New staff application form for Kingston Hospital car parking

1
Personal details
Title
First name
Last name
Postcode (home postcode)
Mobile number
2
Employment details
Please Select
Please Select
Kingston Hospital Foundation Trust
Other (please specify)
Employing organisation
If 'other' organisation, please specify
Work email address
Payroll number (if Kingston Hospital)
Department
Job title
Line manager
3
Employment details (continued)
Please Select
Please Select
Long shift (12+ hours)
Standard shift
Contracted working hours
Please Select
Please Select
Day only
Night only
Day/ Night
Weekends only
Contracted working pattern
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Contracted start time
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2
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11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
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Contracted finish time
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2
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Hour
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10
20
30
40
50
Minutes
AM
AM
PM
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On call arrangements
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Permit detailsYellow - Valid 24hrs a day, 7 days a week Red - Valid 24hrs a day, 7 days a week. (To qualify for the red priority permit you must leave your base (KHFT) three or more times a week to attend other sites. Please note your line manager will be asked to confirm these arrangements). Green - Valid from 4:30pm until 830am Mon-Fri & 24hrs a day on weekends/public holidays. (There is no qualifying criteria relating to these permits)
Standard permit (yellow)
Priority permit (red)
Off Peak permit (green)
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Vehicle detailsA maximum of two vehicles can be specified on a single permit.
Registration 1
Registration 2
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Applicants signature (please type full name)* This field is required.Successful applicants will be issued with a permit and charged directly from their salary at the rates determined for the relevant permit (Yellow/Red permits – 1.65% of salary capped at £550/year. Green permits are free of charge). Unless alternate arrangements are made monthly deductions are set up; these deductions will continue until the permit is cancelled. Successful applicants can also choose to pay either in a lump sum at the time of issue (in cash or cheque). Please note that currently parking charges are suspended but may be re-introduced at a future date in line with the above charges.
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Date
Date
Day
Month
Year
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Terms & Conditions (please refer to the Parking Policy on the Trust Intranet for additional guidance)* This field is required.• Should you the address you live at during the working week you must inform Facilities as soon as possible to allow your permit to be reassessed. • A permit allows the holder to park in an appropriate staff designated parking area, but does not guarantee a space. • Any vehicle parked in a restricted area (disabled bay, pavement, ambulance bay, fire access, etc.) may be issued with a Penalty Notice Charge (PCN) • All vehicles parked with a permit are done so at the owner’s risk. • The permit is not transferable. • Drivers must move their vehicles if requested to by the Facilities department or the car park attendant. • Motorcyclists should register their details by completion of this form, but do not require a permit and may only park in the designated areas. • Permits may be reviewed annually and may not automatically be renewed and receiving a permit one year does not guarantee receiving a permit on subsequent years. • If for any reason you wish to cease parking you must inform the Facilities department in order for your salary deductions to cease (khft.carparking@nhs.net).
I have read and agree to the Terms & Conditions
Should be Empty: