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 or email to info@jib pmes.org.uk 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
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. 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. 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 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 13 Plumbing Related Occupations White Card (For guidance notes see next page) Name: National Insurance Number: Please tick ONE box which best describes your occupation this will be put on the back of your card (Tick one box only) Pump Installer Flue Fitter/Installer Solar Heating Installer CCTV Drainage Installer [ Swimming Pool Installer [ RPZ Valve Engineer Laundry Equipment Installer Unvented System Installer Fuel Tank Installer Medical Gas Services Domestic Installer Lead/Sheet Weathering Installer The above list is not exhaustive. If your occupation is not covered please enter a JOB TITLE below or visit our website for a full list www.jib pmes.org.uk Please note: Only one job title will be put on your 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. *The employer detailed below must sign this section. EMPLOYER S DECLARATION I certify that the details provided by the applicant are correct to the best of my knowledge. The applicant has been known to me for years Company Name: Address: Postcode: Telephone Number: Email Address Employer s signature* Date D D M M Y Y Y Y Position in Company
Section 13 Guidance Notes Plumbing Related Occupations (White Card) i ii. iii. iv. A White UK PHMES CSCS Registration Card is issued to those working in Plumbing Related Occupations e.g. swimming pool installation, sheet weathering, medical gas specialists who pass the CITB Health, Safety and Environment test. For a full list of Plumbing Related occupations visit our website www.jib pmes.org.uk UK PHMES CSCS Registration Cards are valid for up to five years, and may be renewed that period (subject to renewal rules). This route of entry is permanently open. To obtain a White UK PHMES CSCS Registration Gas Card, applicants must: Correctly complete the application form and supply the appropriate fee. Provide evidence of completing appropriate Health, Safety and Environment training Provide a job title which describes the type of work the applicant undertakes together with confirmation from an employer validating experience in this field.