Your details are already registered with this agency, you will need to contact the agency direct to re-register your details.
1. The information that you provide on this form & on any CV given will be used by Jobsworth Recruitment Solutions Ltd to provide you with a work finding service. In providing this service to you, you consent to your personal data being included on a computerised database & consent to us transferring your personal details to our clients. We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in any other way permitted or required by law.


If, during the course of a temporary assignment, the client wishes to employ me directly, I acknowledge that Jobsworth Recruitment Solutions Ltd will be entitled to charge the client an introduction/ transfer fee, or arrange an extension of the hiring period with the client (after which I may be employed by the client without further charges being applicable to the client). I am aware that these terms and conditions have already been agreed between the Client and the Employment Business.


I confirm that the information given to the Employment Business is true and correct. I consent to my personal data, CV and references being forwarded to clients and potential employers. 

1. These regulations offer certain rights to all workers, temporary or permanent. The rights covered by these regulations are: Workers can if they wish work a maximum of 48 hours per week Workers must have a minimum of 1 hours rest period per day Workers are entitled to 5.6 weeks paid holiday to include Statutory Bank Holidays

Opt Out

If you wish to opt out of these regulations you may do so by signing below. This does not affect your holiday entitlement or hourly pay rate. If you wish to opt back in then you can do so by providing 7 days written notice.         

1. 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.

Subject to the filtering rules failure to declare a conviction that you must disclose may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light.               


A Conviction will be removed from a DBS Criminal Record certificate if:

• it is the person’s only offence, and

• it did not result in a custodial sentence.

• Even then, it will only be removed if it does not appear on the list of offences relevant to safeguarding. If a person has more than one offence, then details of all their convictions will always be included

• The elapsed time depends on age please see below;   



Age at Time of Offence Elapsed -  Time for a conviction  - Elapsed time for a Caution.

Under 18                                         - 5.5 year                          - 2 years

Over 18                                            - 11 years                         - 6 years 


I confirm that I have no Criminal Convictions, Cautions or Pending Prosecutions, but if I have I have declared them below in line with the ‘filtering guidelines’.

No Yes
1. Do you have any health issues or disabilities relevant which may make it difficult for you to carry out the role you seek? If so, please explain how this affects you.
2. If you have a disability, what are your needs in terms of reasonable adjustments to enable you to perform the role sought?
3. Do you take regular medication? If so, what for, how often, and does this affect you?
4. Have you ever been dismissed from work due to health reasons? If yes, please explain.
5. Sign
6. Date
1. Date of Vaccine 1 
2. Date of Vaccine 2 
1. Entitlement to drive

It is an offence for a person to drive on a road any vehicle otherwise than in accordance with a licence authorising them to drive it. It is also an offence for a person to cause or permit another person to drive it.


You are required to produce your latest licence to Jobsworth Recruitment Solutions Limited when requested. You must also inform Jobsworth Recruitment Solutions Limited of any road traffic incidents, convictions, endorsements or disqualifications that have occurred or occur, which could affect your entitlement to drive, as soon as possible.

Changes in your health can also affect your entitlement to drive, in particular, for ALL licences:

• Epilepsy

• Fits or blackouts

• Repeated attacks of sudden disabling giddiness (dizziness that prevents you from functioning normally)

• Diabetes controlled by insulin

• An implanted cardiac pacemaker

• An implanted cardiac defibrillator (ICD)

• Persistent alcohol abuse or dependency

• Persistent drug abuse or dependency

• Parkinson’s disease

• Narcolepsy or sleep apnoea syndrome

• Stroke, with any symptoms lasting longer than one month, recurrent ‘mini strokes’ or TIAs (Transient Ischaemic Attacks)

• Any type of brain surgery, severe head injury involving inpatient treatment, or brain tumour

• Any other chronic (long term) neurological condition

• A serious problem with memory or episodes of confusion

• Severe learning disability • Serious psychiatric illness or mental ill-health

• Total loss of sight in one eye • Any condition affecting both eyes, or the remaining eye only (not including short or long sight or colour blindness)

• Any condition affecting your visual field (the surrounding area you can see when looking directly ahead)

• Any persistent limb problem for which your driving has to be restricted to certain types of vehicles or those with adapted controls Also, for vocational licences:

• Angina, other heart conditions or heart operation

• Diabetes controlled by tablets

• Visual problems affecting either eye

• Any form of stroke, including TIAs (Transiant Ischaemic Attacks)


If any of the above affects you, you must inform Jobsworth Recruitment Solutions Limited as soon as possible. You must also inform DVLA by writing to the: Drivers Medical Group, DVLA, Swansea SA99 1TU (the appropriate medical questionnaires can be downloaded from


www.direct.gov.uk/driverhealth). Failure to do so is a criminal offence punishable by a fine of up to £1,000.


Compliance

You are required to understand and comply with all relevant legislation in relation to road transport and any other reasonable requests.


In particular, you must:

• understand and will comply with the rules on EU drivers’ hours and records requirement, domestic drivers’ hours rules and records, and working time limits for mobile workers in the road transport sector, as appropriate

• have taken sufficient daily and weekly rest

• have sufficient duty and driving time available to be able to work the shift(s) allocated to you

• have (and will continue to have) on your person the drivers’ hours records required to be produced to an enforcement officer if requested, namely:

- digital driver’s card (if you hold one)

- analogue tachograph charts for the current day and the previous 28 calendar days (if you drove a vehicle fitted with analogue equipment in that time)

- any written manual records and printouts legally required for the current day and the previous 28 calendar days • ensure the original analogue charts and any legally required printouts or written manual records, which relate to your placement, are returned to Jobsworth Recruitment Solutions Limited within 42 days

• ensure your digital driver’s card is downloaded at the required intervals and in any case at the end of your placement, before you leave the site

• have a full valid licence (with no disqualifications) for the type of vehicle you are being asked to drive

• where appropriate, hold a Driver CPC and carry your Driver CPC qualification card

• inform Jobsworth Recruitment Solutions Limited of any encounters with DVSA (formally known as VOSA), the police or other enforcement officers

• never use a hand-held mobile phone whilst driving

• report any accidents or near misses that you are involved into Jobsworth Recruitment Solutions Limited

• carry out daily walk around vehicle checks using the documents provided and report any defects

• understand and comply with speed limits of roads and vehicles

• not drive a vehicle whilst under the influence of drink or drugs (whether illegal or prescribed)

• ensure that the load on your vehicle is secure and within the limits of the vehicle in terms of weight and distribution

• comply with any health and safety requirements on this site and any site visited during your placement

• return the vehicle and its equipment in the same condition that you received it in You must be satisfied that you are legally able to undertake the duties required of you and must advise Jobsworth Recruitment Solutions Limited if you have any doubts, concerns or problems with any issue in relation to performing your duties. 

1. What is the minimum break requirement after 4 hours 30 minutes of either continuous or cumulative driving under EC rules?
2. Which of the following would meet the requirements of a split break from driving?

1. 15 minutes + 30 minutes

2. 20 minutes + 25 minutes

3. 30 minutes + 15 minutes

4. 17 minutes + 35 minutes
3. A ‘regular’ daily rest is defined as a period of at least how many consecutive hours?
4. Driving time can be extended to 10 hours, on how many occasions in a fixed week?
5. At the end of your working week you have driven under EC Rules for 50 hours. What is the maximum number of hours that you can drive in the following week under EC Rules?
6. A drivers’ digital tachograph card is valid for a period of:
7. A daily rest can be reduced to 9 hours on how many occasions between a drivers’ weekly rest periods?
8. You have reported your driver card lost, stolen, damaged or malfunctioning. Providing you follow the rules you can continue to drive for a maximum of :
9. Under the Road Transport (Working Time) Regulations you are not permitted to work more than how many hours without taking a break?
10. A regular weekly rest is defined as a period of at least 45 hours. This can be reduced to 24 hours within the regulations – what are the rules on compensation?
11. A driver must complete how many hours of periodic training to be awarded the driver qualification card?
12. The fixed penalty for failing to carry the DCPC qualification card, after it has been issued, whilst at work is:
13. What is the meaning of this road sign?
14. This sign means:
15. This sign means:
16. What do yellow lines painted at right angles to the kerb (as shown below) indicate?
17. What is the speed limit for a goods vehicle exceeding 7.5t on a dual carriageway, where national speed limit applies, in England and Wales?
18. What is the legal minimum tyre tread depth on a goods vehicle in excess of 3,500kgs gross vehicle weight?
19. Under current road traffic legislation, which of the following details must a driver give at the scene of an incident or collision?
20. A driver is required to produce their driving licence on demand, if it is not available a police officer can request the licence is produced at a nominated police station within:
21. When should a driver walk around check be carried out?
22. Who is responsible for the roadworthiness of a goods vehicle on the public highway?
23. What is the correct procedure if you find a fault on the vehicle during the walk around check?
24. What is the maximum working time permitted in any one week under the Road Transport (Working Time) Regulations?
25. Which of the following is a defence to a charge of overloading?
26. Why is ensuring the load is secured to the vehicle so important?

1. All planned deliveries are made so customer is satisfied

2. Vehicle stability is not compromised

3. According to the regulations nothing must fall or be blown from the vehicle

4. Safety of the driver and other road users

5. Can travel on all classes of road not just motorways and trunk roads

27. A lorry is overtaking you on two-lane motorway/dual carriageway. It does not have the speed to get past. What should you do?
28. To use a hand held mobile phone is an offence. The penalty through the fixed penalty system is:
29. What is the speed limit on an unrestricted single carriageway for a goods vehicle in England and Wales?
30. When should you use hazard warning lights?
1. NAME / AREA / CONTACT NUMBER / EMAIL ADDRESS
2. CURRENT ROLE / DESIRED ROLE 
3. SALARY EXPECTATIONS