MOT Course Booking Form MOT Course Booking Form Staff Referral donna@motskillsuk.comjohn@motskillsuk.comKarley@premiermot.comtricia@premiermot.com What course would you like to book? * Award in MOT Testing Class 1 & 2Award in MOT Testing Class 4 & 7MOT Quality ManagementAward in MOT Centre ManagementQuality Control CourseMOT Upskill or Refresher CourseAnnual Training and AssessmentVTAA - 1 DayVTAA - 2 DayVTAA - 3 DayHybridF-GasOther What course would you like to book? MOT COURSE BOOKING FORM - INFORMATION I can confirm I hold a current full unrestricted motorcycle license * Yes Centre Location Essex Midlands When would you like to start January February March April May June July August September October November December APPLICANT DETAILS PLEASE NOTE THE NAME YOU ENTER HERE WILL BE ON YOUR FINAL CERTIFICATE Title Mr Mrs Mrs Ms OtherOther First Name * PLEASE WRITE YOUR NAME AS IT APPEARS ON YOUR DRIVING LICENSE. PLEASE NOTE: A £10.00 AMENDMENT FEE WILL BE CHARGED IF YOUR NAME IS INCORRECT Middle Name PLEASE WRITE YOUR NAME AS IT APPEARS ON YOUR DRIVING LICENSE. PLEASE NOTE: A £10.00 AMENDMENT FEE WILL BE CHARGED IF YOUR NAME IS INCORRECT Last Name * PLEASE WRITE YOUR NAME AS IT APPEARS ON YOUR DRIVING LICENSE. PLEASE NOTE: A £10.00 AMENDMENT FEE WILL BE CHARGED IF YOUR NAME IS INCORRECT National Insurance Number * Ethnic Origin * 01 White - British02 White – Irish03 White – Other04 Mixed - White and Black Caribbean05 Mixed - White and Black African06 Mixed - White and Asian07 Mixed - Other08 Asian/Asian British – Indian09 Asian/Asian British – Pakistani10 Asian/Asian British – Bangladeshi11 Asian/Asian British – Other12 Black/Black British – Caribbean13 Black/Black British – African14 Black/Black British – Other15 Chinese16 Other Ethnic Origin Date of Birth * DD/MM/YYYY Do you have any allergies? Medical Needs Religious Needs Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone Number * Work Number Email Address * Please note: We cannot process your application without this. Do you have a FULL driving license? Yes No You must hold a full unrestricted UK license for the classes of vehicles you wish to test as per Section E27.7 of the MOT Test Guide. Please note: We cannot process your application without this. Driving License Number: Please upload an image or scan copy of your ID (Driving Licence or Passport) * Drop a file here or click to upload Choose File Maximum file size: 7MB Emergency Contact Name: * Emergency Contact Phone Number: * MOTOR TRADE EXPERIENCE Company Name or Current Employer * How many years experience do you have in the automotive industry? * If you are have not worked in an MOT garage please advise how many years' experience you have working with the vehicle type you would like to test Work Address * Work Address Work Address Work Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Please tick at least 5 duties that apply to you: * Scan tool usage for engine diagnostics Confident with multimeter for electrical fault finding Gearbox and engine rebuilds and replacement Oil and filter changes, spark plug gapping and changing Brake renewal including replacement of pads and discs and diagnosis of braking faults Understanding a wiring diagram Diagnoses of suspension faults and competent replacement Steering fault finding and understanding of geometry settings WORK EXPERIENCE Company Name * Start Date * Finish Date * Duties * plus1 Add minus1 Remove VEHICLE CLASSES & VOCATIONAL QUALIFICATIONS To test classes 3, 4, 5 & 7 you must hold an acceptable vocational qualification or accreditation What classes of vehicle do you wish to test? * Class 1 & 2 Classes 3, 4, 5 & 7 N/A PLEASE NOTE: These courses require the use of a computer for which basic IT skill will be required. Please upload an image of your qualification certificate Drop a file here or click to upload Choose File Maximum file size: 7MB Please tick any level 3 qualifications you currently hold: * Level 3 Vehicle Mechanical and Electronic Systems Level 3 Vehicle Technician Level 3 Vehicle Maintenance and Repair Level 2 or 3 Repair and Servicing of Road Vehicles Part 3 Motor Vehicle Craft Studies, modular Part 2 or 3 Motor Vehicle Craft Studies Part 2 Motor Vehicle Craft Studies Part 2 or 3 Light or Heavy Vehicle Mechanics Craft Studies Part 1 Motor Vehicle Technician’s Certificate BTEC/ONC Motor Vehicle Engineering studies IMI/ATA Light Vehicle Diagnostic Technician IMI/ATA Light Vehicle Inspection Technician Other Automotive NVQ level 3 QualificationOther Automotive NVQ level 3 Qualification None of the Above You must have an accepted qualification or accreditation if you want to test class 3, 4, 5 or 7 vehicles (cars, private buses and light commercial vehicles). Other Qualifications: Qualification: Subject: Date Obtained: Please list your qualifications. If you have been a tester previously, we will accept a copy of the original letter authorising you to test. If you are returning to testing following cessation for disciplinary reasons, we cannot accept your original authorisation letter. Please see below for examples of acceptable qualifications: NVQ/SVQ/VCQ - Level 3 e.g. - L3 Light vehicle maintenance and repair. - Maintaining automotive vehicles IMI VRQ - Minimum level 3 e.g. - L3 Diploma in Light Vehicle Maintenance and Repair - L4 Diploma for Automotive Master Technicians National craft certificate - Motor vehicle mechanics Automotive Technician Accreditation (IMI Accreditation) - Light Vehicle Diagnostic Technician (Note: you must have a valid IMI Accreditation ID Card) - Light Vehicle Inspection Technician If you have any of these qualifications or any other motor vehicle related certificates we will require a copy of them. DO NOT SEND ORIGINALS. We only accept copies of the FINAL CERTIFICATE. DECLARATION OF NON CONVICTION Do you have any 'unspent' convictions? * Yes - please give details below No Details of 'unspent' convictions Please provide information of any 'unspent' convictions for criminal offences connected with the Vehicle Testing Scheme or the motor trade, or involving acts of violence or intimidation. Declaration Declaration * I declare that the information given on this form is correct & true at the time of completion. I confirm that I have NO UNSPENT CRIMINAL CONVICTIONS as defined in the Rehabilitation of Offenders Act 1974 for criminal offences connected with the Vehicle Testing Scheme or the motor trade, or involving acts of violence or intimidation. I am aware that if, in the future it is brought to DVSA's attention that there are any such unspent convictions that have not been disclosed, this may result in the cessation of my approval to carry out statutory testing. I understand that if I progress onto become an MOT Tester: - I will be legally responsible for the MOT test certificate and other official documents that I use. - I must notify the Authorised Examiner at my VTS (or the DVSA Area Office if I am the Authorised Examiner) if my driving license is suspended or restricted. - I may be disqualified from testing if I fail to carry out tests to the required standard. I understand the following: From 1st November 2019 you must notify DVSA immediately if you get a conviction where one of the following is imposed: -a prison sentence (or suspended sentence) of 3 months or more -a fine exceeding level 4 on the standard scale -a community service order (or equivalent) requiring unpaid work for more than 60 hours -any punishment outside the UK equivalent to these points This applies to: MOT Testers, AEPs, AEs, AEDMs, AEDs, site managers, site admins. From 1st November 2019, any new AEPs and AEDMs will have to sign a declaration that you do not have any convictions and provide a basic DBS check to support this Personal information will be kept for 15 months and then destroyed in accordance with GDPR.. Name * I declare that I have read the above declaration and the information given on this form is correct & true to the best of my knowledge. Job Title * I have read and accept the terms & conditions * Yes Date * How did you hear about us? Internet SearchMagazine AdvertMarketing LetterRecommendationReferral from IMI or ABC AwardsSales CallSeminarWebsiteOther How did you hear about us? Terms & Conditions Please contact your training consultant as soon as possible if there are any mistakes to your booking. PLEASE NOTE: A £10.00 per amendment will be charged for any changes to a registration if you have provided incorrect details at the time of booking. PLEASE NOTE THIS COURSE IS IN LINE WITH DVSA REGULATIONS AND ATTENDANCE IS PART OF THE ACCREDITATION IF YOU ARE MORE THAN 20 MINUTES LATE OR MISS A DAY YOU WILL NEED TO REBOOK ONTO ANOTHER COURSE WITH FULL COURSE FEES. MOT Skills UK trading as Premier MOT Training – Terms and Conditions Attendance and Eligibility Premier MOT Training does its best to ensure that a delegate(s) is assigned to the course(s) most appropriate to their current skill base and learning abilities. A delegate(s) may be asked to complete a pre-assessment questionnaire to determine the most appropriate course based on existing knowledge and current skill set. It is the responsibility of the delegate(s) to answer all questions accurately and without the assistance of others. If on starting a course it is identified that the skills and current knowledge of the delegate(s) is not at the required level for the course, alternative services will be offered. If alternative course options are longer in length or taught in smaller groups, there may be an additional cost to the delegate(s). Deposits A deposit is required to book onto a course. Fees are as follows: i) For courses costing less that £500. 50% of the full course fee is payable at the time of booking and the balance is due 10 working days before the course start date. ii) Courses costing above £500. £500 deposit is required (See T&C’s for payment details) Payment Options Payment plans are offered for the balance of courses priced at more than £500. Please speak to your Training Consultant to discuss this further, (T&C’s Apply). Please note payment plans may carry an additional fee. Course Cancellations Premier MOT Training reserves the right to cancel any course at any time, in which alternative dates will be offered or a full refund given. If you need to cancel a course for any reason please see our full terms and conditions on our website (www.premiermot.com.) for options, entitlements and cancellation fees. Personal information will be kept for 15 months and then destroyed in accordance with GDPR. CAPTCHA If you are human, leave this field blank.
