F1/4 TRANSFER OF SOLAS CSCS EXPERIENCED PLANT OPERATOR CARD TO A CPCS COMPETENT OPERATOR CARD To be completed by the applicant and supported by an independent declaration. Please complete this form in BLOCK CAPITALS using a BLACK or BLUE ball point pen. Please ensure the form is completed correctly to prevent it being returned. SECTION B Other Qualifications B1 CITB Health, safety and environment test passed within 2 years of application receipt SECTION C CPCS Category (ies) available A02B Crawler Crane - All sizes A04A Tower Crane - Trolley Jib - Cab controlled A09A Forward Tipping Dumper - Wheeled A12 Excavator 180° above 5 tonnes A17C Telescopic Handler - All sizes exc. 360° Slew A40B Slinger/Signaller - All types - Static duties A56B Dump Truck - Articulated Chassis - All sizes A59A Excavator 360° above 10 tonnes - Tracked A60A Mobile Crane - Blocked Duties only SECTION D Mailing Address SECTION E SOLAS Independent Declaration CPCS F1/4 01-03-2019 I certify that the details on this application are correct to the best of my knowledge for the applicant detailed above, and confirm that the applicant is eligible for the categories indicated in Section C. SECTION F Payment Payment for this card application was included within the CPCS Technical Test notification fee. SECTION A Applicant Details A58A Excavator 360° below 10 tonnes - Tracked A copy of the front and back of your SOLAS Plant Operator card must be enclosed with your application. B2 CPCS Theory test (for categories ticked in Section C) passed within 6 months of application receipt B3 CPCS Skills and experience interview (for categories ticked in Section C) passed within 6 months of application receipt Surname Job Role Date Forename Signature D D M M Y Y Y Y I confirm that to the best of my knowledge the information above is correct. I accept this personal data will be held and used in accordance with the CPCS Fair Processing Policy set out in the Scheme Booklet for Operators. In signing this form I agree to comply with the terms and conditions set out in the CPCS Scheme Booklet. Applicant signature Date A2 D D M M Y Y Y Y E-mail Title Surname Forename Home Address Postcode CPCS Card No. (if applicable) Telephone Number Date of Birth National Insurance No. D D M M Y Y Y Y A1 A04C Tower Crane - Trolley Jib - Remote controlled A34 Crawler - Tractor/Dozer Company name (if applicable) Address: Postcode Please enter below where you would like the card to be sent: Applicant as in Section A1 Other (as below) Fair Processing Notice: NOCN Job Cards shares your personal data with the Construction Industry Training Board (“CITB“) for the purposes of their role as an Industrial Training Board enabling it to perform its functions under and accordance with the Industrial Training Act 1982. Your data will be held securely and treated confidentially and will not be disclosed to external parties other than as required for the purposes described above, which may include sharing your information on a construction training register as well as with employers, awarding organisations or training providers. For information explaining your legal rights and how NOCN Job Cards uses your information, please view our Privacy Notice online at https://www.nocn.org.uk/privacy/.
Transcript
F1/4 TRANSFER OF SOLAS CSCS EXPERIENCED PLANT OPERATOR CARD TO A CPCS COMPETENT OPERATOR CARD
To be completed by the applicant and supported by an independent declaration. Please complete this form in BLOCK CAPITALS using a BLACK or BLUE ball point pen. Please ensure the form is completed correctly to prevent it being returned.
SECTION B Other Qualifications
B1 CITB Health, safety and environment test passed within 2 years of application receipt
SECTION C CPCS Category (ies) available
A02B Crawler Crane - All sizes
A04A Tower Crane - Trolley Jib - Cab controlled
A09A Forward Tipping Dumper - Wheeled
A12 Excavator 180° above 5 tonnes
A17C Telescopic Handler - All sizes exc. 360° Slew
A40B Slinger/Signaller - All types - Static duties
A56B Dump Truck - Articulated Chassis - All sizes
A59A Excavator 360° above 10 tonnes - Tracked
A60A Mobile Crane - Blocked Duties only
SECTION D Mailing Address
SECTION E SOLAS Independent Declaration
CPCS F1/4 01-03-2019
I certify that the details on this application are correct to the best of my knowledge for the applicant detailed above, and confirm that the applicant is eligible for the categories indicated in Section C.
SECTION F Payment
Payment for this card application was included within the CPCS Technical Test notification fee.
SECTION A Applicant Details
A58A Excavator 360° below 10 tonnes - Tracked
A copy of the front and back of your SOLAS Plant Operator card must be enclosed with your application.
B2 CPCS Theory test (for categories ticked in Section C) passed within 6 months of application receipt
B3 CPCS Skills and experience interview (for categories ticked in Section C) passed within 6 months of application receipt
Surname
Job Role
DateForename
Signature
D D M M Y Y Y Y
I confirm that to the best of my knowledge the information above is correct. I accept this personal data will be held and used in accordance with the CPCS Fair Processing Policy set out in the Scheme Booklet for Operators.
In signing this form I agree to comply with the terms and conditions set out in the CPCS Scheme Booklet.
Please enter below where you would like the card to be sent: Applicant as in Section A1 Other (as below)
Fair Processing Notice: NOCN Job Cards shares your personal data with the Construction Industry Training Board (“CITB“) for the purposes of their role as an Industrial Training Board enabling it to perform its functions under and accordance with the Industrial Training Act 1982. Your data will be held securely and treated confidentially and will not be disclosed to external parties other than as required for the purposes described above, which may include sharing your information on a construction training register as well as with employers, awarding organisations or training providers. For information explaining your legal rights and how NOCN Job Cards uses your information, please view our Privacy Notice online at https://www.nocn.org.uk/privacy/.
This application form is appropriate for individuals holding a SOLAS Experienced Worker CSCS card who wish to transfer into the CPCS Scheme.
SECTION G Terms and Conditions of CPCS Application
1. This form is only valid when Section E is signed by an approved verifying SOLAS signatory.
2.It is the responsibility of SOLAS to ensure that all CPCS requirements for the application (with the exception of Section B) as stated in the CPCS Scheme Booklet for Operators are adhered to, including:
a) the applicant’s stated details are correct for the applicant,
b) the applicant holds the corresponding categories on a current SOLAS CSCS Experienced Worker registration card as detailed in Section I.
3. Application forms are subject to audit checks in accordance with CPCS requirements. Application forms, which are incorrect or not found to meet the requirements, will be returned rejected.
SECTION H Completion Requirements
Section A: The applicant must complete Section A, even if this form is being submitted with other paperwork, with full details. Note: We will use the photo that was captured at the time you achieved the CITB HS&E test on the CPCS Operator Card issued.Section B: Confirm that passed, but there is no need to attach evidence as these can be validated independently.
Section C: An approved SOLAS representative must complete this section. Cross through categories not applicable.
Please tick the categories for which the individual holds a SOLAS equivalent category (please see Section I below for details). Note: If 180° Excavator and/or 360° Excavator are being awarded by SOLAS then the below or junior category will be awarded automatically by CPCS. A copy of the front and back of your SOLAS Plant Operator card must be included with the application for checking.
Section D: The applicant must complete Section D, it must be noted that if a mailing address is not provided the card will be sent to the applicant's home address as provided in Section A1.Section E: This section requires an independent declaration of the applicant’s identity by an approved SOLAS representative.Section F: There is no need to send payment with the application form as the charge for the card application is included within the CPCS Theory Test and Interview notification fee.General: Please return the completed form and a copy of the front and back of your SOLAS CSCS Plant Operator card to: Mount Lucas National Construction Training Centre, Mount Lucas, Daingean, Co. Offaly
If you require help completing this form please contact CPCS on 0844 815 7274. On receipt of this application it will usually take 15 working days to produce the card, providing all registration conditions have been met.
Applications that have been authorised by SOLAS and also have Section B completed should be sent to: CPCS, NOCN Job Cards, P O Box 1242, Kings Lynn, Norfolk, PE30 9FQ.
*A04C Tower Crane -Trolley Jib - Remote controlled supersedes A63A Pedestrian Operated Tower Crane Up to 36M - 100m/te... which has been retired from CPCS.
