Driver Application

Applicant's Personal Details

Position Applied for (required)

Location (required)

Last Name (required)

First Name(s) (required)

Full Address (required)

Postal Code (required)

Home Telephone (required)

Mobile Telephone (required)

Email Address (required)

Date of Birth (required)

Age (required)

National Insurance Number (required)

Do You Need a work permit to be able to work in the UK? (required)
---YesNo

Ordinary Drivers License

License No. (required)

Groups/Categories (required)

Valid From (required)

Valid To (required)

Driving Test Passed Date (required)

LGV License

LGV License No. (required)

Medical Due (required)

LGV Groups/Categories (required)

LGV Test Passed Date (required)

LGV Valid From (required)

LGV Valid To (required)

Driver CPC Card Valid to (required)

Digi Card Valid to (required)

Traffic Violations

Please give details of any traffic violations in the last 5 years, including:
Date, Endorsement Code, Fine, Penalty Points, Suspensions and Offence Details

Violation 1 (full details)

Violation 2 (full details)

Violation 3 (full details)

Violation 4 (full details)

Traffic Accidents

Please give details of any traffic accidents in the last 5 years, including:
Date and a brief description of the event

Accident 1 (full details)

Accident 2 (full details)

Accident 3 (full details)

Accident 4 (full details)

Driver Training Experience

Have you taken any form of advanced/defensive driving training?
---YesNo

If Yes, please provide details

Additional Qualifications/Experience

Have you had any experience or do you hold any qualifications in the areas below?
Please give a detailed description.

Commercial Vehicle Type

Fork Lift Truck

Tail Lifts

Hazardous Chemicals

Other (Please Specify)

Medical

Do you have a DVLA notifiable condition?
---YesNo

If Yes, has the condition been reported?
---YesNo

Is your vision impaired?
---YesNo

When were your eyes last tested - Date?

Is your hearing impaired?
---YesNo

Are you currently taking any medicines or prescribed drugs that may cause drowsiness or otherwise impair your driving?
---YesNo

Employment History

Please list all organizations you have worked for during the past 20 years, including Name(s) and Address(es) of Employer(s), Dates from and to, Main Duties and Reasons for Leaving. Start with the most recent employer and work backwards.

Previous Employment 1

Previous Employment 2

Previous Employment 3

Previous Employment 4

Previous Employment 5

Overtime and Weekends

Are you willing to work overtime and weekends when required?
---YesNo

Criminal Record

Have you ever been convicted of a criminal offence
(which is not considered a spent conviction under the Rehabilitation of Offenders Legislation)?
---YesNo

If Yes, please give further information.

Your Expectations

Salary Range Expected

How much notice are you required to give your current employer?

Have you worked for JCS Express before?
---YesNo

If Yes, please give further detail for leaving.

Are you currently subject to any contractual "restraints of trade"?
---YesNo

If Yes, please give further detail.

Please give details of any holidays already arranged.

Supplementary Information

Please give details of any experience, skills, achievements or circumstances that you think may be relevant to your application for employment.

Additional Details

References

Please give the names of two references who are not related to you, who can be approached for a confidential assessment of your suitability for this job. (One must be a previous employer).

Reference 1

Reference 2

Can we approach your present/most recent employer?
---YesNo

Declaration of the Applicant

I confirm that the above information is correct.

I understand that any false information or deliberate omissions will disqualify me for consideration for employment or may render me liable for dismissal.

I consent to JCS Express processing the information contained herein and using the information to verify its accuracy with the DVLA and other authorities as required. I understand that, if successful, the information will be used to form any personal record and will be retained for the duration of my employment

If I am not successful, I understand that JCS Express will retain the form for a maximum of 6 months, and they may use it to contact me in the event of there being any other vacancies for which I may be suitable.

I agree Agree

Full Name

Date