Position(s) Sought

/

Current Rate / Salary

/ Desired?

How did you hear of us?

/ Date you are available to start
Personal Information

First Name

/ Last Name(s)
Address
Email Address:
/ Home Tel.
/ UTR Number [if applicable]
Mobile #
/ National Insurance Number
- -
Marital Status: / Date of Birth: / Place of Birth : / Nationality:
Next of Kin to be notified in case of emergency
Name Relationship
Address Tel.
/ Are you legally eligible to accept employment in the UK?
Yes No
Visa Number Visa Type
Do you have any pre existing health conditions?
Do you have any Disabilities?
Have you ever worked with Asbestos or in the asbestos industry, if yes give details
Yes No
Have you filed any workers compensation claims, and if so please explain.
Yes No / Smoker? Yes / No
Do you have a valid driving licence? Yes / No
Do you have your own vehicle? Yes / No
Are you prepared to work at heights? Yes / No
Any criminal convictions pending? Yes / No
Qualifications, Memberships & Courses
Qualification / Course /
Award Date
/
Expires
/
Classification
CSCS
/ / /
CPCS
/ / /
Other
/ / /
Experiences and Accomplishments
Describe your relevant courses, or training you have completed that is in direct relationship to the position you are applying for.
Include particular projects or placements you have worked on.
Work Experience
Describe all work experience (paid and unpaid) starting with most recent.
Dates, From and to (dd/mm/yy)
Name of Organization
City
Tel./ Fax /
Position:
Duties:
Hourly rate:
Reason for leaving:
/ Part-time
Full-time
Other: (specify)
Dates, From and to (dd/mm/yy)
Name of Organization
City
Tel./Fax /
Position:
Duties:
Hourly rate:
Reason for leaving:
/ Part-time
Full-time
Other: (specify)
References
Company Name / Contact Person / Position Title / Tel. Number
I certify that the foregoing particulars are correct and accept that previous employers may be contacted for a reference. I understand that if any information I have given or give in the future, regarding statements of skill, experience and employment, if false or misleading will render me liable to summary dismissal.
I am willing to produce if required, at my own expense a statement by a qualified Medical Practitioner confirming that I am fit to work in the construction industry. I agree to undergo a medical examination at any time at the request of the Company (at its expense) by my own doctor
or by a Medical Practitioner appointed by the Company., If your medical circumstances change, you must inform the company.
I understand that smoking is prohibited in all areas of the site.
I understand that personal mobile phones can only be used at break times.
The company reserves the right to keep personal information on all registrations and provides such information only in a need to know basis.
By accepting an offer to work, I agree to the company retaining such information, which can include health and sickness information, ethnic origin, trade union memberships and disciplinary matters. I can request access to my records once a year and, if necessary, require corrections should details be faulty.
Date ______Signature ______
FOR PAYE STATUS Details
Bank Name / Branch / Sort Code [6 digits] / Account Number [8 digits]
- -
PLEASE TICK NEXT THE SKILL****
Sectors / Trade / CSCS / CPCS
HVAC / Cleaner / Black Card - Manager / Crawler CraB233
Engineering / Turner / Red Card - Trainee
Construction / Labourer / Blue Card - Skilled Worker / B295ne over 10 tonnes
Rail/LUL / Gateman / Gold Card - Supervisor / Tower Crane
Ground Works / Traffic Marshall / Green Card - Site Operative / Dragline
Building / Banksman / Concrete Pump - Truck Mt
Civils / Slinger / HVCA Skill Card / Forward Tipping Dumper
Demolition / Skilled Labourer / Red - Trainee / Excavator 180
Electrical / Painter / Green - Site Operative / Tracked
Fire Protection / Decorator / Blue - Craft/Experienced / Wheeled
Facilities Man / Handyman / Gold - Adv Craft/Supervisor / Trolley
Qualifications / Groundworker / White - ACRIB/CRO / Luffing
CSCS - Skills Card / Pipelayer / Dark Green - CRO / Above 5 tonnes
LUCAS - Underground / Briklayer / Black - Managerial / Below 5 tonnes
PTS - Sentinel Card / Plaster / White/Yellow - Prof Qual / Above 10 tonnes
MSc - Master Science / Drylinner / Yellow - Site Visitors / Forklift Truck
BSc - Batchelor Science / Carpenter / ECS JIB Card / Telescopic Handler
Ceng - Chartered Eng / Joiner / Platinum Card - Site Man / Reach Truck
C&G - City & Guilds / Shuttering Carpenter / Gold Card - Qualified/Skilled / Hoist
C&G - 2391 Electrical / Plumber / Blue Card -Unqual/Unskilled / Wheeled Loading Shovel
NVQ - National Vocat / Plumbers Mate / Red Card - Trainee/Apprent / Tracked Loading Shovel
C&G - 17th Edition / Pipe Fitter / Experience / Skid Steer Loader
C&G - 16th Edition / Pipe Fitters Mate / Interiors/Exteriors / Motorised Scraper
C&G – Electrical Part P / Sprinkler Fitter / Sprinkler / MEWP - Scissor
CITB - Construction Ind / Sprinkler Mate / BMS - Building Man Systems / MEWP - Boom
CPCS - Construct Plant / Electrician / HV - High Voltage / MEWP - Mast
Apprenticeship / Electrical Improver / Shop Fitting / Piling Rig - Tripod
Dip - Diploma / Electricians Mate / Shuttering / Ride on Roller
Deg - Degree / Machine Driver Below 10t / 1st Fix / Soil/Landfill Compactor
BEng - Batchelor of Eng / Machine Driver Above 10t / 2nd Fix / Agricultural Tractor
HND - High Nation Dip / Dumper Driver / Carpentry / Crawler - Tractor/Dozer
HNC - High Nation Cert / Roller Driver / Healthcare / Crawler - Tractor/ Boom
ONC - Ordin Nation Cert / Forklift Driver / Risk Assesment / Lorry Loader
OND - Ordin Nation Dip / Telehandler / Cat A / Trencher
Training/Courses / Supervisor / Cat B / Skip Handler
PASMA / Engineer / Procurement / Slinger/Signaller
Gateman / Site Manager / Plastering / Loader Compressor
Banksman / Wireman / Stud Wall / Crusher
IOSH - Managing Safely / Assembler / Fire Alarm / Screener
NEBOSH / Fitter / UPS - Uninterr Power Supply / Concrete Pump Trailer Mt
First Aid / Miller / Data Centre / Piling Rig - below 15t
Asbestos Awareness / Setter / LV - Low Voltage / Below 10 tonnes
CCDO - Demolition / Operator / Fire Detection / Above 15 tonnes
CRB - Criminal Records / Programmer / RFP - Request for Proposal / Below 15 tonnes
SSSTS – Site Supervisor / PTS/Sentential Card / BOQ - Bills of Quantities / Piling Rig - Above 15t
SMSTS - Site Man / ES – Eng Supervisor / HMP - Her Majesty’s Prisons / Piling Rig - Below 15t
NRSWA - Streetworks / CC - Crane Controller / Purchase Ledger / Dump Truck - Articulated
PAL - Powered Access / MC - Machine Controller / Bid Submission / Dump Truck - Rigid
AAT - Accounting / Site Access Controller / Bidding / Excavator 360 below 10t
WRAS - Water Reg / Road Blockman / PQQ - PreQual Questionnaire / Excavator 360 above 10t
Schuco / Site Warden / RFT - Request for Tender / Mobile Crane
Confined Spaces / Lookout / NHS - National Health / Appointed Person – Lift Ops
Manual Handling / Barrierman / EDMS - Electronic Document / Crane/Lifting Op Supervisor
Small Tools / Patrolman / RFI - Request for Information / Pedestrian Op Tower Crane
ACS GAS / Strapman / Facade / Demolition Plant
CEN1 - Domestic Wet / PICOW / Building Envelope / Compact Crane
CCN1 – Ass Domestic / TO - Technical Officer / Roofing / Tunnel Locomotive
COCN1 – Comm Core / RIMINI Planner / Cladding / Plant Driving
CCCN1 – Comm Catering / STO with Handback / Rainscreen / Soil Stabiliser
WELDING / PTO with Handback / Curtain Walling / Static Concrete Boom
MIG / Confined Spaces / CDM - Const Design Man / Rubber Duck
TIG / Medical / Purchasing / LUCAS
ASMIE 9 / D&A - Drug & Alcohol Test / Retail / Fire Watchman
CODOO / Green Card - Less than 2y / SOW - Statement of Works / SPIC
COSS - Controller Of Site / Pat Testing / CP1 – Confined Spaces
PC - Protection Controller / PPM - Plan Preventive Maint / CP2 – Confined Spaces
SPIC / QAF54
IWA - Individual Work Alon

LITERACY & NUMERACY ASSESSMENT

PLEASE FILL IN BOX 1 WITH YOUR FULL NAME, ADDRESS, POST CODE AND DATE OF BIRTH.

USING THE PHONETIC ALPHABET PROVIDED IN BOX 2 BELOW, PLEASE COMPLETE THE QUESTION IN BOX 3.

BOX2

A – ALPHA / H – HOTEL / O – OSCAR / V – VICTOR
B – BRAVO / I – INDIA / P – PAPA / W – WHISKEY
C – CHARLIE / J – JULIET / Q – QUEBEC / X – XRAY
D – DELTA / K – KILO / R – ROMEO / Y – YANKEE
E – ECHO / L – LIMA / S – SIERRA / Z – ZULU
F – FOXTROT / M – MIKE / T – TANGO
G – GOLF / N – NOVEMBER / U – UNIFORM

MEDICAL SELF CERTIFICATION

Alertness and reasonable physical fitness are essential for duties which may interact with moving trains. It is, therefore, important to be accurate with your answers to this questionnaire, although trivial matters should be ignored (e.g. transient dizziness while gardening two years ago). When you declare NO, you are accepting a degree of responsibility for your safety.

Please study this list and sign the declaration at the bottom:

Yes / No
1 / Do you have Diabetes needing Insulin?
2 / Do you suffer from Epilepsy or fits?
3 / Have you ever had blackouts, recurrent dizziness or any condition, which may cause sudden collapse or incapacity?
4 / Do you get discomfort or pain in the chest or shortness of breath on exercise, e.g. climbing a single flight of stairs?
5 / Do you have difficulty in moving rapidly over short distances, including on slopes, steps or rough ground?
6 / Would you have difficulty in looking over either shoulder?
7 / Would you have difficulty working in out-door open areas?
8 / Would you have difficulty working in enclosed spaces?
9 / Would you have difficulty working above head height (e.g. using ladders or maintenance platforms)?
10a / Do you have difficulty with your eyesight?
10b / If “yes to 10a, do you wear spectacles/ contact lenses?
10c / Do you have difficulty in correctly identifying colours?
11 / Do you have any difficulty with your hearing?
12 / Are you taking any medication that is giving you dizziness or drowsiness?
13 / Have you used, or abused, drugs within the last 12 months?
14 / Have you had any alcohol-related illness during the last 12 months?
15 / Have you had any issues with regards to any form vibration at work (HAVS)