APPLICATION FORM FOR EMPLOYMENT
In Confidence
Bowen Projects Ltd (The Company)
And
(The Contractor)
Definitions
In these Conditions:
“Company”
9UT
means Bowen Projects Ltd of R/O 203 Torrington Ave, Coventry CV4
“Contractor” means the Worker that represents the above registered company by
supplying the services below;
“Customer”
means the person/s, organisation or corporate body, requiring the
services of the contractor;
“Assignment” means the period during which the contractor is engaged to render
services to the client as described in the attached Schedule;
As used herein the masculine includes the feminine and the singular includes the
plural and vice-versa.
The headings contained within these Terms are used for convenience only and do not
affect their interpretation.
Please complete this form in full and return, even if you attach a full CV
1. POST APPLIED FOR:
2. PERSONAL DETAILS
Surname (Block Letters):
First Name:
NI Number:
Sex (please
indicate):
Nationality
Date of Birth:
Sentinel Card Number
Email
3. PERMANENT ADDRESS
Address:
Tel Number:
Mob
Number:
Postcode
4. ADDRESS FOR COMMUNICATION (if different from above)
Address:
Postcode
Tel Number:
5. NEXT OF KIN (for emergency contact)
Name & Address:
Postcode
Tel Number:
6. AVAILABILITY
Dates when you will not be available for interview:
If offered, when could you take up the post?
7.
EDUCATION & QUALIFICATIONS
SCHOOLS/COLLEGE
Year of leaving:
Educational qualifications gained at this or other schools and colleges
Give details with dates starting with the most recent exam
Exam
Subject
Grade
Year
Exam
Subject
Grade
Year
8. NETWORK RAIL QUALIFICATIONS
EXPIRY DATES
PTS AC/DC
Track Safety Handbook Held Yes/No
Lookout/Site warden
Equipment Yes/No
COSS
Assessment required Yes/No
Engineering Supervisor
Assessment required Yes/No
PICOP
Assessment required Yes/No
Senior PICOP
Assessment required Yes/No
Hand Signalman
Assessment required Yes/No
DC Strapman
D32
D33
MOD Competencies
PICOM
Emergency First Aid
Medical
Drugs & Alcohol
Please send us colour copies of all certification and relevant assessments
Page 4
9. OTHER QUALIFICATIONS NOT LISTED
10. DECLARATION OF WORK UNDERTAKEN
It is essential that we are aware of the amount of Safety Critical Work undertaken by yourself under each
competency held by yourself. Please complete the declaration below:
In the last 12 months I have undertaken work as a:
Nominated Person
PICOP/ES
COSS
PC
IWA
Lookout/Site Warden
Hand Signaller
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
If Yes, how much
If Yes, how much
If Yes, how much
If Yes, how much
If Yes, how much
If Yes, how much
If Yes, how much
I confirm that the above information is correct
Signed:
Name:
Date:
OFFICE USE ONLY
Discipline
Full Course
Refresher
Nominated Person
PICOP/ES
COSS
PC
IWA
Lookout/Site Warden
Full course/refresher arranged by:
Comments:
Page 5
Date Arranged
11. MEDICAL SELF CERTIFICATION FORM
Alertness and reasonable physical fitness are essential to enable you to carry out Safety Critical duties. It is
therefore important to be accurate with your answers to the questions below. Although trivial matters should be
ignored (e.g. dizziness while gardening two years ago). When you declare “NO” you are accepting a degree of
responsibility for your safety.
Please study this list, answer the questions and sign the declaration
Do you have diabetes needing insulin?
Do you suffer from epilepsy or fits?
Have you ever, or do you, suffer from asthma or chest related breathing problems?
Have you ever had blackouts, dizziness or any condition which may cause sudden incapacity?
Do you get discomfort or pain in the chest or shortness of breath on exercise?
Do you have difficulty in moving rapidly over short distances including steps or rough ground?
Would you have difficulty in looking over each shoulder?
Do you wear/require glasses for normal vision?
Do you wear contact lenses whilst at work?
Do you have any difficulty in hearing normal conversations?
Are you taking any medication that may cause dizziness or drowsiness?
Have you used drugs of abuse in the last 12 months?
Have you had any alcohol related illness in the last 12 months?
Yes, one or more of the above applies to me
No, none of the above applies to me
If you have ticked “Yes” to any of the above please give details in full:
NB: If you have ticked “Yes” to wearing glasses or contact lenses, a second pair must be carried at
all times when working on or near the line.
Signature
Date
OFFICE USE ONLY
Application Progressed
Application refused
Referred for medical examination
Signed:
Name:
Page 6
12. EMPLOYMENT HISTORY
Please give details of all full and part time posts held
Present post
From (month and
year)
Name and address of
current employer
Position held, description
of work and responsibilities
Current Salary
Previous posts held, most recent first
Month & Year
From
To
Name & address of employer
Position of held,
description of work,
reason for leaving
Salary on leaving
13. DRIVING DETAILS
Do you hold a Driving License? /No
Do you have any endorsements? Yes/No
If yes please provide details of endorsements held:
Have you ever been convicted of drink driving?
Yes/No
No
Have you ever been dismissed for any rail related
transgressions within the last 3 years? Yes/No
No
Page 7
14. Please give details of two references to which we may refer now or later. At least one should be
someone responsible for your work in your present or last post.
Name
Organisation:
Position:
Address:
Postcode:
Tel Number:
May the reference be sought without referring to you first? Yes/No
Name:
Organisation:
Position:
Address:
Postcode:
Tel Number:
May the reference be sought without referring to you first? Yes/No
Declaration
I will abide by all Health, Safety and Environmental requirements as laid out by the company and its Clients.
I am aware that I will be subjected to random Drugs and Alcohol testing whilst employed by the company.
I hereby waive the restrictions on the 48 hour average weekly working time set out in Working Time
Regulations 1998.
It is my understanding that only by giving 4 weeks notice can this agreement be terminated.
Signature:
Name:
Date
Page 8
15. BANK DETAILS
Bank name:
Bank address:
Sort Code:
Account number:
NI Number:
I hereby confirm that the above bank details are correct and relate to the account I wish you to credit
for works completed by the undersigned:
Signature:
Name:
Date:
Umbrella Payroll
Company:
Ref Number:
If you wish to be paid through your own Ltd Company please provide a copy of your company
registration number and VAT registration number.
Page 9
INDUCTION
16. QUALITY HEALTH & SAFETY
The undersigned have been formally briefed understood and will adhere to the following Procedures and Policy
Statements
Quality Policy Statement,
Health, Safety and Environment Policy Statement,
Drugs and Alcohol
COSHH
Excess Hours
Accident & Incident Reporting
Signed:
Name:
Date:
17. MODULAR RULE BOOK
You will be briefed and issued with a copy of the new modular rulebook (if you don’t already hold one).
Please confirm you already hold a copy or receipt of and briefing on the rulebook.
Name:
Signature:
PTS Card Number:
18. BASIC PPE
You will be issued (free of charge) with the following basic items of PPE:



Safety helmet
High Visibility vest
Safety footwear / If required
These are the minimum requirements for PPE to be used for all work on railway infrastructure. You may be
issued with additional PPE according to the activities you are involved in.
You must maintain these items in good condition as per the manufacturers instructions at all times.
If you leave the company within 6 months you must return all items of PPE or the sum of £100 will be deducted
from your last weeks payment of work to cover the cost of the PPE.
Page
10
I confirm that I have read the instructions and understand the conditions of receiving and maintaining PPE.
Signed:
19. HOURS OF WORK DISCLAIMER
It is a requirement of the company that the working time of all workers and sub-contractors comply with the
following limits, as stipulated in:
The Railways and Other guided Transport Systems (Safety) Regulations 2006.
I understand that:
a. Maximum hours worked
No more than 13 turn of duty to be worked in any 14 day period.
b. Maximum hours worked
No more than 12 hours to be worked per turn of duty. Hours of work shall include travel to and from
worksite unless a designated non-working driver is available.
c. Minimum Rest Period
Minimum rest period of 12 hours between booking off a turn of duty to booking on for next turn.
d. Maximum Working week
No More than 72 hours to be worked per calendar week (Saturday to Friday)
I confirm that I will not accept assignments from any labour suppliers that would cause a
breach of these regulations.
Name…………………………………………..
Signed…………………………………………
Date………………………………………………
Page
11
TERMS & CONDITIONS OF CONTRACT
(RAIL LABOUR)
In Confidence
1. The Service
These terms constitute a Contract for Services between the Company and the Contractor and the terms herein
govern the Assignment undertaken by the contractor.
The Contractor shall perform the Services in accordance with the terms of this Agreement and any mutually
agreed amendments thereto.
For the avoidance of doubt, these terms shall not give rise to a contract of employment between the Contractor
and the Company. The Contractor is engaged as a self-employed worker through the above registered
company.
No variation to these terms shall be valid unless agreed in writing by the Company.
2. Future Assignments
The Company shall endeavour to obtain suitable Assignments for the Contractor.
The Contractor acknowledges that it is in the nature of contracting for services that there may be periods when
no suitable work is available and agrees that solely the Company shall determine suitability,
And
The Company shall incur no liability towards the Contractor should it fail to offer opportunities of work.
3. Remuneration
The Company shall pay to the Contractor remuneration at the Rate specified in the Schedule during an
Assignment. The actual rate shall be notified on a per Assignment basis, for each hour worked during an
Assignment and be paid weekly in arrears. This however shall not exceed Industry Guidelines as detailed in
the Company’s Working Hours Policy, unless specifically agreed by the Company and the Customer.
Subject to any statutory entitlement under the relevant legislation, the Contractor is not entitled to receive
payment from the Company or Customer for time not spent on Assignment, whether in respect of Absence,
Holidays or Illness.
Upon receipt of a properly authorised time sheet as per Clause 6, payment shall be made via BACS and all
reasonable efforts shall be made for the payment to arrive on the Friday of the week that the time sheet is
received.
4. Time Sheets and Invoices
Unless arrangements have been made to the contrary, at the end of each week of an Assignment (or at the
end of an Assignment where an assignment is for a period less than one week or is completed before the end
of a week) the Contractor shall deliver completed time sheets that are signed by the Contractor and by an
authorised representative of the Customer.
The Company shall not be obliged to make any payment to the Contractor unless a properly authenticated time
sheet has been submitted.
In order that time sheets can be processed and included in the payroll for the current week, it is essential that
signed time sheets are received by the Company no later that 1200 hrs (midday) Tuesday.
Page
12
5. Conduct of Assignments
The Contractor is not obliged to accept any Assignment offered by the Company but if he does so, during every
Assignment and afterwards where appropriate, he shall:

Co-operate with the Customer’s staff and accept the direction, supervision and control of any
responsible person in the Customer’s organisation;

Observe any relevant rules and regulations of the Customer’s establishment to which attention has
been drawn or which the Contractor might reasonably be expected to ascertain;

Unless arrangements have been made to the contrary, conform to the normal hours of work in force at
the Customer’s establishment;

Not to engage in any conduct detrimental to the interests of the Customer;

Not sub-contract to any third party any of the services which is required to perform under an
Assignment;

Not at any time divulge to any person, nor use for his own or any other person’s benefit, any
confidential information relating to the Customer’s or the Company’s employees, business affairs,
transactions or finances.
If the Contractor is unable for any reason to attend work during an Assignment, he should inform the
Company and the Customer by no later than 10.00 a.m. on the first day of absence.
6. Termination
The Company or the Customer may, without prior notice or liability, instruct the Contractor to end an
assignment at any time. The Contractor may terminate an Assignment at any time immediately by informing
the Company
7. Health and Safety
The Contractor shall:

Comply with the full requirements of the Company’s Health and Safety Policy and procedures. The
company has a duty of care that the health and safety of its employees is under no circumstances
overlooked by the company or any customer of the company, and that control measures are in place to
guarantee this duty. Duty includes the refusal to work on grounds of Health and Safety.

Take all reasonable steps to safeguard his own safety and the safety of any other person present who
may be affected by his acts or omissions on the Assignments.

Wear appropriate clothing subject to the requirements of Personal Protective Equipment and Work
specific Risk Assessments.

Agree to adhere to company Drugs and Alcohol policy and procedures. Full guidelines of this process
can be found in the comapny Health & Safety Manual.
Furthermore the contractor shall sign as an acknowledgement that the briefing received has been fully
understood and that the contractor shall abide by the requirements of the Company and the
requirements of the Health & Safety Policy of the customer.
8. Accident Reporting Procedure
In the event of the contractor suffering from an accident, howsoever caused, the contractor shall report the
incident directly to the customer line manager responsible for the contractor. The contractor shall also report
the accident directly to the Company immediately following the completion of the accident book, whereby
further investigation shall be conducted.
9. Grievance Procedure
It is expected that any day to day problems or difficulties shall be resolved in an informal manner. If the
grievance cannot be dealt with in this way then it shall be dealt with formally.
Any worker with a grievance must raise the issue either orally or in writing with the person to whom they are
responsible to at the Company. Should the matter not be resolved satisfactorily, it shall be escalated to the
Head of the Department.
Page
13
10. Disciplinary Procedure
In all cases of disciplinary interviews, workers shall be advised of the reason for the interview and the right to
have a colleague present before commencing a disciplinary interview. Minutes shall be recorded, and a copy
given to the worker and held on the workers personnel file.
11. Warranties
The Contractor warrants that, in performing the Services, all the activities shall be carried out to a high
professional standard and in accordance with best industry standards.
The Contractor warrants that the provision of the Services, to the extent that they are under the Contractor's
control, shall not be in violation of any applicable law, rule or regulation or in any way infringe upon the rights of
third parties, including property, contractual, employment, trade secrets, proprietary information and nondisclosure rights, or infringe or breach any trademark, copyrights or patent rights. The Contractor warrants that
it shall have obtained all permits required to comply with such laws and regulations prior to the provision of any
Services hereunder.
12. Indemnification
The Contractor shall indemnify the Company during and after the Initial Term (as per the attached Schedule,
and, where applicable, the Secondary Term) against any claim for infringement of any copyright, letters patent
or registered design arising out of the provision of the Services and shall indemnify Company against all costs,
legal expenses and damages which Company may incur in the defence of, or resulting from, any action for
such claimed infringement.
The Contractor shall indemnify the Company during and after the Initial Term (and, where applicable, the
Secondary Term) against any claim arising in consequence of any act of default or negligence by the
Contractor in the performance of the Services or any failure by the Contractor to comply with confidentiality or
other obligations, and against all costs legal expenses and damages which Company may incur in the defence
of or resulting from any such claim and also against any legal costs or expenses (including legal expenses)
which Company incurs in protecting its confidential and/or proprietary papers and information.
13. Insurance
The Contractor shall effect and maintain during the Initial Term (and, where applicable, the Secondary Term)
an insurance policy with a reputable Insurance provider in respect of Public Liability, Employer's Liability and
Professional Indemnity. There shall be no limit to the Contractor's liability under this Agreement for death or
personal injury caused by it or the Contractor's negligence. In respect of professional indemnity and loss of or
damage to property the Contractor's liability under this Agreement shall be £5,000,000 (five million pounds) for
any one event. Evidence of such insurance shall be provided to the Company at the Company’s request.
14. Law
This Agreement shall be governed by and construed in accordance with English Law and shall be subject to
the exclusive jurisdiction of the English Courts.
I have read and understand the terms of engagement and accept that these form my Contract for Services with
the Company.
IN WITNESS OF WHICH the parties have signed this agreement as acceptance thereof.
Signed by the Contractor ____________________
Date ______________________________________________________________________
Signed by or on behalf of the Company___________________________________________
Date ______________________________________________________________________
Page
14
Numeracy and Phonetic Alphabet
Test Form
Please covert the following words into individual letters using the phonetic alphabet as shown in the
example below:
Example 1
HORSE
Answer:
Hotel Oscar Romeo Sierra Echo
Q.1
PIN
Answer:
Q.2
WALL
Answer:
Q.3
ZEST
Answer:
Q.4
YACHT
Answer:
Q.5
TRICK
Answer:
Now write these signal post numbers out using the phonetic alphabet and writing the numbers in full
as shown in the example below:
Example 2
HR860O
Answer Hotel Romeo Eight Six Zero Oscar
Q.6
WP432M
Answer
Q.7
LN209Y
Answer
Q.8
374 + 509
Answer (phonetically)
Q.9
7 X 32
Answer (phonetically)
Q.10
48 / 8
Answer (phonetically)
Employee Signature ________________________________
Date
__________________________
Page
15
JOB DECRIPTION
Safety Critical Staff
Title:
Safety Critical Staff
Date:
Dec 2007
Reports to:
Operations Director
Safety Critical:
Yes
1. Purpose of Job:
Ensure that safety critical works are carried out as directed by your Site Supervisor and in line with training
for specific competencies that you may hold.
2. Principle Accountabilities:













To make yourself familiar with and understand the Company's Health and Safety Policy, procedures
and safety rules.
To take all reasonable care for your own health and safety and for that of others who may be affected
by your acts.
To follow safe working practices and obey safety rules at all times.
Not to intentionally or recklessly interfere with, or misuse any equipment, materials or facilities provided
in the interest of health, safety and welfare, or in fulfilment of any legal obligation by the Company.
To maintain a tidy working area, thereby not creating hazards to yourself and others.
To co-operate with the Managing Director and all other members of senior management on all aspects
necessary to provide a healthy and safe working environment, including the participation in any
training.
To keep company vehicles, tools and equipment in your use in good order at all times and to report
any fault to the Quality and Technical Services Director.
To know the location of fire extinguishers within the areas in which you are working and the action to
be taken in the event of a fire.
To ensure, when working on site, that fire extinguishers remain accessible and that fire exits (when
applicable) are not obstructed.
To use any protective clothing and equipment provided and to routinely check the condition of such
equipment and to report any damaged or missing equipment to the Managing Director or the Quality
and Technical Services Director.
You shall not interfere with any equipment provided by the Company in the interest of Health & Safety.
To know the location of first aid boxes within the areas in which you are working and the action to be
taken in the event of an accident.
To report any accident, dangerous occurrence or hazardous condition to the Managing Director and to
co-operate in any resultant investigations
3. Contact With Others:
Contacts:
Purpose:
Clients
As necessary in line with carrying out duties, COSS briefings (if
competent) for example.
Link Up
None
Senior Management
Feedback from site to ensure continual improvement
Page
16
4. Experience, Knowledge, Qualifications and Training:
As dictated by the competencies held on Sentinel card.
Good Knowledge of the relevant sections of the Rule Book applicable to duties being carried out.
I hereby agree to comply with my accountabilities as laid out in this Job Description:
Signed:
Name:
Page
17
Date:
PLEASE RETURN THIS TO THE OFFICE
CONTRACT OF SPONSORSHIP
NEW SENTINEL SCHEME
PRIMARY SPONSOR: Bowen Projects Ltd
SPONSOR REPRESENTATIVE: Sion Bowen
INDIVIDUAL:
CONTRACTUAL RELATIONSHIP: Direct employee, self employed, subcontractor
(Delete as appropriate)
SUB SPONSORS PERMITTED: Yes/No
(Delete as appropriate)
DATE:
This contract sets out the responsibilities of the primary sponsor and the individual following agreement
between the two parties for the sponsorship of the individual for the New Sentinel Scheme operated on behalf
of Network Rail.
Regardless of the employment status of the Individual, the Primary Sponsor through the Contract of
Sponsorship shall fulfil the role of the employer for the purposes of health and safety legislation.
Prior to commencement of this contract the Primary Sponsor shall undertake checks of an Individual’s
suitability to work on NRMI.
The Primary Sponsor shall arrange for the Individual under this Contract of Sponsorship with:

A valid Sentinel Smart Card.

An induction briefing which will include as a minimum the rules and responsibilities of the Sentinel
Scheme.

Suitable PPE, so marked as to identify who an Individual is working for when on NRMI, and suitable
training to be able to use that protective equipment effectively in accordance with the Sponsor PPE
policy.

Regular briefings on changes to standards, Rule Book updates and Sentinel Scheme Rule updates.

Training and assessment to ensure competence at required intervals

Safety Critical Equipment to enable the Individual to undertake their role (jointly with any Sub-sponsor)

Personal issue information such as handbooks, standards and relevant information.
Page
18

Advice, guidance or instruction on any restrictions based on medication and other medical fitness
issues.

Mentoring support to develop the competence of the Individual

Clear contractual arrangements between the Primary Sponsor and Individual, and whether SubSponsors are permitted.

Monitoring and management of working hours of Individuals under their Contract of Sponsorship.
Shifts worked with Sub-Sponsors must be considered in the monitoring of working hours and the
management of fatigue.

Agreeing any sub-sponsorship arrangements with the Individual and to grant permission to any Subsponsor to use their resources.

Enacting the Local Investigation process where any suspected breach of the Sentinel Scheme Rules
becomes apparent.

Collating information from Sub-sponsors to enable conclusion of the Local Investigation.

Maintaining records of Local Investigations and requesting a Formal Review where a Scheme
Outcome is recommended following a Local Investigation.

Providing a reason for de-Sponsoring an Individual

Conducting a Local Investigation before de-Sponsoring an Individual for any breach of the Sentinel
Scheme Rules.

Collating and maintaining all records associated with the Contract of Sponsorship of an Individual as
required by the Sentinel Management System (see Section 3).

Requesting a temporary Suspension pending the conclusion of Local Investigation where appropriate.
The individual shall:

carry their Sentinel Smart Card at all times while working on NRMI and will co-operate with their
Primary Sponsor to ensure the personal information held in the Sentinel Scheme Database and printed
on the Sentinel Smart Card remains accurate.

Follow the rules of personal accountability for working safely on NRMI, including compliance with the
Lifesaving Rules, care and correct use of PPE, attendance and compliance with Safety Briefings, Rule
Book updates and Sentinel Scheme Rules updates.

Notify the sponsor of any competences or training requirements including recertification courses.

have a responsibility to manage their Sponsor relationships and at all times when working on the NRMI
an Individual has a responsibility to:
o
Know the identity of their Primary Sponsor.
o
Know which Sub-Sponsor they are working for (when they are not working for their Primary
Sponsor);
o
Provide the correct name of the Sponsor they are working for when booking into site.
Page
19

notify the Primary Sponsor of any changes in circumstance including health issues, that may require
the Primary Sponsor to take action to ensure the Individual’s continued fitness for work trackside

Notify the Primary Sponsor if they no longer wish to be sponsored by them so they can be desponsored. Change of sponsorship can be requested online through My Sentinel.
Co-operate with any investigation into an alleged breach of the Sentinel Scheme Rules by Primary or
Sub Sponsor


NOTE: Individuals can access their personal records on the Sentinel Scheme Database. This can be
requested from their Primary Sponsor, or by direct access to the My Sentinel area of the Sentinel
website.
Primary Sponsor Representative Signature
Date
__________________________________
_____________
Individual Signature
Date
______________
__________________________________
Page
20
Page
21
Formal Review Appeal process
Page
22
Page
23