PICSWeb : Applicant Sign Up : Expression of Interest (Birmingham)

First Names *

Surname *

Date of Birth *

Gender *

Ethnicity *

NI Number *

Address Line 1 *

Address Line 2 *

Address Line 3

Address Line 4

Postcode *

Email *

Mobile *

Do you have learning difficulties and/or disabilities? *

Types of learning difficulties and/or disabilities (If applicable) *

Primary learning difficulty or disability that may affect your learning? *

Benefit Status Indicator *

Are currently studying English as a second language (ESOL)?

Country of Birth *

Have you got a criminal record or any unspent criminal convictions *

Any other information required for sign up?

Who is completing this form? *

I am completing the form for myself
Momentum Staff
Jobcentre Referral
Other Referral Agency

What date would you like to start the course? *

You are applying to join the Construction course in Birmingham. If you are successful, you will receive:

- Level 1 Health & Safety in a Construction Environment qualification

- CSCS Test plus 1 Resit, paid for by Momentum

- CSCS Labourer's Card, paid for by Momentum

You will also be required to attend at least 1 mandatory Recruitment Morning to meet local employers offering work for CSCS card holders.

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