CSCS SMARTCARD APPLICATION FORM
For Craft and Operative level occupations

Authorisation code (See reverse of form for use)

SECTION A - Your Details - please complete this section
A1 Your details: Title Surname Forename Home Address
ATTACH PHOTOGRAPH HERE

CSCS Registration No. National Insurance No. Date of Birth
DD MM YYYY

Home/Work Telephone Number Mobile Number Postcode

E-mail address: A2 I confirm that I meet: current CSCS Health & Safety requirements A3 Send my card to: my home address yes
(We do not require a copy of your Health and Safety Test pass letter as this is stored on our database).

The company address in section C

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

SECTION B - Occupation & Card Details - please complete this section
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. 1. Card Type Duplicate New Renewal 2. Skilled Cards N/SVQ level 2 or 3 Industry Accreditation Grade: A B N/SVQ Unit card Trainee Basic Level Card Construction Related Occupation Code:
* C S C S 0 3 0 2 0 1 0 1 *

Approved Apprenticeship Employer Apprenticeship

Experienced Worker

(Temporary Card - see reverse)

Other Craft & Operative Cards Construction Site Operative Regular Visitor Assessed Route

SECTION C - Employer Declaration - a current or previous employer must complete this section
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) PLEASE ENSURE THIS BOX IS FULLY COMPLETED (The applicant cannot complete this section) Employer name: Address: Signature:

Print name: Postcode Date Telephone number: Levy Registration Number (if known): Please see reverse of form for further information on your application.
Form number: CSCS/CR/01/10

Section D - Card requirements
Details of evidence required for craft & operative cards: Skilled Cards Approved Apprenticeship - a copy of your completion certificate or other proof of completion. Employer Apprenticeship - a letter from the employer you served your apprenticeship with, stating your name, occupation and completion date, and a copy of your full City & Guilds Craft or Advanced Craft certificate. S/NVQ level 2 or 3 - a copy of your *S/NVQ certificate level 2 or 3 certificate. Industry Accreditation - (only available for a limited number of occupations). **Your employer must read the industry accreditation competences for this card, before signing the box overleaf; ensuring the relevant grade (A or B) is ticked in Section B. If the competences for your occupation ask you to select a number of options from the list provided you must enclose a copy of the competences, with the relevant number of options selected to support your application. Experienced worker cards - this card is issued on a temporary basis, while an S/NVQ is being achieved. It is expected to be replaced by a skilled five year card on achievement of the appropriate S/NVQ. The card is available to everyone with on the job experience (normally at least one year in the last three), but who missed the industry accreditation opportunity. Other Craft & Operative cards Assessed Route - available in some occupations when transferring into CSCS from another scheme e.g. SCORE - you must provide a copy of your existing valid registration card showing the expiry date. N/SVQ unit card - proof of achievement of the relevant *S/NVQ units. Construction Site Operative (labourer) card - you must either supply proof of achievement of a level 1 S/NVQ in the allowed occupations OR **your employer must read the industry accreditation competences for this card, before signing the declaration overleaf. Basic Level card - a copy of your *S/NVQ level 1 certificate. Trainee card - proof of registration onto an *S/NVQ Construction Related Occupations (CRO) card - you must know the full occupation title of the card you are applying for, or the occupation code. **Your employer must read the industry accreditation competences for this card, before signing the box overleaf. Renewals - no other proof is required General Notes *If your S/NVQ registration or certificate was issued by the Awarding Body for Construction (ConstructionSkills /City & Guilds) you do not need to attach a photocopy of your certificate. **The industry accreditation competences can be found at www.cscs.uk.com.

Section E - Check list for returning application forms
IF YOU HAVE NOT ALREADY DONE SO RING 0844 576 8777 TO FIND OUT HOW YOU CAN GET A FASTER SERVICE. Quick Check List Before returning your application please ensure that you have: Completed Section A with your details, attached a photograph and signed and dated the form. Indicated your occupation and which card type you require in Section B. Ensure your employer has completed Section C. Included any extra information required to complete your application. Payment - either • Enclosed payment of £30.00 by cheque or postal order - cheques should be made payable to ConstructionSkills or • If you have pre-paid for your application form enter the authorisation code you were given (see box in top right hand corner of front of this form.) Send form to CSCS PO Box 114, Bircham Newton, King's Lynn, Norfolk, PE31 6XD