Warehouse application

B – this is now my only job but since last 6 April I have had another job, or received taxable Jobseeker`s Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a State Pension or Occupational Pension.
C- As well as my new job. I have another job or receive a State Pension or Occupational Pension.

Do you have a Student Loan wich is not fully repaid and all of the following apply:
You left a course of UK higher education before last 6 April. You received your first Student Loan instalment on or after 1 September 1998. Select ‘NO’ if you are repaying your Student Loan direct to the Student Loans Company by agreed monthly payments.

Please tick as appropriate YESNO

Signed
Date

DVLA Declaration: Please sign only if you agree
I authorize CAMION to ask DVLA or check via the DLVA online service for my driver record information as and when they require, at a frequency they shall determine. I authorize and direct DVLA to disclose to the company, or for Rapier Enployment to obtain via the DVLA online service, all relevant information relating to my driver record from the computerized register of drivers maintained by DVLA. This includes personal details, driving entitlements, endorsement details, disqualifications, convictions, photo images and CPC detail (where appropriate)

This authority will expire when I cease to drive in connection with the company and in any case three years from the date of my signature. I can also opt out of this arrangement by advising CAMION writing and providing 4 weeks` notice in advance.
Please sign only if you agree
Sign
Date
Or I don`t agree Tick box I don`t agree

If you have answered yes to any questions above, please give details and approximate dates where relevant.

I herby declare that the information given is full and true to the best of my knowledge.

Signed
Date
or Tick not applicable Not applicable

DATA PROTECTION:
The Company will collect and process personal data from you, which may include sensitive personal data, for the purpose of carrying out its business of supplying temporary workers to clients and in order to find you suitable assignments. The Company may also collect personal data about you from third parties, such as referees and third part agencies, in order to verify information such as professional qualifications and educational background. We may disclose your personal data to clients for the purposes of an assignment/ potential assignment or periodic review. You will also be consenting to the transfer of essential information to our agents, our clients and the Criminal Records Bureau for the purpose of a criminal records disclosure application.
You hereby consent to us collecting and processing your personal data and disclosing this informationto clients and other relevant third parties for the purposes outline above. If you terminate this contract or enter in to new terms of engagement with a diffirent organization, in circumstances where you continue to work for the same client, we may disclose your personal information to the new organization at the client`s request. We may divulge your personal data to third parties who may provide you with information about their products and activities. If you consent to your personal data being used in this way, please sign here.
Sign
Data

MOBILE WORKERS DECLARATION:
Road Transport(Working Time) Regulations
The Road Transport(Working Time) Regulations (RTWT) requires employment business to maintain records of the Working Time of mobile workers who are involved in operations subject to Community Regulations 561/2006. An employment business is obliged to ensure that the Working Time limits specified below are complied with for temporary workers they engage:
In summary the RTWT regulations provide for the following:
- Mobile drivers ( such as LGV drivers and crew) are subkect to a maximum average Working Time of 48-hours per week over a default 26 week rolling reference period
- There is a maximum weekly limit of 60 hours Working Time
- There is a maximum of 10 hours night work within each 24-hour period. Night time is defined as midnight to 4.00am (for goods vehicles) and 01:00 to 05:00am (for passenger vehicles) . This maximum may be extended in certain circumstances
- Rest Periods : Mobile workers must take the following breaks: 30 minutes after 6 hours Working Time and 45 minutes for over 9 hours Working Time. It is important to note that EU Drivers Hours breaks and rest periods still apply.

How we calculate your average Working Time:
We will calculate your average Working Time over a 26-week calendar reference period. The reference period we will use begins on midnight on the Monday and for the following 26 weeks. The 26 week rolling reference periods includes the latest week worked and omits the data from the oldest week, as your working time progresses week after week.

It is your responsibility to inform us of all your Working Time during the reference periods we use and to keep us updated as to any additional Working Time you undertake for other employers or employment business for these purposes during an assignment.

It si also your responsibility to accurately record your Working Time during an assignment.

RTWT Regulations have been introduced to protect and safeguard the health and safety of mobile workers, other road users and the public. A mobile worker also has a responsibillity for complying with the regulations. If the mobile worker knowingly breaks and rules (e.g. neglects to inform his employer or employment business about other work, or knowingly makes a false records), then they will committing a criminal offence and may subject to a fine on conviction of up to £5000 (Regulation 18 of the RTWT Regulations).

The RTWT Regulations and EU Drivers Hours Rules require that all work undertaken for employers must be taken into account when we calculate your Working time during the relevant reference period. Both transport and non-transport work must be taken into accont. Accordingly , please provide details of Working Time undertaken for any other employers or employment business during the current 26-week reference period. See above for the dates of the relevant 26-week reference period.
Both transport and non-transport working time must be declared. If you are engaged in charitable or voluntary work, or work for the TA, fire service or police you must inform us, even though we may exclude time spent on such activities from our calculation of your Working Time.

Please delete clearly as appropriate
Option 1
I declare that: I AM NOT currently engaged in any work, other than for CAMION which needs to be included in the calculations of my Working Time under the RTWT Regulations, and I will keep CAMION informed in writing as to the details of Working Time undertaken for other employers or employment business on a weekly basis, and I will inform CAMION immediately if there are any changes to my situation which impacts on my Working Time.

Option 2
I declare that: I AM currently engaged in other work in addition to my work for CAMION which needs to be included the calculations of my Working Time under the RTWT Regulations, and I will keep CAMION informed in writing as to the details of Working Time undertaken for other employers or employment business on a weekly basis, and I will inform CAMION immediately if there are any changes to my situation which impacts on my Working Time.

Option 1Option 2

WORKFORCE AGREEMENT: Please delete clearly as appropriate.
Votes will be counted towards creating a workforce agreement on an annual basis from all registered workers.

I believedo not believe that it is in the benefit of both the company and its employees for ceratin provisions of the regulations to be ………………or modified.

I willwill not not work beyond the 10-hour night work limit ststed in the regulations , but only to the extent where this would not be in…..od other provisions of the regulations or EU driver`s hors regulations 3820/85

I agreedo not agree that the first day of a 26 week rolling reference period will begin at 00:00 hours Monday, of the first week of…..with CAMION and continue for the next 25 weeks. The pattern of 26 rolling week reference will continue……terminated. My current verage working hours are less than 48 hours per week when periods of availability are taken………

EMPLYEE STATEMENT: You need to circle one of the following statements A,B or C
A- This is my first job since last 6 April and I have not been receiving taxable Jobseeker1s Allowance, Employment and Support…. Incapacity Benefit, State Pension or Occupational Pensions.

WORK EXPERIENCE : Please tick or delete as appropriate.
Digi cardTippersHIAB/Crane/GrabDraw-Bar/A FrameFurniture RemovalsADR LicenceSkipsNight WorkTacho and Driving LAWPlantTankers/ Non HazardousContainersDust CartFridge WorkDay WorkMulti DropsDemountables
Will you do Nights out? YESNO

CANDIDATE DECLARATION:
I herby confirm that the information given is true and correct. I consent to my personal data and Cv being forwarded to clients. I cosent to references being passed onto potential employers. If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that CAMION will be entitled either to charge the client an introduction/transfer fee, or to agree extension of the hiring period with the Client ( after which I may be employed by the Client without further charge being applicable to the Client).
Signed
Date

CRIMINAL CONVICTIONS: Please tick as appropriate. Do you have any unspent* criminal convictions?
YesNo
If yes , state convictions and dates

*Certain types of employment and professions are exempt from Rehabilitation of Offenders Act 1974 and in those cases particularly where the employment is sought in relation to positions involving working with children or vulnerable adults, details for criminal convictions must be given. The information given will be treated in the strictest of confidence and only taken into account where, in the reasonable opinion of CAMION, the offence relevant to the post to which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment in the offence is not declared but later comes to light.

Filtering rules: As of 29 May 2013 you are no longer required to disclose information about any “filtered” offences. You are not required to disclose on any part of this form any convictions or cautions that have been filtered. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.

PERMISSION TO WORK IN THE UK: Please tick as appropriate.
Do you have immigration permission to work in the UK?
YesNo

In line with UKBA guidance on the prevention of illegal working we will need to verifity and take a copy of your original ID documentation as evidence of your right to work in the UK if you are be engaged by CAMION for temporary work.

HEALT AND DISABILTY : Please tick as appropriate.
The following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to access our recruitment service and to find out your needs in order to perform the job or position sought. If you make a declaration and meet the minimum requirement for an assignment you will be guaranteed an interview.

Do you have any health issues or disability relevant which may make it difficult for you to carry out functions which are essential for the role you seek?
YesNo

If yes , please specify

If you have a disability , what are you needs in terms of reasonable adjustments in order to access this recruitment service and attend interview , or to take aptitude tests etc?
Please specify

NIGHT WORKERS HEALTH ASSESSMENT: Complete or tick not applicable.

These questions are designed for those staff who work regularly at night. Under the Working Time Regulations 1998 , you are entitled to have a health assessment to establish whether you are suffering any adverse health effects from night work. However, this is not compulsory.

Name and address of GP:

Do you work? Please tick as appropriate
Twilight hours/ Nights only YesNo
Internal rotation shift YesNo

Has your employment ever been terminated on the grounds of ill health YesNo

If yes please provide details

Approximately how many days/weeks sickness absence did tou have in the last twelve months?

How many units of alcohol do you consume weekly?

Do you smoke? YesNo

Are you currently taking prescribed medicine? YesNo

Are you currently suffering from or have suffered from any of the illnesses listed below:

Heart troubleCirculatory problemsChest painsAnginaAsthmaDrug/alcohol abuseFrequent diarrheaStomach ulcersDigestive disordersKidney/bladder disorderHigh blood pressureDepression/anxiety