Application for Employment

PERSONAL DETAILS

Preferred Location:

Title *

Mr
Mrs
Ms
Miss

Name *

First

Last

Date of Birth *//

National Insurance Number *

Format: AANNNNNNA

Address (line 1) *

Address (line 2)

Address (line 3)

Postcode *

Email

Mobile Number

Telephone Number

Have you ever applied for employment or worked for James Lewis? *

Yes
No

Previous employment 1

Have you ever applied for or worked for any other bus company?

Yes
No

Previous employment 2

DRIVING LICENCE INFORMATION

Do you hold a full driving licence ‘Cat B’?

Yes
No

Cat B Manual or Automatic

Manual
Automatic

Date Passed Test//

Expiry Date

Do you hold a PCV ‘Cat D’? *

Yes
No

Cat D Manual or Automatic *

Manual
Automatic

Date Passed Test *//

Expiry Date *

Please provide details of where PCV training and test was taken? *

Do you have any endorsements on your driving licence? *

Yes
No

How many current penalty points are on your licence? *

Have you been disqualified from driving in the last five years? *

Yes
No

Driving Disqualification Details *

Do you hold a CPC?

Yes
No

Expiry Date

Driver Qualification Card Number

CONVICTIONS

Please give details of any convictions, unless they are regarded as ‘spent’ as defined by the rehabilitation of offenders Act 1974. Please include the date, place and offence as well as the sentence order. Please put ‘not applicable’ in the box if this section doesn’t apply to you.

Conviction Details *

WORK PERMIT

Do you need a work permit to work in the UK?

Yes
No

Work Permit details

You will be required to provide original documents

EMPLOYMENT HISTORY

Please complete details covering the last ten years of employment starting with the most current or last employer including the Bus/Transport Industry. Please explain any periods of unemployed or gaps in employment if applicable.

Employment History 1

Company Name *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From *//

Date To *//

Job Title *

Salary

Reason for leaving

Employment History 2

Company Name *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From *//

Date To *//

Job Title *

Salary

Reason for leaving

Employment History 3

Company Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From//

Date To//

Job Title

Salary

Reason for leaving

Reason for gap(s) in employment (if applicable)

REFERENCE DETAILS

Please provide full details of two referees, they should be your most current or last employer(s).

Reference 1

Name of Employer *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone *

Fax

Email *

Reference 2

Name of Employer

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone

Fax

Email

EDUCATION DETAILS

Course 1

Name of School / College / University

Address of School / College / University

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From//

Date To//

Course Title

Qualifications Gained

Course 2

Name of School / College / University

Address of School / College / University

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From//

Date To//

Course Title

Qualifications Gained

Course 3

Name of School / College / University

Address of School / College / University

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From//

Date To//

Course Title

Qualifications Gained

PROFESSIONAL QUALIFICATIONS

Do you hold a BTEC Certificate?

Yes
No

Certificate Number

Date Achieved//

PERSONAL STATEMENT

Our Aims

• To provide the best possible service to our Customers
• To provide our staff with secure, rewarding employment
• To be successful, profitable company with a long term future

Please use the space below to explain how our aims, your skills and attributes match those on the job description. Include any further information to support your application for employment with our Company.

Personal Statement

Please give the date you would be available to start employment in the event of your application being successful//

Please provide details of any holiday’s dates that are confirmed

Whilst we will try to ensure that we accommodate any dates already confirmed, they are also subjective to Local Management authorisation.

REFERENCE DECLARATION

I hereby give my consent and authorise James Lewis to contact the person or organisations mentioned in my application for the purposes of obtaining employment and personal reference information.

Printed name *

Date *

Signature *

UK DOMESTIC DRIVING RULES – EMPLOYEE DECLARATION

Our drivers are required to comply with the UK Domestic Driving Rules as set out in the Transport Act 1968. These rules stipulate a maximum daily driving limit of 10 hours and a maximum daily duty time of 11 hours. They also stipulate that you must take adequate rest between periods of paid work. In order for us to ensure that you and James Lewis operate legally within these rules we need to know if you undertake any paid work outside of James Lewis. It is your responsibility to declare, in full, all paid work and to notify James Lewis should there be any changes to your paid work commitments in the future. Failure to do so may result in your dismissal. Failure to comply with the UK Domestic Driving Rules could lead to you being prosecuted and fined. The UK Domestic Driving Rules stipulate maximum driving and duty times for our drivers. In order for us to help ensure that you and you and James Lewis operate legally within these rules, please complete and sign the declaration below that is applicable to you.

OPTION A

I hereby declare that I AM NOT currently engaged in any paid work outside of my commitments to James Lewis. I understand that it is my responsibility to inform James Lewis immediately if this situation should change at any point during my employment.

Printed name

Date

Signature

OPTION B

I hereby declare that I AM currently engaged in other paid work outside of my commitments to James Lewis. I understand that it is my responsibility to keep James Lewis informed in writing, of the hours worked elsewhere should these change from those listed below.

Printed name

Date

Signature

Please provide basic details of any other employers

Employer name, Type of work, Start date, and Hours worked per week

48 HOURS OPT-OUT AGREEMENT

1. Definition. 1.1 In this opt out agreement the definitions and clause 1.2 used in the terms apply in "Working week" means an average of 48 hours each week calculated over 17 weeks reference period. 2. Restrictions. 2.1 The Working Time Regulations 1998 provide that the Temporary Worker shall not work on assignment with the client in excess of the working week unless he/she agrees in writing that this limit should apply. 3. Consent. 3.1 The Temporary Worker hereby agrees that the working week limit shall not apply to the assignment. 4. Withdrawal of consent 4.1 The Temporary Worker may end this agreement by giving the employment business 7 days notice in writing. 4.2 For the avoidance of doubt any notice bringing this agreement to an end shall not be constructed as termination by the Temporary Worker of an assignment with the client. 4.3 Upon the expiry of the notice period set out in clause 4.1 the Working Week Limit shall apply with immediate effect. 5. Law 5.2 These terms are governed by the Law of England & Wales and are subject to the exclusive jurisdiction of the Court of England & Wales.

Date

Signature

MEDICAL QUESTIONNAIRE

Have you ever suffered from...

Angina *

Yes
No

Heart attack *

Yes
No

Chest pain *

Yes
No

Stroke/mini stroke *

Yes
No

High blood pressure *

Yes
No

Palpitations *

Yes
No

Poor circulation, swelling of the legs, deep vein thrombosis *

Yes
No

Varicose veins, leg ulcers *

Yes
No

Shortness of breath, wheezing, troublesome bouts of coughing *

Yes
No

Regular cough and/or production of phlegm *

Yes
No

Bronchitis *

Yes
No

Asthma *

Yes
No

Any other lung disorder *

Yes
No

Do you smoke? *

Yes
No

If no, have you ever smoked? *

Yes
No

Nervous breakdown, panic attacks, phobias, neurosis *

Yes
No

Anxiety, depression, Severe stress *

Yes
No

Do you suffer from allergies? *

Yes
No

Eye disease, infection, inflammation, bleeding *

Yes
No

Do you suffer from any other medical condition affecting your sleep? *

Yes
No

Have you ever had a medical condition not mentioned above that has involved your GP? *

Yes
No

DATA PROTECTION

I give consent for James Lewis to share my personal information with 3rd Parties and for James Lewis to hold my information on file and process it including sharing it with the Department of Work and Pensions.
I give consent to being contacted by James Lewis via email, SMS and direct mail, to provide updates, open vacancies and other relevant marketing material.

The data and information provided will be passed on to 3rd parties for payroll and /or clients for insurance purposes. All information you share with James Lewis will be treated in strict confidence and will be dealt with in line with the Data Protection Act 1998 and General Data Protection Regulation (EU) 2016/679.

Date *

Signature *

DECLARATION

I declare that the information given in this application is to the best of my knowledge, true, accurate and complete.

I declare that I have the right to reside and work in the U.K.

I will inform James Lewis of any cautions, warnings, reprimands, convictions and prosecutions subsequent to this application and any information provided at interview.

I shall inform James Lewis immediately upon factors/circumstances affecting my availability, right and/or ability to work.

I understand that any misrepresentation of the facts and documents provided in support is ground for refusal of employment and/or disciplinary (and possibly criminal) proceedings.

I agree that James Lewis can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the Data Protection Act 1998.

I understand that any offer of employment is subject to satisfactory screening results and if I am unable to satisfy and of the screening process my employment will be terminated.

I acknowledge that no contractual relations will exist until such times as I have accepted in writing the terms of a letter of appointment and/or form of contract.

I understand as from 19th January 2009 James Lewis had employed the use of random drug and alcohol testing in order to ensure compliance and provision of operator requirements in the supply of all staff. In light of the same, I hereby authorise James Lewis to carry out any drug and alcohol testing as and when required.

Printed name

Date

Signature

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my enquiry.