days will be subject to an additional 30.00 non-refundable application fee. We may contact you by mail, telephone or e-mail to let you know about other goods or services or promotions which may be of interest to you. Please tick this box if you wish to receive such information from us. Your signature: Date: DD MM YYYY Please send VAT receipt Construction Site Operative N/SVQ Unit card Basic Level Card Regular Visitor Trainee Construction Related Occupation Assessed Route (We do not require a copy of your Health and Safety Test pass letter as this is stored on our database). Authorisation code (See reverse of form for use) DD MM YYYY CSCS Registration No. National Insurance No. Home/Work Telephone Number Mobile Number Date of Birth A2 I confirm that I meet: current CSCS Health & Safety requirements yes A3 Send my card to: my home address The company address in section C A1 Your details: 1. Card Type 2. Skilled Cards Other Craft & Operative Cards PLEASE ENSURE THIS BOX IS FULLY COMPLETED (The applicant cannot complete this section) CSCS SMARTCARD APPLICATION FORM *
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* C E N S U R A C O N S U L T I N G Dear Mr.
Attached is the conversion form for your CSCS card.
Please complete section A, sign it (below section A4-Your signature:) and return with:
1) 2 passport size photos (with your name & signature at the back)
2) A copy of your photo .D. (passport or driving licence)
3) A copy of your CSCS pass certificate 4) Copies of your S/NVQ qualifications, City and Guilds certificate + proof of an apprenticeship (employer or approved apprenticeship) (except the Electrotechnical qualifications)
By post or recorded delivery. PIease make sure that you return your appIication strictIy to the address beIow. FaiIure to do this wiII deIay your appIication.
Censura ConsuIting Ltd CSCS Department 11 ChurchiII Court 58 Station Road North Harrow HA2 7SA Please be aware that the whole process for the card is 28 working days from the day we received your application form unless you are a FASTTRACK customer when a 10 day turnaround is targeted. For FASTTRACK go to http://www.censura.co.uk/cscs Please tick one of the following and attach with the form: [ ] authorise you to send to me by normal post (royal mail) to the address have given on the application form as soon as you receive it, my cscs card. agree and accept that you bear no responsibility or liability for my cscs card should it be lost or go missing in the post. [ ] Contact me when you receive the card will instruct you then whether will collect it from your given collection address or require you to send to me by other method of which understand that all costs will be borne by me and must be paid in advance to enable you to carry out. Thank you. Signature:............. Print:............. Date:......................................... Censura Consulting Ltd, 11 Churchill Court, 58 Station Road, North Harrow HA2 7SA Tel: 0844 567 1004 ~ Fax: 0844 567 1005 ~ Email: enquiriescensura.co.uk For Craft and Operative level occupations SECTION A - Your Details - please complete this section SECTION B - Occupation & Card Details - please complete this section SECTION C - Employer Declaration - a current or previous employer must complete this section Title Surname Forename Home Address Postcode ATTACH PHOTOGRAPH HERE CSCS Occupation Title: Your occupation must be one as listed on the CSCS website: www.cscs.uk.com/occs as titles vary e.g. The CSCS occupation title for a groundworker is a General Construction Operative Please tick one box from section 1 and one box from section 2 N.B - Don't forget to attach any necessary evidence - see overleaf. By completing and signing the declaration below, I certify that: The applicant meets the requirements for the CSCS card they are applying for (www.cscs.uk.com) The applicant has 1 years site experience in the last 3 years (basic level card only) Grade: A B Code: Duplicate New Renewal N/SVQ level 2 or 3 Approved Apprenticeship Experienced Worker (Temporary Card - see reverse) Industry Accreditation Employer Apprenticeship Form number: CSCS/CR/01/10 E-mail address: Employer name: Address: Postcode Date Signature: Print name: Telephone number: Levy Registration Number (if known): Please see reverse of form for further information on your application. a different address, which is: Postcode A4 I confirm to the best of my knowledge the information above is correct and I agree to comply with the CSCS Scheme rules as laid out in the CSCS Scheme booklet. I understand and agree that the information on this form will be used by ConstructionSkills for the purposes of administering the CSCS Scheme, this may include passing on information to Employers or Training Providers and for this purpose, your data may be entered onto a secure database accessible via a website. Please note that all application fees are non-refundable. If your application is incomplete you will be given 90 days to resolve any issues. Any applications returned after 90 days will be subject to an additional 30.00 non-refundable application fee. We may contact you by mail, telephone or e-mail to let you know about other goods or services or promotions which may be of interest to you. Please tick this box if you wish to receive such information from us. Your signature: Date: DD MM YYYY Please send VAT receipt Construction Site Operative N/SVQ Unit card Basic Level Card Regular Visitor Trainee Construction Related Occupation Assessed Route (We do not require a copy of your Health and Safety Test pass letter as this is stored on our database). Authorisation code (See reverse of form for use) DD MM YYYY CSCS Registration No. National Insurance No. Home/Work Telephone Number Mobile Number Date of Birth A2 I confirm that I meet: current CSCS Health & Safety requirements yes A3 Send my card to: my home address The company address in section C A1 Your details: 1. Card Type 2. Skilled Cards Other Craft & Operative Cards PLEASE ENSURE THIS BOX IS FULLY COMPLETED (The applicant cannot complete this section) CSCS SMARTCARD APPLICATION FORM *
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* MR SAMPLE SAMPLE 1 HIGH STREET LONDON LL10 2LL sample@sample.co.uk 0000001 TN010110M 2010 01 01 012113133321 0772323672 V V V Signature 1 01 01 2010 Construction Site Operative V V SAMPLE LTD. 1 Sample Street Example Town SS12 3SS Signature 2 MR A BROWN 020834343423 C E N S U R A C O N S U L T I N G Dear Mr.
Attached is the conversion form for your CSCS card.
Please complete section A, sign it (below section A4-Your signature:) and return with:
1) 2 passport size photos (with your name & signature at the back)
2) A copy of your photo .D. (passport or driving licence)
3) A copy of your CSCS pass certificate 4) Copies of your S/NVQ qualifications, City and Guilds certificate + proof of an apprenticeship (employer or approved apprenticeship) (except the Electrotechnical qualifications)
By post or recorded delivery. PIease make sure that you return your appIication strictIy to the address beIow. FaiIure to do this wiII deIay your appIication.
Censura ConsuIting Ltd CSCS Department 11 ChurchiII Court 58 Station Road North Harrow HA2 7SA Please be aware that the whole process for the card is 28 working days from the day we received your application form unless you are a FASTTRACK customer when a 10 day turnaround is targeted. For FASTTRACK go to http://www.censura.co.uk/cscs Please tick one of the following and attach with the form: [ ] authorise you to send to me by normal post (royal mail) to the address have given on the application form as soon as you receive it, my cscs card. agree and accept that you bear no responsibility or liability for my cscs card should it be lost or go missing in the post. [V] Contact me when you receive the card will instruct you then whether will collect it from your given collection address or require you to send to me by other method of which understand that all costs will be borne by me and must be paid in advance to enable you to carry out. Thank you. Signature:.Signature.... Print:.MR SAMPLE EXAMPLE Date:.20/05/2010 Censura Consulting Ltd, 11 Churchill Court, 58 Station Road, North Harrow HA2 7SA Tel: 0844 567 1004 ~ Fax: 0844 567 1005 ~ Email: enquiriescensura.co.uk