HGV Driver Application Form Multimodal Logistics Ltd

PLEASE PROVIDE AS MUCH INFORMATION THAT YOU POSSIBLE CAN TO

ENHANCE YOUR APPLICATION. ALL INFORMATION PROVIDED MUST BE

ACCURATE AND UP TO DATE – IF A SECTION DOES NOT APPLY TO YOU, PLEASE

ENTER N/A

All of information provided will be considered Private and Confidential

2019-3-1

1

PART 1 - APPLICATION FOR EMPLOYMENT

Writing in BLOCK CAPITALS please answer all questions as fully as possible, ticking

boxes () where appropriate.

A. PERSONAL DETAILS

B. CONTACT DETAILS

C. PREFERRED METHOD OF CONTACT

D. GENERAL

Do you hold a full Driving Licence? Yes No

If you answered Yes to Driving Licence, please enter your Driving Licence number below

Do you have your own transport? Yes No

Are you aware of the UK Smoking Law in Company vehicles? Yes No

Do you have any unspent criminal convictions Yes No

If you have answered Yes to criminal convictions, please give details(Use the additional information sheet if required)

Please generate a licence check code from the DVLA Website (please note case sensitive)

https://www.gov.uk/view-driving-licence

SECTION 1

Title

Surname

First Name (s)

Address

Post Code

Home Tel No.

Mobile Tel No

Email

In writing Yes No

By phone (home) Yes No

By phone (mobile) Yes No

By email Yes No

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E. RIGHT TO WORK IN THE UK

F. YOUR EMPLOYMENT RECORD

Current Employment Name & full address of current employer

Nature of

Business

Current

Position

Start date Notice period (wks/mths)

DD/MM/YYYY

Reason(s) for

Leaving or

wishing to leave

Employment History (last 4 employers, not including your current employer)

Name of employer Dates

Position Held Reason for leaving From To

MM/YYYY MM/YYYY

MM/YYYY MM/YYYY

MM/YYYY MM/YYYY

MM/YYYY MM/YYYY

SECTION 2

Are you eligible to work in the UK? Yes No

Are you able to provide confirmation that you are entitled to work in the UK? Are

you

able

to

prov

ide

conf

irma

tion

that

you

are

entit

led

to

wor

k in

the

UK?

No

Are there any restrictions on your right to work in the UK? Yes No

If you have answered Yes to work restrictions, what are they? (Use the additional information sheet if required

If you are invited to interview please could you bring your original UK work Permit

SECTION 3

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Please explain any gaps in your employment (sabbaticals, charity work etc.) (Use the additional information sheet if required)

Have you applied for a position at Multimodal before? Yes No

If you have answered Yes to previous applications or employment, please give details (inc dates) (Use the additional information sheet if

required)

G. YOUR LICENCE & CONVICTIONS/POINTS

Do you hold an LGV 1 (C+E) category on your licence? Yes No

Do you have any motoring convictions/points on your licence? Yes No

If you have answered Yes to any motoring convictions, what are they?

Motoring

Conviction code

Date of

offence

DD/MM/YYYY Points

Motoring

Conviction code

Date of

offence

DD/MM/YYYY Points

Motoring

Conviction code

Date of

offence

DD/MM/YYYY Points

Applications with more than 6 points will not be considered

H. DRIVING BANS

I. ROAD TRAFFIC ACCIDENTS

SECTION 4

Have you been banned from driving in the last 5 years Yes No

If you have answered “Yes” to a driving bans, what was the reason? (Use the additional information sheet if required)

Have you been involved in any ‘at fault’ road traffic accidents in the last 5 years? Yes No

If you have answered “Yes” to road traffic accidents, what were the reasons? (Use the additional information sheet if required)

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J. VEHICLE & LOAD

K. ADR

L. DIGITAL TACHOGRAPH CARD

M. RHIDES CARD

N. DRIVER CPC

Have you ever lost a vehicle or load (stolen or damaged), which was under your

responsibility? Yes No

If you have answered “Yes” to vehicle & load, please provide details. (Use the additional information sheet if required)

Do you hold a current ADR licence (hazardous)? Yes No

What Classes? 1 2 3 4 5 6 7 8 9

When does your ADR licence expire? DD/MM/YYYY

Do you hold a Digital Tachograph Card? Yes No

If you have answered “Yes”, please state the serial number & expiry date below:

Digital Tachograph Card

Serial Number Expiry Date DD/MM/YYYY

Do you hold a RHIDES Card? Yes No

If you have answered “Yes”, please state the serial number & expiry date below:

RHIDES Card Serial

Number Expiry Date DD/MM/YYYY

Do you hold a valid driver CPC? Yes No

How many hours training have you completed

Can you provide proof of driver CPC training to an interview? Yes No

I have a CPC password from the DVSA Website

Yes No

If no, it can be requested from

https://dsa.dft.gov.uk/cpcode/flow/user;jsessionid=HaGjAoUv5mt2fWQVAatgvkTHNXqAH9v1OMnXV1L7.cpc-front-i-

07c24e7f0aa4a3528?execution=e1s1

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O. OTHER INFORMATION

P. ADDITIONAL INFORMATION

Q. TRAINING & QUALIFICATIONS

Are you trained or conversant with the Road Transport Directive? Yes No

Are you conversant with the Highway Code? Yes No

Have you used and do you understand a digital tachograph? Yes No

Any additional information or qualification i.e. Vehicle Mechanic or fitter, First Aider, Fire Marshal, Computer Skills etc. that may aid your

application.

Are you willing to work weekends when required? Yes No

SECTION 5

Secondary School(s) Attended Qualification(s) gained (including

level & grade))

Subjects

Further Education Qualification(s) gained Subjects

University/Polytechnic College(s) Qualification(s) gained Subjects

6

R. MEDICAL

Please note that you may be required to undergo a medical examination, which will include

a drug and alcohol test before any offer of full time employment can be confirmed. A disability

or health problem does not preclude full consideration for the job, and applications are

welcome from people with disabilities.

Are you willing to have a medical examination when required? Yes No

Do you require any special arrangements to enable you to attend an interview? Yes No

If you have answered “Yes” to special arrangements, please state what is required. (Use the additional information sheet if required)

S. HEALTH & SAFETY

Are you currently taking any prescribed medication, which may impact on your

ability to drive?

Yes No

If you have answered “Yes” to prescribed drugs, please state the name of the medication. (Use the additional information sheet if required)

Are you currently taking any non-prescribed drugs or medication, which may impact

on your ability to drive?

Yes No

If you have answered “Yes” to non-prescribed drugs, please state what. (Use the additional information sheet if required)

Do you require glasses for driving? Yes No

If you wear glasses to drive have you informed DVLA? Yes No

Does the code for wearing glasses (01) show on your licence? Yes No

Professional/technical training e.g.

institute, chartered society

Qualification(s) gained (indicate if

by examination)

Subjects

SECTION 6

7

Do you wear a hearing aid when driving? Yes No

If you wear a hearing aid to drive have you informed DVLA? Yes No

Does the code for wearing a hearing aid (02) show on your licence? Yes No

T. LONE WORKER

Are you aware of any reasons, which may impact on your ability to drive distances?

safely or stay away from home

Yes No

Do you require any special arrangements to enable you to attend interview? Yes No

If you have answered “Yes” to please explain? (Use the additional information sheet if required)

U. REFERENCES

Please give names and addresses of two referees

SECTION 7

Current/Most recent Employer Previous Employer

Name & Full

address

Name & Full

address

Post Code Post Code

Tel No Tel No

Occupation Occupation

Working

relationship

To provide consent for us to action references as

specified please sign below

Can we contact your present employer

Your signature Sign Now

After interview

After offer has been made & accepted Date DD/MM/YYYY

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V. DECLARATION

I confirm that all the information provided is true and complete and that I understand that

any falsification or deliberate omissions may disqualify my application or lead to my

dismissal. I confirm that I am entitled to work in the UK and can provide original

documentation to confirm this. I understand that my employment is subject to satisfactory

references.

I consent to the information I have given on this application form and in all other enclosed

documentation being held, used and updated under the security safeguards of the Data

Protection Act 1998.

Signature Sign Date DD/MM/YYYY

W. APPLYING

Please return this application form with the drivers hours multiple choice either by post to:

Multimodal Logistics Ltd, China Shipping House, Walton Avenue, Felixstowe,

Suffolk. IP11 3HG

or email: Fleet@multimodal-logistics.co.uk

Should, after receipt of your application you are asked to attend an interview, you must ensure

that you provide the original documentation or licence as stated in this application.

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X. ADDITIONAL INFORMATION

Section/paragraph

e.g. D, E, G etc Use this area to assist with expanding on any points which may aid your application

(Add more ADDITIONAL INFORMATION sheets as required)

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Driver’s Hours Assessment

1) The time is now 09:00am. You have been driving non-stop since 05:00am. Under EC

Rules, how much longer can you drive without a break?

a) 15 minutes □ b) 45 minutes □

c) 30 minutes □ d) 1 hour □

2) Under EC Rules, what is the maximum driving time allowed in a fortnight?

a) 85 hours □ b) 90 hours □

d) 100 hours □ d) 100 hours □

3) Under EC Rules, you can drive a maximum of 9 hours per day. How many time can week

can this be extended to 10 hours?

a) Once □ b) Twice □

e) Three □ d) Four □

4) Please state if the daily rest for the below driver is reduced or not.

NR – Not Reduced R – Reduced

DAY Start Time End Time Daily Rest

Monday 04:00 19:00 R – 9 hours

Tuesday 04:00 15:00 NR- 11 hours

Wednesday 02:00 15:00

Thursday 06:00 16:30

Friday 03:01 16:30

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5) You have started your shift at 06:00am. You have been on other work for 1 hour before

driving for 4 hours to your delivery point. They have asked you to assist with unloading

(other work). When is your next break required?

a) No Break Required □ b) 12:00 □

c) 13:00 □ d) 14:00 □

6) In accordance with Working Time Rules (directive 2002/15/EC) which of these

statements is not true

a) 65 hours’ working time in any one week □

b) 48 hours’ working time per week averaged over the reference period □

c) No more than 6 hours’ work without a break □

d) 60 hours’ working time in any one week □

7) Which of the below tachograph modes count towards working time?

a) Other Work □ b) Driving □ c) POA □ d) Break □

8) How many driving hours can the below driver do in week 3?

Week 1 Week 2 Week 3

42 hours driving 46 hours driving ____ Hours driving

9) The driver below is currently on Other Work. Looking at the schedule of their day please

indicate when the driver next needs to take a break and how long for?

Time Mode Duration Hours / Mins

06:00 Other Work 1:00

07:00 Driving 2:30

09:30 Other Work 00:30

10:00 Break 00:30

10:30 Driving 00:30

11:00 Other Work 1:00

12:00 Driving 1:00

13:00 Other Work ….

___:___ BREAK ____ Mins

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10) You have driven for a total of 4 hours and 30 minutes. After 2 hours driving you took a 30

minutes break. How long of a break do you need now?

a) 15 minutes □ b) 30 minutes □ c) 45 minutes □

Within six 24 hour periods from the end of the last weekly rest period, a driver is required to

extend a daily rest period into either: a regular weekly rest period or a reduced weekly rest

11. A Regular Weekly rest is at least

a) 36 hours □ b) 45 hours □ c) 48 hours □ d) 50 hours □

12. A reduced weekly rest is at least

a) 12 hours □ b) 20 hours □ c) 24 hours □ d) 30 hours □

13. To qualify for a split daily rest how many hours does the first rest period need to be?

a) 1.5 hours □ b) 2 hours □ b) 3 hours □ b) 4 hours □

14. Is the below legal?

a) Yes □ b) No □

04:15 Other Work 15 minutes

04:30 Driving 4.5 Hours

09:00 Rest 30 minutes

09:30 Other Work 2.5 Hours

12:00 Rest 3 hours

15:00 Driving 4.5 hours

19:30 Other Work 30 minutes

20:00 Rest