For Craft and Operative level occupations

SECTION A - Your Details - please complete this section

SECTION B - Occupation & Card Details - please complete this section
SECTION C - Employer Declaration - a current or previous employer must complete this section
Title
Surname
Forename
Home
Address
Postcode
ATTACH
PHOTOGRAPH
HERE
CSCS Occupation Title:
Your occupation must be one as listed on the CSCS website: www.cscs.uk.com/occs as titles vary e.g. The CSCS occupation title for a
groundworker is a General Construction Operative
Please tick one box from section 1 and one box from section 2 N.B - Don't forget to attach any necessary evidence - see overleaf.
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)
Grade: A B
Code:
Duplicate New Renewal
N/SVQ level 2 or 3 Approved Apprenticeship
Experienced Worker
(Temporary Card - see reverse)
Industry Accreditation Employer Apprenticeship
Form number: CSCS/CR/01/10
E-mail
address:
Employer name:
Address:
Postcode
Date
Signature:
Print name:
Telephone number:
Levy Registration Number (if known):
Please see reverse of form for further
information on your application.
a different address, which is:
Postcode
A4 I confirm to the best of my knowledge the information above is correct and I agree to comply with the CSCS Scheme rules as laid
out in the CSCS Scheme booklet. I understand and agree that the information on this form will be used by ConstructionSkills for the
purposes of administering the CSCS Scheme, this may include passing on information to Employers or Training Providers and for this
purpose, your data may be entered onto a secure database accessible via a website.
Please note that all application fees are non-refundable. If your application is incomplete you will be given 90 days to resolve any
issues. Any applications returned after 90 days will be subject to an additional 30.00 non-refundable application fee.
We may contact you by mail, telephone or e-mail to let you know about other goods or services or promotions which
may be of interest to you. Please tick this box if you wish to receive such information from us.
Your signature: Date:
DD MM YYYY
Please send VAT receipt
Construction Site Operative N/SVQ Unit card Basic Level Card
Regular Visitor Trainee Construction Related Occupation
Assessed Route
(We do not require a copy of your Health and Safety Test
pass letter as this is stored on our database).
Authorisation code
(See reverse of form for use)
DD MM YYYY
CSCS Registration No.
National Insurance No.
Home/Work Telephone Number
Mobile Number
Date of Birth
A2 I confirm that I meet: current CSCS Health & Safety requirements yes
A3 Send my card to: my home address The company address in section C
A1 Your details:
1. Card Type
2. Skilled Cards
Other Craft & Operative Cards
PLEASE ENSURE THIS BOX IS FULLY COMPLETED (The applicant cannot complete this section)
CSCS SMARTCARD APPLICATION FORM
*




C




S




C




S




0




3




0




2




0




1




0




1




*
C E N S U R A
C O N S U L T I N G
Dear Mr.

Attached is the conversion form for your CSCS card.

Please complete section A, sign it (below section A4-Your signature:) and return with:

1) 2 passport size photos (with your name & signature at the back)

2) A copy of your photo .D. (passport or driving licence)

3) A copy of your CSCS pass certificate
4) Copies of your S/NVQ qualifications, City and Guilds certificate + proof of an apprenticeship
(employer or approved apprenticeship) (except the Electrotechnical qualifications)

By post or recorded delivery.
PIease make sure that you return your appIication strictIy to the address beIow. FaiIure to
do this wiII deIay your appIication.

Censura ConsuIting Ltd
CSCS Department
11 ChurchiII Court
58 Station Road
North Harrow
HA2 7SA
Please be aware that the whole process for the card is 28 working days from the day we
received your application form unless you are a FASTTRACK customer when a 10 day
turnaround is targeted. For FASTTRACK go to http://www.censura.co.uk/cscs
Please tick one of the following and attach with the form:
[ ] authorise you to send to me by normal post (royal mail) to the address have given on the application
form as soon as you receive it, my cscs card. agree and accept that you bear no responsibility or liability
for my cscs card should it be lost or go missing in the post.
[ ] Contact me when you receive the card will instruct you then whether will collect it from your given
collection address or require you to send to me by other method of which understand that all costs will be
borne by me and must be paid in advance to enable you to carry out.
Thank you.
Signature:.............
Print:.............
Date:.........................................
Censura Consulting Ltd, 11 Churchill Court, 58 Station Road, North Harrow HA2 7SA
Tel: 0844 567 1004 ~ Fax: 0844 567 1005 ~ Email: enquiriescensura.co.uk
For Craft and Operative level occupations
SECTION A - Your Details - please complete this section
SECTION B - Occupation & Card Details - please complete this section
SECTION C - Employer Declaration - a current or previous employer must complete this section
Title
Surname
Forename
Home
Address
Postcode
ATTACH
PHOTOGRAPH
HERE
CSCS Occupation Title:
Your occupation must be one as listed on the CSCS website: www.cscs.uk.com/occs as titles vary e.g. The CSCS occupation title for a
groundworker is a General Construction Operative
Please tick one box from section 1 and one box from section 2 N.B - Don't forget to attach any necessary evidence - see overleaf.
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)
Grade: A B
Code:
Duplicate New Renewal
N/SVQ level 2 or 3 Approved Apprenticeship
Experienced Worker
(Temporary Card - see reverse)
Industry Accreditation Employer Apprenticeship
Form number: CSCS/CR/01/10
E-mail
address:
Employer name:
Address:
Postcode
Date
Signature:
Print name:
Telephone number:
Levy Registration Number (if known):
Please see reverse of form for further
information on your application.
a different address, which is:
Postcode
A4 I confirm to the best of my knowledge the information above is correct and I agree to comply with the CSCS Scheme rules as laid
out in the CSCS Scheme booklet. I understand and agree that the information on this form will be used by ConstructionSkills for the
purposes of administering the CSCS Scheme, this may include passing on information to Employers or Training Providers and for this
purpose, your data may be entered onto a secure database accessible via a website.
Please note that all application fees are non-refundable. If your application is incomplete you will be given 90 days to resolve any
issues. Any applications returned after 90 days will be subject to an additional 30.00 non-refundable application fee.
We may contact you by mail, telephone or e-mail to let you know about other goods or services or promotions which
may be of interest to you. Please tick this box if you wish to receive such information from us.
Your signature: Date:
DD MM YYYY
Please send VAT receipt
Construction Site Operative N/SVQ Unit card Basic Level Card
Regular Visitor Trainee Construction Related Occupation
Assessed Route
(We do not require a copy of your Health and Safety Test
pass letter as this is stored on our database).
Authorisation code
(See reverse of form for use)
DD MM YYYY
CSCS Registration No.
National Insurance No.
Home/Work Telephone Number
Mobile Number
Date of Birth
A2 I confirm that I meet: current CSCS Health & Safety requirements yes
A3 Send my card to: my home address The company address in section C
A1 Your details:
1. Card Type
2. Skilled Cards
Other Craft & Operative Cards
PLEASE ENSURE THIS BOX IS FULLY COMPLETED (The applicant cannot complete this section)
CSCS SMARTCARD APPLICATION FORM
*




C




S




C




S




0




3




0




2




0




1




0




1




*
MR
SAMPLE
SAMPLE
1 HIGH STREET
LONDON
LL10 2LL
sample@sample.co.uk
0000001
TN010110M
2010
01
01
012113133321
0772323672
V
V
V
Signature 1
01 01
2010
Construction Site Operative
V
V
SAMPLE LTD.
1 Sample Street
Example Town
SS12
3SS
Signature 2
MR A BROWN
020834343423
C E N S U R A
C O N S U L T I N G
Dear Mr.

Attached is the conversion form for your CSCS card.

Please complete section A, sign it (below section A4-Your signature:) and return with:

1) 2 passport size photos (with your name & signature at the back)

2) A copy of your photo .D. (passport or driving licence)

3) A copy of your CSCS pass certificate
4) Copies of your S/NVQ qualifications, City and Guilds certificate + proof of an apprenticeship
(employer or approved apprenticeship) (except the Electrotechnical qualifications)

By post or recorded delivery.
PIease make sure that you return your appIication strictIy to the address beIow. FaiIure to
do this wiII deIay your appIication.

Censura ConsuIting Ltd
CSCS Department
11 ChurchiII Court
58 Station Road
North Harrow
HA2 7SA
Please be aware that the whole process for the card is 28 working days from the day we
received your application form unless you are a FASTTRACK customer when a 10 day
turnaround is targeted. For FASTTRACK go to http://www.censura.co.uk/cscs
Please tick one of the following and attach with the form:
[ ] authorise you to send to me by normal post (royal mail) to the address have given on the application
form as soon as you receive it, my cscs card. agree and accept that you bear no responsibility or liability
for my cscs card should it be lost or go missing in the post.
[V] Contact me when you receive the card will instruct you then whether will collect it from your given
collection address or require you to send to me by other method of which understand that all costs will be
borne by me and must be paid in advance to enable you to carry out.
Thank you.
Signature:.Signature....
Print:.MR SAMPLE EXAMPLE
Date:.20/05/2010
Censura Consulting Ltd, 11 Churchill Court, 58 Station Road, North Harrow HA2 7SA
Tel: 0844 567 1004 ~ Fax: 0844 567 1005 ~ Email: enquiriescensura.co.uk