Attach SECTION One Colour C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER SECTION C Passport TO BE COMPLETED BY THE ACCREDITED

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1 Attach SECTION One Colour C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER SECTION C Passport TO BE COMPLETED BY THE ACCREDITED TRAININ Photograph Please G PROVIDER print your name on reverse Supervisor, Manager, Senior Manager CSR Application This application form is required for all operatives completing the Supervisor, Manager and Senior Manager Health and Safety training. CSR One Day Health and Safety training applications should be made on form CSR.02 V3.0 SECTION A TO BE COMPLETED BY THE APPLICANT (Please use BLOCK CAPITALS) 1. TYPE OF CARD REQUIRED (Please tick) New Upgrade Renewal Skill Area: 2. PERSONAL DETAILS Title: (Mr, Miss, Mrs, Ms) Forename: Surname: Home Address: Telephone Number: National Insurance No: Address: Date of Birth: Post Code: 3. EMPLOYMENT STATUS & DETAILS (Please tick) Employed Self Employed Unemployed Employer Name: Address: Telephone Number: Employer Contact Name: Address: Post Code: 4. NVQ If the Applicant does not hold an NVQ an employer, main contractor or sub-contractor must complete Number 7 below. Applicants should continue at Number 5. NVQ Title: Highest Level NVQ Awarded: Certificate Number: Date Awarded: Do you hold a construction related degree: PLEASE ATTACH A COPY OF NVQ CERTIFICATE If yes, Degree title: 5. CURRENT CARD DETAILS (if known) 6. APPLICANT S SIGNATURE (Applicable only to Renewals and Upgrades. New Applicants please move to Number 6.) Registration Number: Skill Area: Expiry Date: SECTION B I certify that the above details are correct. Signature: Date: TO BE COMPLETED BY THE EMPLOYER (Please use BLOCK CAPITALS) 7. CONFIRMATION OF RELEVANT INDUSTRY EXPERIENCE (OCCUPATIONAL ASSESSMENT/NON-NVQ APPLICANTS) To be completed by the employer. If the Applicant is self-employed or unemployed this section may be completed by a main contractor or sub-contractor. THE APPLICANT MUST NOT SIGN. I certify that the Applicant named above has achieved a satisfactory standard of workmanship and has been engaged in the selected skill area within the last five years. Company Name: Address: Telephone Number: Signature: Position: Address: Post Code: Print Name: Date: FORM CSR.03 V4.0 28/11/2016

2 SECTION C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER 8. CONTACT DETAILS Accredited Training Provider: Contact Name: 9. CHECKLIST (Documents must be retained by Training Provider for monitoring purposes) Date Health and Safety Training Completed: Date CSkills Health & Safety Touch Screen Test Completed: (Required for Site Supervisor Cards only) NVQ Title and Level: Date NVQ Certificate Awarded: OR Date of Assessment: Assessor: Card Colour Awarded: Site Supervisor (Gold) Manager (Platinum) Senior Manager (Black) Skill Category Awarded SECTION C CHECKLIST Copy of one of the required Health and Safety Certificates for Managers/Senior Managers I enclose a cheque for card and assessment 190+VAT ( 228). Cheques should be made payable to Construction First Ltd, Or I enclose a cheque for a renewal card only 50+VAT ( 60). Cheques should be made payable to Construction First Ltd, Or I have made payment by BACS. Sort Code: , Account No , Danske Bank Colour Passport Photograph enclosed (Please print name on reverse) 10. RETURN OF APPLICATION FORM The completed application form should be returned to: Construction First Limited 143 Malone Road Belfast BT9 6SX SECTION D 11. DATA PROTECTION ACT The information provided by you in this application form will be held on the CSR database and will be used for the following purpose: - to maintain an accurate and up to date record of workers in the construction industry who have met the requirements of CSR We may share your information with our associated service companies and third parties with whom we have a business relationship unless you inform us otherwise in writing. You have a right to apply for a copy of your information and to have any inaccuracies corrected.

3 Construction Skills Register Senior Manager Pre-Assessment Questionnaire Please complete this questionnaire and return it to Construction First Limited 1. Candidate s Personal Details Title (Mr/Miss/Mrs/Ms):... Forename:... Surname:... Home Address: Post Code:... National Insurance No: / / / / Date of Birth: / / 2. Employer s Contact Details Employers Name:... Address: Post Code:... Telephone Number:... Address:... Employer Contact Name: Employment Details Currently Employed By:... As:... For:... yrs... mths Previously Employed By:... As:... For:... yrs... mths 4. Candidate s Professional And Other Qualifications Data Protection The information provided by you in this assessment will be held in paper and electronic form and will be used to maintain an accurate and up to date record of workers in the construction industry who have met the requirements of CSR. You have a right to apply for a copy of your information and to have any inaccuracies corrected. We may share your information with our associated service companies and third parties with whom we have a business relationship. Please tick here if you do not wish to receive this information. ( )

4 Information for Senior Manager Candidates Overview (i) (ii) Candidates for this qualification are expected to have substantial and extensive experience, knowledge and understanding of the operational and general management of a construction company. They will have a significant role in management and will have a good understanding of the financial management of the company or their part of the company. The candidates are unlikely to carry out personally all the different functions (eg tendering, programming, work methods, cost/valuation reports, contractual claims, etc). They will, however, be responsible for ensuring these functions are carried out properly and that, ultimately, the customer s requirements are met and the work is carried out profitably and safely to the right quality. Candidates should: Have operational responsibility for substantial programmes and resources Have a broad span of control Proactively identify and implement change and improvements in quality Negotiate budgets and contracts Lead high level meetings (iii) Some candidates may have less involvement with operational matters and more involvement in strategic matters and the organisation s structures and systems. This will be recognised. These candidates should: Have responsibility for substantial programmes and resources Have responsibility for the strategic development of the organisation Have a broad span of control Proactively identify and implement change and improvements in quality Negotiate budgets and contracts Lead high level meetings (iv) In order to fulfil their managerial responsibilities, candidates will be required to demonstrate good human resource management through communication, delegation, team building, motivation, control and training. Note Where applicable, National Vocational Qualifications at Level 5 have been used as a guide for the assessment process. Return of Assessment Form The completed assessment form and the relevant payment should be sent to Construction First Limited, 143 Malone Road, Belfast, BT9 6SX.

5 Assessment Questionnaire The purpose of this questionnaire is to prepare you and your assessor in the areas of management that you feel yourself to be competent and that you will be questioned on. The interview is to establish the level of responsibility, involvement and competence that you have in managing the various units described. It is not expected that you will be very involved in all units. In order to indicate the degree to which you have been responsible for, involved in and consider yourself competent in the particular subject, please tick (1) for very, (2) for moderately, (3) for little and (4) for none. UNIT 1.0 UNIT 2.0 UNIT 3.0 UNIT 4.0 UNIT 5.0 Develop and agree a contract brief Please tick 1.1 Use of Conditions of Contract, Specification, Bills of Quantity, Drawings (1) (2) (3) (4) Manage and participate in the preparation, processing and finalising of estimates, bids and tenders 2.1 Manage the assessment and selection of potential tenderers eg subcontractors and suppliers for your tender (1) (2) (3) (4) 2.2 Participate in the preparation and finalising of tenders (1) (2) (3) (4) Manage the development and content of a procurement programme of subcontractors, materials, etc (ie after the award of the contract) (1) (2) (3) (4) Manage the planning of work methods, resources and systems to meet contract requirements 4.1 Manage the evaluation and selection of contract methods (1) (2) (3) (4) 4.2 Manage the planning of work activities and resources to meet contract requirements (1) (2) (3) (4) 4.3 Manage the selection and formation of contract teams (1) (2) (3) (4) 4.4 Manage the operation and maintenance of organisation and communication systems (1) (2) (3) (4) Control contract costs, quality, progress and financial claims with understanding of overall financial management 5.1 Control contract costs (1) (2) (3) (4) 5.2 Control contract quality standards (1) (2) (3) (4) 5.3 Maintain compliance of a contract with legal and statutory requirements (1) (2) (3) (4) 5.4 Control contract progress (1) (2) (3) (4) 5.5 Oversee claims for reimbursement for loss and expense (1) (2) (3) (4) 5.6 Understand overall financial management (ie Profit and Loss Account, Balance Sheet, Cash Flow) (1) (2) (3) (4) UNIT 6.0 Manage health, safety, welfare and risk control systems (1) (2) (3) (4) UNIT 7.0 NB Candidates should attend and pass the CFS course, Essential Health & Safety for Senior Executives Manage customer care requirements and contribute to a marketing strategy and corporate image (1) (2) (3) (4) UNIT 8.0 Develop teams, individuals and self (1) (2) (3) (4) UNIT 9.0 Develop effective working relationships Please tick 9.1 Enhance the trust and support of colleagues (1) (2) (3) (4) 9.2 Enhance the trust and support of those to whom you report (1) (2) (3) (4) 9.3 Provide guidance on values at work (1) (2) (3) (4)

6 9.4 Support team members who have problems affecting their performance (1) (2) (3) (4) 9.5 Implement disciplinary and grievance procedures (1) (2) (3) (4) UNIT 10.0 Evaluate and agree design recommendations (Optional Unit) 10.1 Identify and assess design factors (1) (2) (3) (4) 10.2 Select and evaluate existing design options (1) (2) (3) (4) 10.3 Present design recommendations (1) (2) (3) (4) 10.4 Advise customers on a design recommendation (1) (2) (3) (4) UNIT 11.0 Review external and internal operating environments (ie the external market, the economy, legislation, etc and the internal working conditions, communications, etc) (1) (2) (3) (4) UNIT 12.0 Establish strategies to guide the work of your organisation 12.1 Create a shared vision and mission to give purpose to your organisation (1) (2) (3) (4) 12.2 Define values and policies to guide the work of your organisation (1) (2) (3) (4) 12.3 Formulate objectives and strategies to guide your organisation (1) (2) (3) (4) 12.4 Gain support for organisational strategies (1) (2) (3) (4) UNIT 13.0 Evaluate and improve organisational performance (1) (2) (3) (4) Note Please have available at the interview (to be examined by the assessors but not retained by them) some examples of the work you are involved in, such as: (a) (b) (c) (d) (e) (f) (g) (h) (i) Tender summary Contract programme Organisational Structure Minutes of meeting in which you took a leading role Contract cost/valuation report or other method of cost control Letter, minutes, claim make-up or other evidence of involvement in contractual claims or disputes Evidence of continuing training for yourself and others (eg Skills Development Programme) Company disciplinary and grievance procedure Quality Assurance Procedures Employer Confirmation As the Employer of., I confirm that the above information given by him/her on this questionnaire accurately reflects his/her level of responsibility, involvement and competence. Signature of Employer:... Date: / / Position held within Company...