Please note: Any field marked with a * must be completed before the form can be submitted. If at the end you click to submit and you do not see a confirmation message then a field is not completed and will be highlighted with a red frame on the form. PERSONAL PARTICULARS Surname * Forename(s) * Postal Address * Email Address Home Telephone Number Mobile Telephone Number * National Insurance Number * Date of Birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010 Marital Status No of Children Height * Weight * Do you have the legal right to live and work in the UK? NOTE: If invited for interview you will need to bring original documents (See link for list: https://www.gov.uk/government/publications/right-to-work-checklist) in order for us to copy to prove your right to work. * Yes No HEALTH DETAILS Are you in good general health? * Yes No Do you meet DVLA health standards for driving, including hearing and eye sight ? * Yes No Do you suffer from asthma ? * Yes No Have you now, or ever had, any physical mobility impairment ? (specifically, we are seeking to clarify your capability to undertake the physical requirements of our work, including, for example, the repeated access, ascent and descent of vehicle steps and tank ladders on multiple occasions throughout the working day). * Yes No Have you had medical attention in the last 5 years ? * Yes No Are you required to take regular medication ? * Yes No Are you allergic to penicillin (or any other medication (please list)) * Yes No Are there other health matters an employer should be aware of ? List any DVLA notifiable conditions. See https://www.gov.uk/health-conditions-and-driving for details. * If yes to any medical questions then please give details below How much absence from work did you have last year ? * How many years of fitting experience do you have List your experience with different manufacturers of trucks How many years of experience have you had working on Tankers List any Hazardous Chemicals that you are used to working around : Note any additional comments and/or details of experience below : (i.e. Experience with pumps or compressors, welding, etc) OTHER DETAILS Are you a good timekeeper ? * Yes No Are you applying to work night-shift ? * Yes No Our fitters normally work on a rolling week shift pattern. Please state you preference from the options below * - Select - early/late shift days days Nights Mon-Fri Any List any experience of working shifts, or unusual work patterns List any supplementary details that may assist your application : i.e. relevant training / certificates PREVIOUS EMPLOYMENT Job 1 - Company Name Job 1 - Contact Name Job 1 - Contact Title Job 1 - Is the above contact a referee Yes No Job 1 - Start Date (most recent) Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Job 1 - Job Description Job 1 - Leave Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20162017201820192020202120222023202420252026 Job 1 - Reason For Leaving Job 2 - Company Name Job 2 - Contact Name Job 2 - Contact Title Job 2 - Is the above contact a referee Yes No Job 2 - Start Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Job 2 - Job Description Job 2 - Leave Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Job 2 - Reason For Leaving Job 3 - Company Name Job 3 - Contact Name Job 3 - Job Title Job 3 - Is the above contact a referee Yes No Job 3 - Start Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Job 3 - Job Description Job 3 - Leave Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Job 3 - Reason For Leaving LICENCE PARTICULARS (Complete where LGV held, not mandatory for application) If you do not hold HGV or ADR, scroll to bottom and click submit. Driving Licence Number Car Driving Licence Valid From Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010 Car Driving Licence Valid To Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096 HGV Driving Licence Valid From Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006 HGV Driving Licence Valid To Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096 List & date any endorsements List any details of pending convictions List any details of Accidents in the past 3 years May we have your permission to go online and check the licence details which the DVLA hold for you ? You can do this yourself and give us a current, valid Check Code - visit https://www.gov.uk/view-driving-licence Yes No If you answered ‘No’, please supply a valid checkcode ADR TRAINING (If held, not mandatory for application) ADR Licence Valid From Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2020202120222023202420252026 ADR Licence Valid To Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2026202720282029203020312032 ADR Classes – Tanks 1 2 3 4 5 6 7 8 9 ADR Classes – Other Than Tanks 1 2 3 4 5 6 7 8 9 CPC TRAINING (If applicable for LGV licence holders, not mandatory for application) CPC Licence Valid From Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2020202120222023202420252026 CPC Licence Valid To Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2026202720282029203020312032 CPC Course Titles CPC Hours toward next renewal held CPC Hrs uploaded Yes No
