driver application form - stewarts...
TRANSCRIPT
Driver application form
1. POSITION
Position applied for:
Where did you hear of the vacancy?
Date available to commence employment
Are you currently subject to any 'restraints of trade' clauses?
If 'YES' please provide details
Wage/salary required £
2. PREPARED TO WORK
Full time Part time Shifts Weekends
Do you have any holiday commitments?
If 'yes' please give details
3. PERSONAL DETAILS
Name N.I. Number
Date of birth Marital status
Address
Home phone number Mobile number
Work phone number May we contact you at work ?
4. EDUCATIONAL BACKGROUND
Please list schools, colleges, universities attended (from age 14):
Name of school/colleges attended Dates attended Qualifications gained
5. EMPLOYMENT HISTORY
Please list your employment history starting with the most recent.
Current employer Contact name
Telephone number Address
Date employed from
Date employed to Nature of work
Rate of pay
Reason for leaving
Previous employer Contact name
Telephone number Address
Date employed from
Date employed to Nature of work
Rate of pay
Reason for leaving
Previous employer Contact name
Telephone number Address
Date employed from
Date employed to Nature of work
Rate of pay
Reason for leaving
6. MEMBERSHIP OF PROFESSIONAL ORGANISATIONS / INSTITUTIONS
Are you a member of any professional organisations / institutions
If 'yes' please provide details
7. WORK PERMITS
Are there any restrictions to your residence in the UK that might affect your right to take up employment here?
If yes please give details below
If you are successful in your application, would you require a permit to work in the UK?
8. REFERENCES
Please supply details of two referees – one of whom must be your present or previous employer. Please note, it is not permissible to nominate family members as referees.
Name Name
Address
Address
Tel. No. Tel. No
Occupation Occupation
May we contact the above prior to interview or engagement?
May we contact the above prior to interview or engagement?
9. HEALTH
Please answer the undernoted questions and in addition please also complete the pre‐employment health questionnaire contained at the back of this application form.
Are you in good health?
Do you have any disabilities that may affect your application?
If ‘Yes’ please state the nature of your disability:
Please state any reasonable adjustments which may be made to the recruitment process that may assist you in your application for a position within the Company:
Please state any reasonable adjustments, which may be made to the position for which you are applying which would enable you to carry out your duties more effectively:
Are you prepared to undergo a medical examination prior to employment?
10. EMERGENCY CONTACT DETAILS
If you wish to do so, please give details of next of kin or a person who can be contacted in the event of an emergency.
Name
Address
Relationship to you
Tel. No Home Work Mobile
11. CONVICTIONS
5ƻ ȅƻdz ƘŀǾŜ ŀƴȅ criminal convictionsΣ excƭdzŘƛƴƎ those spent under the Rehabilitation of Offenders Act 19т4. This relates to !b¸ offence, not just thƻse connŜcted with driving.
If ¸9{Σ please supply details of the convictions below. bΦ. Your declaration is made subject to the Rehabilitation of Offenders Act 1974.
NB: Due to the nature of the work you will be subject to an enhanced CRB police check. Failure to submit to such a check will render your application with Stewarts Coaches invalid.
Do you hold a current CRB clearance?
Please confirm that you will be willing to consent to a check on your criminal record.
12. DRIVING LICENCES
Type NUMBER EXPIRY DATE DATE MEDICAL DUE (if applicable)
CATEGORIES HELD
CAR
PCV
HGV
OTHER
Do you have any endorsements on your licence or prosecutions pending?
If YES ‐ please supply details
PLEASE NOTE: The Company requires all drivers to complete a driving licence mandate to enable periodic checks on the status of a driver’s licence to be made with the DVLA. These checks are then filed in the relevant personnel file for further examination if required. This will be done on an annual basis.
13. DRIVER TRAINING
Have you ever undertaken any form of advanced and/or defensive driver training?
If yes please give details below
Do you have a Driver CPC Qualification card?
If NO, how many hours of Driver CPC training have you undertaken in the past 5 years?
14. DRIVING HISTORY
In the past 5 years I have committed the following traffic violation(s):
please include details of any prosecutions pending:
DATE OFFENCE ENDORSEMENT CODE PENALTY
In the past 5 years I have been involved in the following motor vehicle accidents:
DATE DETAILS
15. ADDITIONAL PERSONAL DETAILS
Applicants are requested to tick the relevant boxes below to enable the organisation to monitor its equal opportunity policy. Monitoring is recommended by the Codes of Practice for the elimination of racial discrimination and for the elimination of discrimination on the grounds of sex and marital status. The information is used for no other purpose and will be treated as confidential.
White – British Mixed – White and Black Caribbean
White – Irish Mixed – White and Black African
White – other Mixed – White and Asian
Black / Black British – Caribbean Mixed – Other
Black / Black British – African Asian / Asian British – Indian
Black / Black British ‐ other Asian / Asian British – Pakistani
Chinese Asian / Asian British Bangladeshi
Other Other Asian Background
Male Female
16. ADDITIONAL QUALIFICATIONS
Please give brief details of any additional qualifications:
17. RECRUITMENT POLICY
It is the Company’s policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate because of race, colour, national origin, age, sexual orientation, religion or belief or marital status or disability. I authorise the Company to obtain references to support this application once an offer has been made and accepted and release the organisation and referees from any liability caused by giving and receiving information. Declaration: I confirm that the information given on this form, to the best of my knowledge is true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal.
Signed
Date
ASYLUM AND IMMIGRATION ACT 1996
Please complete the form below and bring it with specified documentation to the interview.
(PLEASE USE BLOCK CAPITALS)
NAME
POST APPLIED FOR
INTERVIEW DATE
You should bring either:
One of the original specified documents from List 1 below
or
Two original specified documents from List 2,
If you are using documents from List 2 as evidence of the right to work in the UK, you must refer to documents in
either the first combination or the second combination; you must not mix documents from each combination.
Please insert the number(s) of specified documents from the list below:
Signature………………………………………………. Date……………………………………
PLEASE BE AWARE: Information or documentation supplied which later proves to be false or misleading will be
grounds for dismissal.
LIST OF SPECIFIED DOCUMENTS
You should note that all specified documents listed below have equal status with none having more importance than another. The type of document supplied will not have any bearing on the decisions made by the interview panel.
LIST 1
11 A passport showing that the holder is a British Citizen or has a right of abode in the United Kingdom
12
A document showing the holder is a national of a European Economic Area country or Switzerland. This must be a passport or national identity card.
13 A residence permit issued by the Home Office to a national of a European Economic Area country or Switzerland
14
A passport or other document issued by the Home Office which has an endorsement stating that the holder has a current right of residence in the UK as the family member of a named national from a European Economic Area country or Switzerland who is resident in the UK.
15
A Passport or other travel document endorsed to show that the holder can stay indefinitely in the UK, or has no time limit on their stay.
16
A Passport or other travel document endorsed to show that the holder can stay in the UK; and that this endorsement allows the holder to do the type of work you are offering if they do not have a work permit.
17
An Application Registration Card issued by the Home Office to an asylum seeker stating that the holder is permitted to take employment in the UK
LIST 2
FIRST COMBINATION
21 A document giving the person’s permanent National Insurance number and name. This could be a: P45, P60, National Insurance card, or a letter from a Government agency;
AND
212 a full birth certificate issued in the UK, which includes the names of the holders parents; OR
213 a birth certificate issued in the Channel Islands, Isle of Man or Ireland; OR
214 a Certificate of registration or naturalization stating that the holder is a British Citizen; OR
215
a letter issued by the Home Office, to the holder, which indicates that the person named in it can stayindefinitely in the UK, or has no time limit on their stay; OR
216
an Immigration Status Document issued by the Home Office, to the holder, with an endorsement indicating that the holder can stay indefinitely in the UK, or has no time limit on their stay; OR
217
a letter issued by the Home Office, to the holder, which indicates that the person named in it can stay in the UK and allows them to do the type of work you are offered; OR
218
an Immigration Status Document issued by the Home Office, to the holder, with an endorsement indication that the person named in it can stay in the UK and this allows them to do the type of work being offered.
SECOND COMBINATION
22 A work permit or other approval to take employment that has been issued by Work Permits UK;
221
A passport or other travel document endorsed to show that the holder is able to stay in the UK and is permitted to take the work permit employment in question; OR
222
A letter issued by the Home Office, to the holder, confirming that the person named in it is able to stay in the UK and can take the work permit employment in question.
DATA PROTECTION
The details provided on your application form will be used, in the event of a successful appointment, to provide the basis of your employee documentation. In the event that the application is unsuccessful, details will be held on file for a maximum of 12 months in case of query. Please sign and return the attached slip to confirm your consent to the holding of this data. I declare that the information provided on my application form can be used for the basis of my employee documentation. In the event of my application being unsuccessful this information will be kept on file for a maximum of 12 months.
Signed
Name
Date
FOR OFFICE USE ONLY
16. GENERAL DETAILS
Starting date
Job offered
Pay
Hours of work
Department / Supervisor
Payroll No.
Recruitment Source
P45 or P46
Reference requested
MEDICAL QUESTIONNAIRE
16. HEALTH
Yes No
1 Any skin disease(s)
2 Discharge or infection of the ears or hearing defect
3 Asthma or hay fever of sufficient severity to require time off work
4 Any allergies (including sensitivity to antibiotics or other drugs)
5 Recurrent sore throats or sinusitis
6 Bronchitis or pneumonia
7 Tuberculosis
8 Heart disease or high blood pressure
9 Headache or migraine requiring time off work
10 Fits, blackouts or epilepsy
11 Depression, nervous breakdown or mental illness, psychiatric treatment
12 Backache or sciatica requiring time off work
13 Rupture, varicose veins or foot ailments
14 Indigestion or stomach pain requiring time off work
15 Kidney of bladder infection
16 Eye disease, injury or significant defect of vision not corrected by spectacles
17 Diabetes
18 Serious injury or operation. Have you been admitted to hospital, if yes give details:
19 Do you suffer from any defect or disability not included in the above? If yes give details
20 Roughly how many days have you had off work for illness over the past two years? Briefly state reasons:
21 Are you regularly receiving injections, pills, tablets or medicines from a doctor? If so give details:
22 What is your height? What is your weight?
I understand and acknowledge that should I knowingly make a false statement regarding my medical history either in answering the above questions or to any medical examiner, or should I conceal wilfully and material fact, I will, if engaged be liable to have my contract terminated. In the event of any health enquiries I consent to my General Practitioner supplying relevant information to the Medical Examiner.
Signed Date