Section 1 - General Details1a - Personal DetailsDate of ApplicationName of ApplicantContact Telephone NumberEmail AddressHome AddressHow long have you served within your specific trade?What is your position / job title?Section 2 - Work Experience2a - Current Employment / ContractAre you currently employed or providing your services permanently on a sub-contract labour only basis? If so please provide the details of the company below. If you provide your services to different companies then you must complete a sole trader application form.Trading Name of BusinessLegal Name of BusinessGroup Name (If Applicable)Main Trading AddressMain Telephone NumberEmail AddressWeb AddressIs your current employer registered with VeriTrade?- Select -YesNo2b - Experience / Work HistoryPlease provide any positions that you've held that are relevant to your current trade.Trading Name of BusinessLegal Name of BusinessAddress / LocationPosition HeldStart Date of WorkEnd Date of WorkBrief list / description of duties or services providedPrevious related work experienceTrading Name of BusinessLegal Name of BusinessAddress / LocationPosition HeldStart Date of WorkEnd Date of WorkBrief list / description of duties or services providedPrevious related work experienceTrading Name of BusinessLegal Name of BusinessAddress / LocationPosition HeldStart Date of WorkEnd Date of WorkBrief list / description of duties or services providedPrevious related work experienceTrading Name of BusinessLegal Name of BusinessAddress / LocationPosition HeldStart Date of WorkEnd Date of WorkBrief list / description of duties or services providedSection 3 - Health & Safety3a - Health & Safety PolicyHave you seen and read your company's health & safety policy?- Select -YesNoWhat is the most recent review date of your policy?3b - Occupational Health ChecksDoes your business provide free health checks for employees & contractors?- Select -YesNoIf yes, when was the last time you under went a check?Have you or are you deemed fit to carry out your trade?- Select -YesNo3c - Medical ConditionsDo you have any medical conditions that could put you at risk or effect you ability to carry out your trade in any way?- Select -YesNoIf you have answered yes to the above question, please provide any details below…3d - Accidents & NoticesHave you ever had any notifiable accidents in the last three years?- Select -YesNoHave you been served any Enforcing Prohibition Notices / Improvement Notices, etc. or been prosecuted as a result of health, safety or environmental breaches? - Select -YesNoNOTE: If you have answered yes to any of the above please provide details separately and submit with your application.Section 4 - Training & Competence4a - Training & QualificationDo you hold any of the following…CSCS / ICATS or industry equivalent- Select -YesNoExpiry DateLUCAS Certification / Card- Select -YesNoExpiry DatePASMA Certification / Card- Select -YesNoExpiry DateIPAF Certification / Card- Select -YesNoExpiry DateEUSR Certification / Card- Select -YesNoExpiry DateCOSHH Training Certificate- Select -YesNoExpiry DateAsbestos Awareness Training Certificate- Select -YesNoExpiry DateWorking at Height Training Certificate- Select -YesNoExpiry DateManual Handling Training Certificate- Select -YesNoExpiry DateHand Arm Vibration Awareness (HAVS) Training Certificate- Select -YesNoExpiry DateFace Fit Training Certificate- Select -YesNoExpiry DateIf you have any other training or qualifications which you thing is relevant to your trade and this application, then please provide further details below…Have you completed any manufacturer training and obtained certification in the application or operation of specific products, if so please list details below…4b - Competence in ComplianceAre you competent in compliance and able to complete the following…Harness Check RecordsRPE Maintenance RecordsVehicle Maintenance / Check RecordsFilm Thickness Checks & RecordsNon-Conformance ReportsProject Specification DocumentsFume Monitoring & AssessmentsInspection & Defect IdentificationHAVS Assessments / Monitoring RecordsTool Box TalksPUWER RecordsCondition & Application ReportsSite Survey ReportsDust Extraction AssessmentsRisk & Method StatementsPreparation Proposal4c - Methodology & EquipmentAre you competent in the following methods and use of equipment…Hand PaintingHVLP Paint SystemElectro Static ApplicationAnodising / GalvanisingHydro BlastingSteam CleaningRoller ApplicationAirless Paint ApplicationPowder CoatingAbrasive Blast CleaningJet WashingGrinding & Mechanical AbrasionAre you competent or trained in any other systems that you think is relevant to your application, if so please provide further details below...4d - Onsite ServicesAre you competent in providing on site services?- Select -YesNoIf you do provide your services on site, please provide a list below separated by a comma's…4e - In House ServicesAre you competent in providing in house services?- Select -YesNoIf you do provide your services in house, please provide a list below separated by a comma's…Section 5 - Insurances5a - Public Liability InsuranceDo you have your own personal public liability insurance policy (self-employed only)?Does your company hold this type of policy?- Select -YesNoInsurance ProviderPolicy Number / ReferenceLevel of CoverExpiry DateSection 6 - DeclarationI declare that the information provided is correct at the time of signing the declaration.I confirm that any significant changes to the information provided will be communicated to VeriTrade as soon as practicable. I confirm that we will cease works if any changes to our position means we cannot carry out works in accordance with Statutory or VeriTrade’s minimum requirements.Agreement:By signing this document with an electronic signature, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding. General Data Protection Regulation (GDPR) controls how your personal information is used by VeriTrade Everyone responsible for using data has to follow strict rules called ‘data protection principles’. They must make sure the information is:Used fairly and lawfullyUsed for limited, specifically stated purposesUsed in a way that is adequate, relevant and not excessive accurateKept for no longer than is absolutely necessaryHandled according to people’s data protection rightsKept safe and secureNot transferred outside the UK without adequate protectionAccept DeclarationFull NamePositionDateSignature [recaptcha]
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