RAIL REGISTRATION PACK
Contact us:
Head Office
Trackforce Recruitment Limited
The Whitehouse,
Wilderspool Park,
Greenalls Avenue,
Warrington,
Cheshire,
WA4 6HL
Tel: 01925 430 318
Email: [email protected]
Rail Registration Pack
Please complete and return this registration pack with all supporting information to the head office address
on this page, or by email with the supporting information to: [email protected]
Personal Details
Surname:
Forename:
N I Number:
Date of Birth
Sentinel Number:
Driving License:
Your date of birth is required as a form of identification and we may need to undertake age-related medicals,
risk assessment etc.
Permanent Address
Address:
Telephone number:
Mobile number:
E-mail address:
Postcode:
Emergency Contact Details: (Next of Kin)
Name:
Relationship:
Address:
Contact number: (Home)
Contact number: (Mobile)
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Education, Qualifications and Employment History
Please provide details of your education and qualifications. You do not need to complete this section if you
have submitted current valid CV that include your qualifications and work experience.
Secondary school:
From:
To:
Exams taken:
Results:
Further education:
From:
To:
Exams taken:
Results:
Other Qualifications:
Employment history
Company name:
Job Title:
Date
From:
To:
Disability
A person has a disability if he or she has a physical or mental impairment; the impairment has an adverse
effect on his/her ability to carry out day to day activities; the effect is substantial or the effect is long term.
For further information, please see: The Disability Discrimination Act 1995 and the Disability (Employment)
Regulations 1996.
Do you consider yourself to be disabled?
Yes
If you have answered Yes, please give details on a separate sheet of paper.
No
References
Please provide contact details of at least two referees. One of the referees should be your line
manager/supervisor from your present or most recent job or assignment (or study course if no job held).
Please note: references will be sought before you start an assignment.
Tick here if you do not want us to contact your current employer:
Company name:
Company name:
Contact name:
Contact name:
Job title:
Job title:
Contact number;
Contact number:
Relationship with
contact (manager
etc.)
Your position
held
Date from
Relationship with
contact (manager
etc.)
Your position held
To
Date from
To
2
Criminal conviction(s)
Please declare whether you have any unspent criminal convictions, including a driving ban. If declared,
please give details of the offence(s) and sentence(s) on a separate sheet of paper. The company will
comply fully with the requirements of the Rehabilitation of Offenders and Data Protection Acts.
Do you have any unspent criminal convictions (including current driving ban)?
Yes
No
If Yes, please give details on a separate sheet of paper, the information provided may be disclosed to
a client in the event you being potentially offered an assignment.
Failure to disclose this information will result in the termination of any assignment.
Eligibility to work in the UK
Under the immigration, Act 2003 we are obliged to check your eligibility to work in the UK or within a specific
country. Before you start an assignment with us you must produce documents proving eligibility to work in
the UK or any other specific country.
Are you a UK citizen?
Yes
No
If No, are you a national of an EU/EEA member country?
Yes
No
I require a work permit in order to take employment in the UK
Yes
No
I hold other immigration documentation endorsed to work in the UK
If yes to above – copies of these documents must be
accompanied with this registration form.
Yes
No
Yes
Yes
No
No
If Yes to a national of EU/EEA, please state which one
If No to both above questions, please select the statement below that
applies to you:
Eligibility to work outside of the UK (if applicable)
What country or countries are you planning to work in?
I hold a permit to work in the above countries
I hold other immigration documents to work in the above
countries
If yes to above – copies of the documents must be accompanied
with this registration form
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The following sections to be completed by all contractors
**Supporting information: please ensure all copies are in colour**
To enable us to process your application and to comply with legislation, please enclose legible colour
photocopies/scanned copies of the following:

Qualification/Training/Competency Certificates/cards in colour

Medical & Alcohol and Drugs Certificates (if applicable) in colour

Valid Passport or Work Visa & Permit in colour including front cover of passport

Or – full birth certificate (showing a place for both parent’s names)

Any other relevant supporting documents required to support your application

Supporting documentation relating to your pay status
Mailshots
Upon your registration, you will automatically be included to receive SMS messages and mailshots from
Trackforce Recruitment Limited. This information will relate directly to your work. Please tick here if you do
not want to receive information from us.
NB: those who are under sponsorship will still receive: monthly briefings and updates and any
other information required for Network Rail and LUL Workers.
For more information on how we store and process your information, please see our Private Policy
Statement attached.
Declaration
I confirm that all the information I have provided in this registration pack, is correct, and I will inform
Trackforce Recruitment Limited of any changes in writing. I also confirm that I give Trackforce Recruitment
Limited permission to verify any qualifications, accreditations, references, etc. that I have disclosed. I
confirm that I have received, read and understood the policies and induction pack.
Signed:
Dated:
Print Name:
Please ensure you return the whole pages to Trackforce Recruitment Limited
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Medical Self Certificate
Access to Trackforce Recruitment Ltd work sites where full Medical Examination is not required
Alertness and reasonable physical fitness are essential for duties, which may interact with moving trains. It
is therefore important to be accurate with your answers to this questionnaire, although trivial matters should
be ignored (e.g. transient dizziness while gardening two years ago). When you declare NO you are
accepting a degree of responsibility for your safety.
Please study this list and sign the declaration at the bottom.
Yes
No
1. Do you wear contact lenses or glasses?
2. Do you suffer from Epilepsy or any other fits?
3. Have you ever had Blackouts, recurrent dizziness or any condition, which may
cause sudden collapse or incapacity?
4. Do you get discomfort or pain in the chest or shortness of breath?
5. Do you have difficulty in moving rapidly over short distances?
6. Would you have difficulty looking over either shoulder?
7. Do you have difficulty with your eyesight (simple problems needing
glasses need not be included)?
8. Do you have Diabetes needing Insulin
9. Do you have difficulty in correctly identifying colours?
10. Do you have difficulty hearing?
11. Would you have difficulty working in out-door or open spaces?
12. Would you have difficulty working in enclosed spaces?
13. Would you have difficulty in working at height?
14. Do you suffer any stomach or intestinal disorders?
15. Do you suffer from any condition that causes difficulties sleeping?
16. Do you suffer from chronic chest disorders, especially if night time
symptoms are troublesome?
17. Do you suffer from any medical condition requiring medication to a strict
timetable?
18. Do you suffer from any other health factors that might affect fitness at work?
19. Are you taking any medication that is giving you dizziness or
drowsiness?
20. Have used drugs of abuse within the last 12 months?
21. Have you had any alcohol – related illness during the last 12 months?
Medication: prescribed and/or non-prescribed:
Start
Medication Name
Reason for
Date
taking
Signed
…………………………
Dosage Frequency
Name (print)……………………..
Side
effects
Yes/No
Prescribed
Yes/No
Date.……………….
Action taken by Issuing Manager
Application Progressed ( ) Application Refused ( ) Referred for Medical Examination ( )
Signed………………………………… Name (print)……………………………. Date………………………
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Hand Arm Vibration Medical Questionnaire
Those employees and potential employees whose role involves the use of vibratory tools must
complete this HAVS Medical Questionnaire at pre-employment and then at 12-monthly intervals.
Trade: …………………………………………………………………………….
Please study this list and sign the declaration at the bottom.
All to complete:
1. Did previous jobs involve the use of vibrating equipment?
Yes
No
2. Have you ever suffered from your fingers going white on exposure to cold?
3. Have you had any tingling or numbness in your fingers after using vibrating
equipment?
4. Are you experiencing any problems with muscles or joints in your hands or arms?
5. Do you have any difficulty picking up small objects such as screws or nails?
6. Do any of your hobbies expose you to hand-arm vibration? If yes please give
details
7. If you answered yes to any question between 2 – 5 when did you first notice this?
8. If you suffer now how often does it occur?
 Several times a year?
 Several times a month?
 Several times a day?
 Every day?
 Does it occur in winter only?
 Winter and summer?
One or more of the above applies to me:
Signed: ……………………………
Action taken by Manager at:
Application Progressed:
None of the above applies to me:
Name: (print) ..……………………… Date: .…………..
Interview
12-monthly period
Application Refused:
Referred for Medical Examination (employees only)
Signed:..…………………………….
Name: (print)…………..…………... Date:.……………
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Hours of work policy
Trackforce Recruitment Ltd have accepted the Network Rail Policy on working time and as a consequence
have now implemented our own policy for those staff and operatives, including sub-contractors who work or
may work on the Network Rail Controlled Infrastructure.
1.
Introduction
This statement sets out our policy in respect of any duties that may be impaired as a result of working
excessive hours.
We have taken into account Regulation 25 of the Rail and Other Guided Transport Systems (Safety)
Regulations 2006. Provided that employees and sub-contractors adhere to the provisions of this policy, they
will normally be able to demonstrate compliance with the Group Standard and Railway Regulations.
It is important, therefore, that all persons concerned are made aware of this statement and become familiar
with its contents.
2.
Policy
We will take all reasonable steps to ensure that employees or contractors are made aware of the contents of
this statement, together with the relevant sections of the Group Standard and the implications therein.
Furthermore, as a responsible employer, we have in place procedures to prevent, insofar as it is reasonably
practicable, an offence under Railway Regulations and a monitoring process to measure the progress of
such procedure.
3.
Requirements
It is a requirement of the company that the working time of employees and sub-contractors comply
with the following limits.
3.1
Maximum Number of Turns of Duty
No more than 13 turns of duty to be worked in any 14-day period
3.2
Maximum Hours Worked
No more than 12 hours to be worked per turn of duty
No more than 72 hours to be worked per week
3.3
Minimum Rest Periods
Minimum rest period of 12 hours between booking-off from a turn of duty to booking on for the next
turn. In the case of employees working a regular shift pattern, which rotates or alternates on a
weekly basis, the rest period at the weekly shift changeover may be reduced to not less than 8 hours.
4.
Exceptional Circumstances
4.1
Exceeding working time limits
In emergency situations, to cover essential work only, and provided no alternative
arrangements can be made, the limits shown in 3.1 to 3.3 may be exceeded if authorised by a
nominated representative of the Company or Network Rail.
4.2
Records to be kept
The person authorising the variation must record the actual times worked, and the reason why such
authority was given. This record must be monitored and subjected to audit.
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5.
Definitions
14-day period Any 14 successive days, starting and ending on any day of the week
Hours worked Actual (not rostered) paid hours of work, inclusive of paid
Travelling, walking time and paid meal breaks
Week
Emergency/
Call-Out Situations
Essential Work
In clause 3.2, refers to a pay bill week, i.e. Sunday to Saturday
Circumstances which cannot be anticipated and which threatened serious
disruption to the service, e.g. severe weather conditions such as fog, flooding
or heavy snow, breakdowns, accidents or sudden illness to a key member of
staff.
Work necessary to avoid serious disruption to the service.
6.
48 Hour Opt Out: Working time Directive (WTD)
Under the WTD you can opt out, which means by opting out you will be able to work more than 48 hours per
week over an average of 17 weeks. If you do not wish to opt out, your hours will be check to ensure you do
not work more than 48 hours per week over an average of 17 weeks.
I agree that I wish to opt out of the WTD. If I change my mind, I agree to give Trackforce Recruitment
Limited three months’ notice in writing to end this agreement.
Signed: _____________________________
Dated: _______________________
This opt out will not supersede any client restrictions on working hours.
7.
Statement
I have read and understand the Trackforce Recruitment Ltd Policy on Hours of Work.
Name (please print):
________________________________________
Signature:
________________________________________
Date:
______________________
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Contract of Sponsorship
To be completed prior to Sponsorship and retained in individual’s personnel file.
Trackforce Recruitment Ltd, Sentinel ID: 206051
Details of Individual to Be Sponsored:
Contractual Relationship
with the Company:
Print Name:
Directly Employed
Sentinel No.
Sub-Contractor
Contract of Sponsorship
As the Sentinel Smart Card holder named above I declare that:
 I have been issued with or already hold a valid Sentinel Smart Card
 I have been briefed on and understand my responsibilities and that of the company under the
Sentinel Scheme Rules.
 I have been issued with suitable railway specification PPE and have been instructed how to use it
correctly, how to maintain it and how to obtain replacement items.
 I have been issued with any necessary safety critical equipment required to undertake my role.
 I have notified the company of all current medical conditions and medication and will notify the
company immediately should this change.
 I understand that Sub Sponsors are permitted in some circumstances but only with written
permission from Trackforce Recruitment Ltd.
 I understand that Trackforce Recruitment Ltd may de-sponsor me at their discretion but will provide
notification and a reason for de-sponsorship.
 I understand that a breach of the Sentinel Scheme Rules may result in suspension pending an
investigation followed by de-sponsorship.
 I understand that I can request to be de-sponsored if I wish and can do this via the ’My Sentinel’
area of the Sentinel website if required.
 I understand I can access my personal records in the ‘My Sentinel’ area of the Sentinel Website.
 To my knowledge, I am eligible to work in the UK.

I can understand verbal and written communications in English
Contract of Sub-Sponsorship
 Does your contract of Sponsorship with your Primary Sponsor permit you to have sub-sponsors?
 Do you wish to be Sup Sponsored by Trackforce Recruitment Ltd and do you consent to Trackforce
Recruitment Ltd requesting Sub-Sponsorship from your Primary Sponsor via the Sentinel portal?
Under this Contract of Primary Sponsorship Trackforce Recruitment Ltd will act as the employer for
health & Safety legislation and will ensure that:
 The Smart Card Holder is briefed on relevant changes to Standards, rule book updates and
changes to Sentinel Scheme Rules.
 The individual is notified of de-sponsorship and provided with the reason for de-sponsorship.
 De-sponsorship due to a breach of the Sentinel Scheme Rules will only take place following an
investigation. Records of such an investigation will be maintained.
 Checks have been made to ensure the individual is eligible to work in the UK
The individual can communicate sufficiently in Verbal/written English

Trackforce to be Primary Sponsor
Sign:
Trackforce to be Sub-Sponsor Sign:
Date:
Signed on behalf of Trackforce:
Position:
Print Name:
Date:
New Entrant Name:
Location:
……………………………
………………………………………
Date:
Inducted by:
………………………….
Date:
………………………….
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It will be noted that there is no skills training (abrasive wheels, tower scaffold, etc.) for Operatives or
development training for Managers and Supervisors entrants (Safety Plans, Method statements, CDM
Regulations, etc,) included within this basic induction program. These items will be included within the
Managing Director’s training requirements and programmed throughout the year.
Please visit www.trackforcerecruitment.co.uk to review Trackforce Recruitment’s Ltd Policies and
Procedures.
I ….
Yes No
I fully understand the contents of the Induction Briefing Pack and that it is a requirement of my
employment terms to fully comply with those instructions.
I have completed and signed the Medical Self Certificate & HAV Medical Questionnaire and the
answers are to the best of my knowledge true
Have read and understand the Health & Safety at Work Act 1974.
Have read and understand the Health & Safety, Environmental and Quality Policies Statements and
have seen the Company’s Safety Organisation.
Have read and understand the Safety Responsibility Statement and Job Description for my position
that details my Health & Safety duties as an Employee towards the Company, Fellow Employees,
Visitors and Myself.
Have read and understand the Drugs & Alcohol Policy and understand the importance of informing
the Administrator of any prescribed medication I may be taking.
Have read and understand what to do if there is an Accident or Incident; where to find the names
and locations of trained First Aiders, plus the requirement to report all accidents to my
Manager/Supervisor.
Understand the significance of all information and mandatory warning signs.
Have read and understand my responsibility to report all Near Misses, defective plant & equipment,
unsafe practices or methods of work which have the potential to cause injury.
Have read and understand the need for good housekeeping and my own housekeeping
responsibilities.
Have read and understand the significance of complying with the Hours of Work Policy at all times
and informing my Employer if I work for other Employers during rest periods.
Have read and understand that should I want to use a substance that has not been issued on site I
must inform my Manager/Supervisor to enable a COSHH Assessment to be carried out prior to its
use and I must adhere to the guidance and instruction within the COSHH Assessment whilst using a
substance.
Have read the rules applicable to the use of all plant & equipment including scaffolding, ladders, etc
and understand the company “Safe Work Permits” procedures
Have read and understand what action to take if Asbestos is discovered or disturbed.
Have read and understand the Work Safe Procedure, the Confidential Reporting Process & the
CIRAS Process (CIRAS for PTS Certificated Employees only).
Read and understand the Policy on Bribery & Malpractice
Read and understand that the correct Manual Handling Techniques should be used when lifting.
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I have…..
Read and understand that the correct PPE must be worn at all times whilst working,
Been informed that I will receive a Site Specific Briefing when I first arrive at my Site and that I should
receive a Site Induction at every site I work on and it should include as a minimum:
 I have been briefed on the Network Rail Life Saving Rules and have been issued with my
Life Saving Rules Aide-Memoire
 The Site’s Hazard Identification process, risk assessments, and safety instructions applicable
to my job.
 The access and exit routes applicable to the site and also those locations on the site, which
access is prohibited or restricted. The reasons for the prohibition or restriction have been
explained to me.
 The emergency arrangements the evacuation routes & emergency exits from my place of
work, location of fire points, equipment and assembly points and have been introduced to the
Fire Warden responsible for my place of work.
 The Local Site Rules
 The Location of all Welfare Facilities (Canteen, Toilets, Washrooms, etc)
Yes
No
The above training in conjunction with the relevant Operational Induction is the minimum to ensure compliance
with legislation, Clients and Trackforce Recruitment Ltd’s Safety Management System requirements.
If in doubt – Ask your Manager or Supervisor!
A copy of this Checklist will be handed to the Inductee on completion of the Induction Training and a further
copy held on the Inductee’s Training File.
Signed:
_______________________________
Print Name:
_______________________________
Date:
_______________________________
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For more information visit the Network Rail Safety Central website.
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