Application Form - PCV Drivers

Application Form - PCV Drivers

All information given will be treated as strictly confidential

What position are you applying for?
Title
Name

First NameLast Name
Address

Street Address

Street Address Line 2

Town/CityCounty

Postcode
Telephone Number (mobile or landline)
Email Address
example@example.com
Date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit year
What is your marital status?
What is your nationality?
Do you need a work permit to work in the UK?
For how many years have you lived in the UK?
How many children do you have?
If you do not have any children please enter '0'
Please enter the age of your children below...
Separate line for each child
Do you have a next of kin?
Who is your next of kin?

First NameLast Name
What is their relationship to you?
What is your next of kin address?

Street Address

Street Address Line 2

Town/CityCounty

Postcode
In the last 10 years have you had a period of illness resulting in a long term absence from work?
A long term absence is considered to be 4 weeks or more
Please provide some details below about why you had a long term absence from work...
You're disabled under the Equality Act 2010 if you have a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities. Are you disabled as per this definition?

Please enter the date you passed your car (category B) driving test

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Please enter the date you passed your bus/coach (category D/D1) driving test

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Do you have a Driver Qualification Card (DQC)/Driver CPC card?
Please enter the expiry date on your Driver Qualification Card (DQC)/Driver CPC card.

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Have you ever been convicted of a motoring offence, or have a prosecution pending, or sustained a fixed penalty resulting in an endorsement on your licence during the last five years, or in the case of an alcohol/drug related conviction the last ten years?

In the last 3 years have you been involved in a road traffic collision that has resulted in an insurance claim? (Company or privately owned vehicles)

Please list all previous employment history over the last 10 year period starting with the most recent employer first. Please also list and explain any gaps in your employment history.

Rows	Company Name & Address	Job Title & Description of Duties	Date Employed from/to	Reason for Leaving
1
2
3
4
5
6

Can we take references from your previous employers?

All Golden Boy drivers are subject to an enhanced DBS check by Hertfordshire County Concil to confirm suitability to work with children and vulnerable adults. Please note DBS clearance must be maintained at all times as a condition of our Contract of Employment.
Do you have a criminal record?
Have you ever received a Police Caution?
You have answered yes to having a criminal record or receiving a police caution. Please provide more details below...

Please verify that you are human
I declare that the information I have given on this form is true and accurate and any misrepresentation by me may be sufficient grounds for my dismissal if I am employed.
Should be Empty:

Rows	Date of Offence	Date of Conviction	Offence Code	Penalty Points	Licence Endorsed	Alcohol Level & Reading	Lenght of Ban Years/Months	Did a Collision Occur
Conviction One
Conviction Two

Rows	Date of Collision	Details of Collision	Were you at Fault
Collision One
Collision Two
Collision Three
Collision Four