Work Experience Red SmartCard Application Form JIB UK-PHMES CSCS HOW TO APPLY: Enter your name, address and other personal details on this page. Your tutor should complete section 3 (the card will be sent to this contact) Attach a passport-style colour photograph of yourself in the space provided 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 Return this application to: JIB-PMES, Lovell House, Sandpiper Court, Phoenix Business Park, Eaton Socon, St Neots, Cambs PE19 8EP WORK EXPERIENCE CARD TERMS & CONDITIONS Please read this information carefully and sign the disclaimer before completing the application form. This card is specifically for learners who are engaged on a high quality work experience placement. The purpose of this card is to allow the cardholder to access CSCS card-controlled sites with their designated employer to undertake work experience. This card is NOT permitted to be used for access to CSCS card-controlled sites for the purpose of completing paid work The card will be valid for 12 months only and CANNOT be renewed. If, as a result of the work experience placement, the learner is offered a formal apprenticeship with an employer and is then enrolled on the appropriate sector specific NVQ/NVQ Diploma qualification, the work experience card must be returned immediately and will be replaced with a JIB-PMES Apprentice/Trainee CSCS card. There is a charge of 20.00 for this card Disclaimer: I confirm that I understand the information outlined above and agree to adhere to the terms & conditions relating to the JIB-PHMES Work Experience CSCS card. Signature: Section 1 Your details Da Title (Mr, Mrs etc) First Name Date: Surname Address Date of birth Contact Telephone number Postcode National Insurance Number Methods of payment: Cheque/Postal Order payable to JIB-PMES BACS payment call the JIB-PMES on 01480 476925 Debit/Credit card payment complete section 3A
Section 2 Health and Safety Training To meet the Health and Safety criteria for this card, please provide the following: Evidence of passing a recognised JIB-PMES CITB Health, Safety & Environment Test (a list of acceptable tests is on our website www.jibpmes.org.uk) OR Evidence of successfully completing a programme of learning which includes completion of the appropriate Health and Safety modules of one of the following qualifications: Access to Building Services Engineering (L1 or L2) Diploma in the Built Environment or Engineering (BSE option) Plumbing/H&V technical certificate L2 NC/HNC/HND in the Built Environment (BSE option) L2/L3 full-time Diploma in Plumbing/H&V studies Traineeship (BSE specific) Study programme (BSE specific) Please tick the box to confirm that you have met this criteria and that you have either included a copy of your test certificate or that your college/centre tutor has completed the declaration below (Section 3b) confirming your successful completion of Health, Safety & Environment units. Section 3 College/Training Centre Section 3.1 to be completed by the College or Training Provider Tutor/Lecturer (Please note that the card will be sent to this contact) I certify that the applicant named in Section 1 has met the criteria for the work experience placement (as detailed in the Guidance Notes) and is currently enrolled on the following qualification Signed (By tutor/lecturer) Date Tutor/Lecturer Name College/Training Centre Name and postal address (where the card will be sent to) Section 3.2 This section to be completed ONLY if the applicant has NOT completed a recognised JIB-PMES CITB Health, Safety & Environment test. I certify that the applicant named on Section 1 has successfully completed the appropriate Health & Safety units that are contained within the qualification stated on Section 3.1 Signed (By tutor/lecturer) Date
Section 3A I hereby authorise the JIB-PMES to charge the required fee (plus applicable handling charge) to my credit/debit card as detailed below. Do NOT complete this section if you are returning this form by email. 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 *Please note you must NOT complete Section 3A with payment details if you EMAIL this Application* Note 1: If we are unable to obtain payment from the above details, dependant on time constraints, we may attempt to contact you. However, this application may be rejected without further attempts to contact the cardholder. Note 2: Invoices will not be provided prior to 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 4 Declaration SECTION 4: 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
WORK EXPERIENCE GUIDANCE NOTES JIB UK-PHMES Work Experience Card A Work Experience card is available for trainees who are recommended by their college/training provider and who meet the following criteria: The applicant is enrolled on one of the following full-time Building Services Engineering (BSE) qualification: Access to Building Services Engineering (L1 or L2) Diploma in the Built Environment or Engineering (BSE option) Plumbing/H&V technical certificate L2 NC/HNC/HND in the Built Environment (BSE option) L2/L3 full-time Diploma in Plumbing/H&V studies Traineeship (BSE specific) Study programme (BSE specific) The applicant has completed an approved CITB Health, Safety & Environment test or have completed the appropriate health & safety training as part of one of the above qualifications To demonstrate a good attitude and is punctual whilst studying at college Achieved a high standard of success in theoretical and practical tasks and assignments undertaken at college To demonstrate good practical skills and have a basic understanding of the materials, equipment and hand tools used in the BSE sector Demonstrate a good understanding of the career routes and progression opportunities within the BSE sector Show a real desire to work in the BSE sector and progress to a recognised apprenticeship framework Is willing to commit to undertaking a work experience placement over a set period of time ie 2 days per week over a 2 month period Willingness to travel to the company s place of work and to fit into the normal working practices of the organisation To conduct themselves professionally at all times and be an excellent ambassador for the college thereby inspiring and mentoring peers in the future. The purpose of this card is to allow the cardholder to access CSCS card-controlled sites with their designated employer in order to undertake work experience. This card is not permitted to be used to gain access to card-controlled CSCS sites for the purpose of carrying out paid employment. This card is valid for 12 months and CANNOT be renewed. If, as a result of the work experience placement, the learner is offered a formal apprenticeship with an employer and is then enrolled on the appropriate sector specific NVQ/NVQ Diploma qualification, the work experience card must be returned immediately and will be replaced with a JIB-PMES Apprentice/Trainee CSCS card. There is a charge of 20.00 for this card. Other JIB-PMES CSCS Registration Cards will be chargeable at the usual rate. If you have queries regarding the completion of this form please refer to the scheme guidance available on our website www.jib-pmes.org.uk or call 01480 476925 for assistance.