Craft and Operative Occupations, Trainees and Site …

1 Section 1 - Your occupationPlease tick the box which best describes your occupation. Tick one box SKILL card for Advanced Modern Apprentice - Please also complete section B Advanced Modern Apprentice (with NVQ/SVQ Level 2)*Blue or Gold SKILL card for Skilled Personnel - Please also complete section Bwith NVQ/SVQ (or recognised equivalents) and/or Indentured ApprenticeshipsYellow Construction site Visitor SKILL card Construction site visitorGreen Mate/Assistant SKILL card Domestic Heating Fitter s Mate/Assistant H&V Craftsman s Mate/Assistant* Plumber s Mate/Assistant Refrigeration/Air Conditioning Technician s/ Engineer s Mate/Assistant Service and Maintenance AssistantRed trainee SKILL card - Please also complete section A Adult trainee Advanced Modern Apprentice (also known as Modern Apprentice - Junior and Intermediate) Commissioning trainee /Assistant Foundation Modern Apprentice (also known as National trainee ) Intermediate Commissioning Balancing Technician Student Engineer* Personnel in occupations marked with an asterisk may also use section B1 of this form to register their National Agreement grade (where relevant).

2 ** Refer to section B Building Services Engineering Service & Maintenance Technician/Engineer Commissioning Engineer Commissioning Technician Domestic Heating Installer/Fitter/Service Engineer Ductwork Erector/Ductwork Installer* Gas Fitter (Domestic) Gas Fitter (Industrial & Commercial)* H&V Fitter* H&V Fitter/Welder* H&V Installer* H&V Pipefitter* H&V Welder* Plumber (Domestic) Plumber (Industrial & Commercial)* Refrigeration/Air Conditioning Technician/Engineer** HOW TO APPLY:1. Please complete sections 1-6 of this form. Section 1 will also tell you if you need to complete any additional sections of the Complete the appropriate section (if applicable) for the Engineering Services SKILL card you are applying for. The additional section (if required) is detailed in section 1 against the occupation you tick. If no section is indicated complete sections Hand this form to your employer (not your agency) together with all supporting documents (certificates etc) and ask them to complete section Attach your photograph in section 2.

3 Remember to write your name and National Insurance number on the Attach a cheque or complete credit card details in section note: please send certified copies of your certificates with your application. They should be signed and endorsed by your : Check 1 - Have you completed all the appropriate sections of this form for the particular type of SKILL card you are applying for? Check 2 - Have you provided evidence that you meet the SKILL card Health and Safety requirements? Check 3 - Have you provided evidence of qualifications/courses to support your application? Check 4 - Have the applicant s and the employer s declaration both been completed? Check 5 - Have you included the appropriate fee for your SKILL card?Fill in the form using black ink and capital letters. If you have any queries about this form or how to complete it, please check the FAQs section of our website ( ) or call us on 01768 860406 Engineering Services SKILL card application form Craft and Operative occupations , Trainees and site Visitor cardsC&O 2017 WEBS ection 3 - Health and Safety awarenessTo obtain a SKILL card, you must within two years prior to the date of application for the card have satisfactorily completed the recognised ConstructionSkills/SKILL card Health, Safety and Environment Test.

4 Alternatively, if you have completed one of the health and safety awareness training courses in the SKILL card list of approved courses, you may also satisfy the requirements for the issue of a SKILL card (provided you undertook the course within two years of applying for your card).If you have obtained a relevant National or Scottish Vocational Qualification, or a qualification under the Qualifications & Credit Framework (NVQ/SVQ/QCF) Level 2 or 3 within the past two years, you do not need to complete this one box and enclose relevant certificates: ConstructionSkills/SKILL card Health, Safety and Environment Test Other approved course (as listed on the SKILL card website) NVQ/SVQ Exemption (see note above)Section 4 - Applicant s declarationI certify that the details on this application are correct and complete to the best of my knowledge.

5 I agree that the information contained on this application form may be used by Engineering Services SKILL card and related companies in the BESA Group in connection with my application for an Engineering Services SKILL card and the provision of other services associated with my employment in the building services engineering industry. I acknowledge that the personal information given here will be used for the purpose of processing my application for an Engineering Services SKILL card, this may include passing on information to employers, labour agencies or training providers and for this purpose, your data may be entered onto a secure database accessible via the website. I also agree that information from this application may be held on a database in accordance with the Data Protection Act agree SKILL card may contact me from time to time with information about SKILL card and information regarding updates or additional services available from SKILL card Ltd and its associated companies.

6 If you do not wish to receive such information please tick here SignatureDate / / Section 2 - Your detailsPlease provide the information requested below, and attach your photograph in the space provided. Write your name and National Insurance number on the back of the photograph. Please complete all would you describe your ethnic origin? White Black (African descent) Black (Caribbean descent) Asian (Indian/Pakistani/Bangladeshi) Asian (Chinese) Other National Insurance number Email addressSurnameForenamesAddress (line 1)Address (line 2)Address (line 3)TownCountyPostcodeMobile telephone number Home telephone numberPlease attach your photograph hereDate of birth / / Date you started in the H&V industry / / Your sex Male FemaleC&O 2017 WEBS ection A - Red trainee SKILL cardComplete this section if you are an Advanced or Foundation Modern Apprentice or Adult TraineePlease indicate the National/Scottish Vocational Qualification, or qualification under the Qualifications and Credit Framework (NVQ/SVQ/QCF) which you are undertaking by ticking the box which applies to tick the level of NVQ/SVQ/QCF you are undertaking.

7 NVQ/SVQ/QCF Level 2 NVQ/SVQ/QCF Level 3 Please tick the trade for which you are receiving training:Section B - Complete this section if you are an Advanced Modern Apprentice (with NVQ/SVQ Level 2) or Skilled Personnel applying for a Blue or Gold SKILL cardPut a tick against each qualification to be shown on your Engineering Services SKILL card. Remember, certified copies of relevant certificates must be attached to this tick the level of qualification you studied:Section B1 - Grade DetailsOnly for applicants employed under the H&V Industry s Operative National you are employed under the National Agreement for the Heating, Ventilating and Air Conditioning industry and wish to register your grade, please tick the grade in which you are employed. Provided you comply with the grading definitions of Clause 6 of the National Agreement, your grade will appear on your SKILL card.

8 Mate Senior Apprentice Installer Craftsman Senior CraftsmanApprenticeship/Upgrading/Indust ry Training Scheme (please specify):Please provide details of any other relevant qualifications or courses you wish to be considered for inclusion on your SKILL card: Industrial & Commercial Gas Fitting Domestic Plumbing Ductwork Refrigeration Building services Other - please specify below NVQ/SVQ/QCF Level 2 Applicants must hold a relevant Refrigeration qualification as shown below: City & Guilds 2079 City & Guilds Level 2 NVQ Diploma City & Guilds Level 3 Diploma City & Guilds Certificate CITB J11 College attendingDate you started at college NVQ/SVQ/QCF Registration Number / / NVQ/SVQ/QCF Level 3 City & Guilds Craft City & Guilds Advanced Craft SCOTVEC ModulesPlease tick the trade in which you trained.

9 Industrial & Commercial Gas Fitting Domestic Plumbing Ductwork Refrigeration Building services Other - please specify belowComplete this section if you are a Student Engineer/Student Apprentice, Commissioning trainee /Assistant or an Intermediate Commissioning/Balancing TechnicianPlease indicate the details of the recognised building services engineering or construction related qualification for which you have registered at the education establishment where you are being trained, or are * / National* Certificate** / Diploma** (*delete as appropriate) (**delete as appropriate)Please state title of qualificationName and address of educational establishment at which being trained/studyingName of awarding body Building Services Engineering specialism Other relevant engineering/ construction qualifications Construction and the Built Environment with relevant Building Engineering options Mechanical/Electrical EngineeringDate you started training/studying / / C&O 2017 WEBBESA F Gas Cat 1 Section 5 - Employer endorsementSection 5 should be completed only by a manager of appropriate seniority within the employing organisation.

10 The applicant must NOT complete this section of the form. If the applicant is unemployed, section 5 should be completed by the applicant s previous employer. If the applicant is self-employed or an agency worker, section 5 should be completed by a manager of appropriate seniority from the applicant s previous employer (NOT the agency).Tick only those boxes in section 5 which are relevant to this application. Not all boxes may need to be ticked. I confirm that the applicant named on this form has been known to me personally in the occupation shown of the front page since: Date / / I confirm that the necessary documentary evidence supporting the qualifications indicated in section B is attached. I also confirm that I have verified them by checking them against the originals, and that I have signed and dated them as authentic. I certify that the photograph is a true likeness of the applicant and that the details on this form are correct to the best of my knowledge.