Registration Form - Nationwide Driver Supply

Personal Details

Title:*

First name:*

Last name:*

Job Reference: *

Home address:*

Postcode:*

Telephone:*

Mobile phone:

Email Address:

Date of Birth:*

Nationality:*

Next of Kin:

Next of Kin number:

Relationship to you:

National Insurance number:*

Driving Licence

Licence number:*

How long have you held this licence?

Medical due:

Do you hold the following:

LGVI
Held for: years months

Valid from: to:

LGVII
Held for: years months

Valid from: to:

Other:
Held for: years months

Valid from: to:

Do you hold a GB Digital Tachograph Driver Card?

If yes: Valid from: to:

Endorsements/Convictions and Suspensions

Date	Offence	Endorsement Code	Fine	Points	Date Spent

Traffic Accidents in the last 5 years that were your fault

Date	Details

Driving Experience

Have you taken any form of Advanced/Defensive Driver Training?

If Yes, please provide details:

CPC Hours completed

Health

Are you in good health?

Have you a disability which may affect your ability to perform this job?*

If yes to above, please describe disabilites and:

a) Any reasonable adjustments which you feel should be made to the recruitment process to assist you in your application for the position which you have applied; and b) Any reasonable adjustments which you feel should be made to the job itself which would enable you to carry out the job for which you have applied.

Are you registered disabled?*

RDP Number:

Have you taken time off work through sickness or injury in the last 2 years? If so, how much and please give details:

Are there any physical or medical factors that would prevent you working as a driver on both day and night shifts? If yes, please give details below:

Employment details

Current/Last employer

Employer name:

Employer address:

Postcode:

Employer Telephone:

Contact name:

May we contact your current employer for a reference before you leave?

Note - We will not contact your present employer for a reference prior to your leaving date without your permission. However, any job offer made will be subject to receipt of satisfactory references.

Dates employed: From: to: (if still in employment, please leave 'to' field blank)

Position(s) held:

Annual salary (£):

Reason for leaving (if applicable):

Notice period:

Previous employer

Employer name:

Employer address:

Postcode:

Employer Telephone:

Dates employed: From: to:

Contact name:

AWR

Please state below what companies you have worked at in the last 8 weeks:

Company Name	Location	Agency You Worked Through	Duration

Right to work in UK

Are you entitled to work in the UK?*

We will require evidence of this prior to commencing employment. Either a passport or tax/NI document.

Criminal record

Have you ever been convicted of a criminal offence?

If yes, please provide details:

Declaration subject to the Rehabilitation Of Offenders Act
You are advised that if you are offered a position, a criminal record disclosure will be requested from the Criminal Acts Bureau.

Data Protection

The Data Protection Act 1998 ("The Act") sets out certain requirements for the protection of your personal information against unauthorised use or disclosure. The Act also gives you certain rights. Except to the extent we are required or permitted by law, the information which you provide in this application form and any other information obtained or provided during the course of your application ("the information") will be used solely for the purposes of assesing your application. If your application is unsuccessful or you choose not to accept any offer of employment we make, the information will not be held for any longer than necessary, after which time it will be destroyed, although relevant information will be retained in the longer term to facilitate our equal opportunity monitoring. If your application is successful, the information will form part of your employment file and we will be entitled to process it for all purposes in connection with your employment including its release to our customers and their agents. So that we may use the information for the above purposes and on the above terms, we are required under the act to obtain your explicit consent. Accordingly please sign the consent section below.

Please note, both name fields below MUST match EXACTLY for the registration to be valid.

I consent to my personal information being used for the purposes and the terms set out above

Full Name*: Date*:

Undertaking

Please read and print your name under the following undertaking:
I confirm that the infomation I have given on this application form is, to the best of my knowledge and belief, true in all respects. I understand that, should I have deliberately made a false or misleading statement on the form, my future employment could be jeopardised or terminated. I also agree that I may work for up to 60 hours per week but not average more than 48 over a 26 week period. If I change my mind, I will give NDS three months notice in writing.

Full Name*: Date*:

Note: We are an equal opportunities employer and will not tolerate discrimination in any form. Our equal opportunities policy forms part of the terms and conditions of all employees. Appointments and promotions are made on grounds of ability and suitability only.

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