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: ...view middle of the document...
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
(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...