FENCING CONTRACTORS ASSOCIATION LTD Meridien House, 69-71 Clarendon Road, Watford, WD17 1DS Tel: 01923 797012 Fax: 01923 797011 Web Site: www.fencingcontractors.org E-mail: info@fencingcontractors.org Company No. IP 30077R SUB CONTRACTOR REGISTER – REGISTRATION FORM DETAILS OF APPLICANT Full Name Address Postcode Tel. No. Email Address Fax No. National Insurance No. Mobile No. CIS Unique Tax Reference (UTR) QUALIFICATIONS How long have you been installing fencing? Your qualifications including NVQ/SVQ/Diplomas (please list all) 1. 4. 2. 5. 3. 6. FISS/CSCS CARD REGISTRATION NUMBER? Red (Trainee) What FISS/CSCS Card do you hold? (please tick all that apply) *Lantra VRS Card Registration Number? Level 2 Level 3 Level 4 Green (Fencing Operative) White (Electric Fence Installer) Blue (General Fence Installer) White (Automatic Gate & Barrier Installer) Blue (VRS* Fence Installer) Gold (Supervisor) White (Parapet Installer) White (Temporary VRS*) Black (Manager) * List all VRS product training courses undertaken Have you had any plant training? If yes, please list below Card Type and Plant Categories (list all) Card Type Plant Categories Card Type Plant Categories DRIVING QUALIFICATIONS Do you hold a Full UK Driving License? (please tick) Yes No Do you hold an HGV License, If so which class? Do you have your own transport? Yes No Type of Vehicle INSURANCE DETAILS Public Liability (Please tick) Expiry Date Employers and Public Liability (Please tick) Do you work alone? (Please tick) Yes If no, how many people do you directly employ? FCA 60 Rev.1 PLEASE ATTACH A COPY OF YOUR Expiry Date CERTIFICATE(S) No PLEASE NOTE: If you contract with other labouronly subcontractors, they will ALL be required to be registered on FCA Sub Contractors Register Average Number regularly sub contracted to you? Page 1/3 October 2012 TYPES OF FENCING INSTALLED What types of fencing have you installed? (please tick all that apply) Chain Link Open Mesh Panels Rectangular Wire Mesh Anti Climb Systems TYPES OF FENCING / PRODUCTS Post and Wire Synthetic Product Fencing Systems Cleft Chestnut Concrete Post and Panel Close Boarded Vehicle Safety Barrier Timber Palisade Environmental Noise Barrier Timber Post and Rail Pedestrian Guardrail Mild Steel Bar Electric Security Fencing Welded Mesh Gates Wood Woven and Lap Panels Electrically Operated Gates Steel Palisade Access Barriers Site Hoarding Ornamental Railings and Gates Turnstiles Closed Circuit TV Bollards Agricultural Electric Fencing Decking Balustrades AREAS OF THE COUNTRY IN WHICH YOU ARE PREPARED TO WORK Where are you prepared to work? (please tick all that apply) *National - All of UK Eire Northern Ireland Europe All England *By ticking ‘National All of UK’ you will be automatically confirming your availability for contracts in all of the UK Counties listed below All Southern England Home Counties Greater London Kent Essex Hertfordshire Surrey East Sussex West Sussex Hampshire Buckinghamshire Berkshire Isle of Wight All South West Devon Cornwall Somerset Dorset Bristol Gloucestershire Herefordshire Wiltshire All Eastern England Suffolk Norfolk Oxfordshire Cambridgeshire Bedfordshire All Midlands All West Midlands Warwickshire Worcestershire Shropshire Staffordshire All East Midlands Nottinghamshire Derbyshire Leicestershire Lincolnshire Rutland Northamptonshire All North West Lancashire Cheshire Cumbria Merseyside Greater Manchester Isle of Man All North East Northumberland Durham Tyne and Wear Humberside All Yorkshire North Yorkshire South Yorkshire West Yorkshire E R of Yorkshire All Wales Blaenau Gwent Bridgend Caerphilly Cardiff Carmarthenshire Ceredigion Conwy Denbighshire Flintshire Gwynedd Isle of Anglesey Merthyr Tydfil Monmouthshire Neath Port Talbot Newport Pembrokeshire Powys Rhondda Cynon Taff Swansea Torfaen Vale of Glamorgan Wrexham All Scotland Aberdeen City Aberdeenshire Angus Argyll and Bute Borders Scottish City of Edinburgh City of Glasgow Clackmannanshire Dumfries and Galloway Dundee City East Ayrshire East Dunbartonshire East Lothian East Renfrewshire Falkirk Fife Highland Inverclyde Midlothian Morey North Ayrshire North Lanarkshire Orkney Islands Perth and Kinross Renfrewshire Shetland Islands South Ayrshire South Lanarkshire Stirling Western Isles West Dunbartonshire West Lothian Guernsey Jersey Page 2/3 FCA 60 Rev.1 October 2012 SECURITY CLEARANCE Do you have written evidence that you have obtained any Security Clearance? (Please tick) Yes No If you answered yes to the above question, what type of Security Clearance was it, and at what level? E.g. Criminal Records Bureau (CRB) Please attach copy of you approval paperwork I, the undersigned, confirm that to the best of my knowledge the information I have provided is correct. I understand and agree that the information on this form will be used by the Fencing Contractors Association Ltd for the purposes of administering the Labour Only Sub-Contractors Register and this will include passing information to potential Employers for this purpose. I also understand and agree that my data may be entered onto a secure database. Please sign below to accept these terms: Signed……………………………………………………….. Print Name………………………………………………….. Date…………………………………………………………. 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 let us know if you wish to receive such information from us (please delete as appropriate) Yes No APPLICATION ENCLOSURES CHECK LIST PLEASE ENSURE THAT YOU ENCLOSE THE FOLLOWING DOCUMENTATION WITH YOUR APPLICATION AND TICK THE RELEVANT BOXES 1. REGISTRATION FEE (£25.00) 2. COPY OF YOUR FISS/CSCS AND/OR LANTRA VRS CARD 3. COPY OF YOUR INSURANCE CERTIFICATES 4. COPY OF YOUR SECURITY CLEARANCE APPROVAL PAPERWORK Office use only Our Registration Fee to the value of £25.00 (Inc. VAT) is enclosed (Please make cheques payable to Fencing Contractors Association Ltd). A receipted invoice will be forwarded to you by return. Alternatively I wish to pay by Credit/Debit Card. Upon receipt of my application form please contact (name) on (Telephone No.) to take the payment. FCA 60 Rev.1 October 2012