Driver registration form

Step 1 of 16 - Personal details

Personal details

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Date

MM slash DD slash YYYY

Select your nearest branch(Required)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City County Post Code

Date of birth(Required)

Day

Month

Year

Telephone Number(Required)

Email(Required)

Nationality(Required)

Ethnicity(Required)

National Insurance Number(Required)

Type of employment required

Please tick which types of employment you are looking for:

HGV Class 1 Driver

HGV Class 2 Driver

7.5 tonne Driver

Tramping

Abnormal/Unusual load Driver

ADR Driver

Hiab Driver

Drivers mate

Please tick which locations you are looking for employment in:

East Midlands

East England and Home Countries

London

North East

North West

Scotland

South East

South West

West Midlands

Yorkshire

Work History

Do you have an up to date CV?(Required)

Yes

Upload your CV(Required)

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 16 MB.

Employment History(Required)

Employer

Date From

Date To

Reason for leaving

Position Held

Main Duties

Reference Contact Details(Required)

Contact Name

Company Name

Position

Phone Number

Email Address

Skills & Experience

Please select all relevant experience and skills.
* Where marked(*), please ensure that relevant licences are produced and copied.

Driving skills

7.5 Tonne Driver*

ADR / Hiab*

Draw Bar

Dray

Handballing

HGV 1 Driver*

HGV 2 Driver*

Light Van*

Low Loader

Multi-drop

Nights Out

Rope & Sheet

Skips

Shunting

Tachograph (digi)

Tail Lift / Fridge

Safety wear

Please tick what safety wear you have:

Hi-viz Vest Jacket

Overalls

Safety Footwear

Safety Helmet

Shift preferences

Please tick your preferred shifts:

Afternoons

Days

Nights

Preferred Start Time:

Hours

Minutes

AM/PM

Contract for services for the engagement of an agency worker

Between
(1) 1st Choice Staff Recruitment Limited (“the company”) and

(2) Contractor(Required)

First Last

Click to read our Terms and Conditions.
(T&Cs will open in a new window. The link will also be included in the completed PDF that will be emailed to you once you finish your registration).

I agree to the terms and conditions(Required)

Yes

I agree to receive marketing communications(Required)

Yes

Signature(Required)

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Date

MM slash DD slash YYYY

Working Time Test

1. Under EC regulations what is the maximuim number of "shifts" a driver is permitted to work prior to taking a daily rest?(Required)

2. What is the maximum driving hours permitted in a week?(Required)

3. What is the maximum number of driving hours permitted per fortnight?(Required)

100

4. What is the maximum driving period permitted before a break must be taken?(Required)

4.5

4.75

5. As an alternative to a 45 min rest period, the rest period can be split into two. How long must the second rest period be (minimium)?(Required)

6. What is the normal Daily driving limit?(Required)

8.5

7. How many hours can the daily driving limit be extended to?(Required)

9.5

8. How many times can this daily driving limit be extended by?(Required)

9. How many hours rest should a driver NORMALLY take before starting next shift?(Required)

10. Daily rest can be reduced to 9 hours on how many occasions between two weekly rest periods?(Required)

11. How many hours is a typical weekly rest period?(Required)

12. You can reduce your weekly rest period to what (minimum)?(Required)

13. If after 6 hours you have not reached 4.5hours and taken a rest break - how many minutes rest do you need for WTD?(Required)

14. In WTD rules what can your average working week be over a 17 week average period?(Required)

15. IN WTD what is the maximum hours that can be worked in one week?(Required)

Lifestyle

Do you smoke?(Required)

Yes

Do you drink alcohol?(Required)

Yes

How much alcohol do you consume in a week?(Required)

0 - 5 units

5 - 10 units

10 - 15 units

Over 15 units

Medical history

Do you suffer from, or have you ever received treatment for any of the following?

Heart problems (angina, heart attack etc)

Blood Pressure (high or low)

Chest problems eg. Bronchitis, Asthma, Emphysema shortness of breath

Persistent Indigestion, Stomach Ulcer, Persistent Diarrhoea?

Skin conditions e.g. Eczema, Dermatitis, Psoriasis

Any dental problems or Tooth/gum infections

Bite your nails

Recurring eye, nose or ear infections

Contact with or had Enteric Fever or Typhoid

Liver disease – Hepatitis or Jaundice

Type 1 or 2 Diabetes

Mental health condition- Stress, Anxiety, Depression etc

Any condition that may cause you to pass out - epilepsy, fainting, dizziness

Any condition affecting your joints/musculo-skeletal system – Back, Neck, Hands, Wrists, Elbows, Shoulders, Knees etc.

Dependency to drugs and/or alcohol

Loss of vision/serious defect in either eye

Hearing problem or discharge from either ear

None of the above

Please provide more details:(Required)

Do you suffer from, or have you ever received treatment for an allergic reaction to any foods e.g. gluten, nuts, prawns, spices, food additives?(Required)

Yes

If yes, please provide more details.

Would the condition affecting your joints/musculo-skeletal system affect your ability to stand, kneel, climb stairs or sit for long periods? Please provide details.(Required)

Do you have a medical condition that would affect you working shifts including nights?(Required)

Yes

Please provide details:

Do you wear contact lenses or glasses?(Required)

Yes

Please provide details:

Are you colour blind?(Required)

Yes

Please provide details:

Have you traveled outside of Europe in the previous three months?(Required)

Yes

Did you suffer any illness during your trip or since you returned?(Required)

Yes

Please provide details:

Do you consider yourself to be in a good state of health and able to carry out the job for which you are applying in a safe manner?(Required)

Yes

Please provide details:

Do you have any medical problem that has not been mentioned in the previous questions?(Required)

Yes

Please provide details:

Are you currently taking any medication at present either over the counter or prescribed by your Doctor or from a Pharmacy?(Required)

Yes

Please provide details:

Does this medication have to be taken at strict times?(Required)

Yes

Do you require any support with break times at work?(Required)

Yes

Please provide below any further information about your health that we need to be aware of that has not been covered above:

Signature(Required)

Next of Kin

Please provide details of your Next of Kin(Required)

Name

Daytime telephone number

Evening telephone number

Section Break

The main provisions of the RTD are;
A 48-hour average working week over a 4 or 6-month reference period (No individual opt-out is allowed).
Up to 60 hours can be worked in one week providing that the 48-hour averages are not exceeded.
Working time is limited to 10 hours in any 24 hour period if any work is carried out at night time. The UK Government has announced that through a collective agreement the 10-hour limit can be extended.
Nighttime is defined as between midnight and 04:00 am for workers in the road freight sector and 01.00 am and 05.00 am for workers in the bus and coach sector.
EU Drivers’ Rules require a break of 45 minutes after 4.5 hours of driving. If driving is combined with other work additional break requirements apply. The RTD states a 30-minute break must be taken after 6 hours of consecutive work.

Work Time Regulations and UK Drivers’ Hours Regulations
All mobile workers not covered by the EU drivers’ Hour Rules receive protection under UK Drivers’ Hours regulations and the horizontal Amending Directive which was incorporated into the Working Time Regulations in August 2003.
The Working Time Regulations provided for;
A 48-hour average working week (an individual opt-out is allowed) (This does not include LGV Drivers – this applies to buses etc.)
4 weeks paid annual leave
A requirement for night workers to have regular health checks
The need for adequate rest

Please choose one of the following:(Required)

A) You are solely working for 1st Choice Staff Recruitment

B) You are working for multiple agencies on various contracts and you will inform 1st Choice Staff Recruitment of any additional hours worked.

Do you want to opt out of the WTD requirement preventing you from working a maximum of 10 hours if that shift includes work between 12am – 4am?

Yes

Worker seeker declaration

Do you have any criminal record other than those ‘spent’ under the Rehabilitation of Offenders Act 1974?(Required)

Yes

Do you have any criminal convictions pending?(Required)

Yes

Have you at any point in the last five years been convicted of a motoring offence or have any convictions pending?(Required)

Yes

Have you in the last 10 years had your licence suspended?(Required)

Yes

Have you held the relevant class of licence for the positions for which you are applying for at least 2 years?(Required)

Yes

I hereby declare that the information supplied on my Application Documents is true and correct to the best of my knowledge and that any documentation I have supplied with my application has not been falsified or altered in any way from the original document.

I undertake that should any of the information I have supplied change, in any way, that I shall inform 1st Choice Staff Recruitment of this with immediate effect.

I confirm that 1st Choice Staff Recruitment has supplied me with a copy of their contract for services containing an agreed minimum pay rate. Further, I confirm, they have satisfactorily advised me of my duties whilst on assignment and that it is my responsibility to ensure that I follow all procedures to ensure a safe working environment whilst on assignment. I also confirm that I have provided 1st Choice Staff Recruitment with sufficient evidence for them to obtain two years checkable work history on me and that 1st Choice Staff Recruitment has my consent to approach those people named by myself to obtain such details.

Whilst on assignment with 1st Choice Staff Recruitment I agree to be bound by all current legislation relating to the assignments on which I may be placed. Further, 1st Choice Staff Recruitment will update me on occasion that this legislation changes, I understand that it is my responsibility to ensure that I work within the provisions of English Law at all times.

Signature(Required)

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Date

MM slash DD slash YYYY

Section Break

Please note that this information can only be used to pay money into your bank account. It is securely transmitted to Bluestones Staffing and will be used to pay you your wages.

Name as it appears on bank account(Required)

Sort Code(Required)

Account Number(Required)

Have you ever taken out a student loan?(Required)

Yes

When did you take out your student loan?(Required)

Scotland, NI & pre-2012 England & Wales

England & Wales post-2012

Personal Information Declaration

I acknowledge and understand that in the course of their normal business, from time to time, 1st Choice Staff Recruitment may need to share some of the information supplied to them by myself. This information will be limited to:

• Address/contact detail
• Right-to-work documentation
• National Insurance number
• Photo Identification
• Copies of relevant accreditations or licences

I understand that any information sharing will be limited to 1st Choice Staff Recruitment and its client companies and shall not be passed to third-party agencies or anyone other than to secure work for myself and demonstrate my suitability for that work.

Please sign here to confirm the above statement is true:(Required)

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Date

MM slash DD slash YYYY