Full registration

1. Personal Details

Please complete in block letters.

Title

First Name *

Surname *

Address *

Town *

Country *

Post Code *

Tel (inc STD) *

Mobile *

Email

NI Number

Date of Birth (for licence & insurance purposes only) *

2. Next of Kin

Next of Kin *

Relationship

Tel (inc STD) *

3. Own Transport & Contact Permissions

Own Transport? *

Reg No

I hereby give / do not give the employment business permission to give out my mobile telephone number to clients that I may work for should they need to contact me. *

4. Criminal Convictions & DSS Benefits

Have you been convicted of any criminal offences which is not spent within the terms of the Rehabilitation of Offenders Act 1974? *

YesNo

Are you receiving and/or claiming any DSS benefits? *

YesNo

Where did you hear about us?

Have you worked for an agency before? *

5. Employment History (last 5 years)

Give details of previous employment starting with the most recent, ensuring you cover the last 5 years.

From	To	Name of Employer	Employed As	Reason for Leaving

6. Medical Questionnaire

A complete and correct history is required and may be verified by your doctor. Answer yes or no to each question.

If applying for an HGV driving role, do you suffer from any condition which you are required to report to the DVLA?

YesNo

Do you have any visual impairments that are not corrected by glasses/contact lenses?

YesNo

When did you last have an eye test? (Date)

Do you have a hearing impairment which is not corrected by a hearing aid?

YesNo

Are there any other health factors that might affect your ability to undertake the role for which you have applied?

YesNo

Any other relevant information

If you have answered yes to any of the above you may be asked to see a doctor or nurse for further assessment. Please sign below to declare all medical information provided is accurate.

Signed *

7. Data Protection

The employment business will collect the personal details you provide for the purpose of providing work-finding services, and may transfer them to clients, insurers or other relevant parties.

I do not want my information disclosed to client companies (by ticking, you limit your availability to clients).I do not want my information disclosed to market research companies (by ticking, you limit your availability to clients).

8. Working Time Regulations (WTD) Declaration

Confirm your compliance with the Road Transport (Working Time) Regulations and provide details of any work undertaken for other employers.

Part A - Previous working time

A - I confirm I have worked in accordance with the Road Transport (Working Time) Regulations 2005 throughout the current reference period of my current/most recent employer.A2 - I confirm I have NOT worked in accordance with those regulations throughout that reference period.

Part B - Current work for other employers

B - I am NOT currently engaged in any work outside my commitments to Recruitment Solutions Alba that would count towards working time.B2 - I AM currently engaged in work outside Recruitment Solutions Alba which needs to be taken into account for working time calculations.

Signed (WTD declaration) *

9. Opt Out of the 48 Hour Working Week

The Working Time Regulations 1998 provide that you shall not work in excess of an average of 48 hours each week (over a 17 week reference period) unless you agree in writing that this limit shall not apply.

Do you agree that the 48 hour working week limit shall not apply to your assignments? *

10. Qualifications & Experience

What type of licence do you hold?

In which country did you pass your test?

Details of any accidents you have had in the last five years and/or any endorsements

Have you ever been convicted of an offence relating to drivers hours / driving records / overloading of a vehicle / road worthiness of a vehicle within the last four years? *

YesNo

11. Operative & Key Skills

Indicate your competence in any of the following areas by ticking the boxes.

12. Applicants Declaration

Please read and tick each declaration below.

I understand that for health and safety reasons it is recommended that protective clothing (e.g. safety boots) be worn at all times whilst carrying out assignments.I confirm that I am eligible to work in the UK.I am aware that the employment business is an equal opportunities employer.I have received and understood the terms of engagement for temporary workers issued by this office.I confirm that I will correctly declare my earnings in respect of any benefit claim.I undertake to inform this office of the number of hours I have driven should I at any time work as a driver on my own behalf or on the behalf of any person, firm or company.I undertake to inform this office of any future change in circumstances, including any driving offences or endorsements which may alter my replies to the above questions.I understand that should I be asked to work for any company at which I have worked within the last 12 weeks, I will inform Recruitment Solutions Alba at the earliest possible moment.I confirm that all of the above are true to the best of my knowledge and authorise you to seek the references you require.

Signed *

13. Bank Details

Bank Name

Name on Account

Account Number

Sort Code

14. References

Please provide at least 2 references with telephone numbers.

Reference 1

Reference Name

Position

Company

Contact Number

Address

Reference 2

Reference Name

Position

Company

Contact Number

Address