Please Complete This Form and Return It, by Post To

Membership Enrolment V2

Please complete this form and return it, by post to:

The National Logistic Training Consortium, 1 Portside, Portside North Business Park, Ellesmere Port, CH65 2HQ

Or complete and e mail the completed forms to

Company Name
Trading Address
Contact Person
Contact Telephone No
Contact E Mail
Company
Do you currently deliver ADR training? / Initial courses / Tanks
Refresher courses / Class 1
Mobile courses / Class 7
Number of instructors
Please list Driver CPC courses, other than ADR, that you currently deliver; if any.
(optional) / Driver CPC
Driver CPC
Driver CPC
Driver CPC
Driver CPC
Please list any other courses you currently deliver
(optional)
Please list any awarding bodies you are currently approved by. Include SQA / JAUPT approval numbers if applicable. / SQA / JAUPT
Please provide a Nominated Person who will receive voting rights on behalf of this company
Name
Position in company
Please sign, print and date the bottom of each page

Instructor Details

Please copy this form and complete one form per instructor

Continue on a copied form if required

Instructor Name
ADR Subject(s) / Core / Packs / Classes
Tanks / Explosive / Radioactive
SQA Instructor No
DGSA / No / Yes / Number
Last SQA grade awarded while this instructor was invigilated
Driver CPC
Please complete the instructor subject knowledge and experience page.
Also, please list any additional information below (optional)
Knowledge / Experience

Location / Venue Details

This form must be completed for each training venue used.

Please note that training is only authorised at venues once this form has been completed and received by NLTC.

Address
Name of person conducting assessment / Position in company
Date of assessment / Room No
Assessment
Item / Number / Acceptable
Or Yes / Fail
Or No
How many candidates can be seated
How many seats are available
Room for invigilator during a full course
Is access granted for an invigilator
Condition of electrical equipment
Is parking available on site
Are refreshments available
Is food available
Approximate square feet of class
Is the room free from distractions
Does the room have a fire exit
Does the venue have a fire plan
Is there room for practical exercises
What is the state of décor
Is there access for disabled people
Is the temperature adequate
Is the lighting adequate
Can all candidates clearly see the screen
Can SQA examinations rules be met
Is there a rest area for candidates
Please sign this box, confirming that in your opinion the room / venue is safe and adequate for use for training courses. Electronic signature is acceptable.
Signature Print Name Date
Please indicate what Driver CPC courses you would like the NLTC to provide.
We will provide a full 35 hours of Driver CPC to members, however in the interest of all members these courses will be decided by means of the most commonly requested via this form.
Outline / Contents
NLTC can incorporate some Driver CPC courses that members specifically require. There is a charge of £252 for this – paid to JAUPT- for course approval if the member has an existing course. There is an additional charge if NLTC is required to write and produce the course . If other members choose to use this course and, therefore, it becomes part of the Driver CPC courses provided by NLTC; then this money will be refunded to you.
Please contact NLTC if you require additional / specific course including or manufacturing.

Please complete this form stating that you, or your instructor, have sufficient experience and subject knowledge to deliver the Driver CPC courses listed below. Tick each box and sign in order to confirm that you, or your instructor has sufficient knowledge or experience, in your opinion, to deliver each of these courses. If you, or your instructor, does not have sufficient experience or knowledge then you, or your instructor, will be required to undertake an NLTC training course on that course.

Course / Experience / Knowledge / Signature
Vehicle Checks and Defects
Company and Public Image
Drivers Hours
Economical Driving
Emergency Aid
Health & Safety
Licence, Weights & Dimensions
Security
Tachograph
Tiredness, Diet & Lifestyle
Instructor Name
Instructor Name
Instructor Name
Your Company
NLTC Number / Completed by NLTC
Name of person completing this form
Date of form completion
Position in company
Signature
Please complete this form and sign confirmation below
Question / Yes / No / See Notes
Do you have experience in adult training
Are you currently approved by JAUPT
Have you ever been approved by JAUPT
Have you ever been suspended from trading
Have you ever been suspended from training
Are you currently suspended or disqualified from trading
Are you currently suspended or disqualified from training
Are you aware of any reason why you would not be permitted to conduct adult training
Are you aware of any other issue, condition or matter that the consortium should be aware of
If you have answered YES to either of the last two question please give details in the NOTES section
The signature below confirms that the information contained within this form is correct, current and without negligent or intentional misrepresentation
Print Name
Date
Signature
NOTES
Please use this page to make any comments or include any relevant information

Confirmation of Accuracy

Members should sign the box at the bottom of this page confirming that all of the information given within the entire document is correct, accurate and up to date; furthermore the information is given without misrepresentation or omission.

Signature confirms that the signatory has authorisation from the company represented to complete this form and holds a position with said company of authority relevant to complete this form.

The signature also confirms that as a member, the company; including all persons associated, will abide by the consortium rules, both at the time of joining and any future corrigendum’s, addendum’s or alteration and additions implemented by the consortium.

Signature ………………………………………………………………………………………..

Position in company

Printed NameDate