EXPRESS FREIGHT SOLUTIONS LTD SURNAME ………………………FORENAME(S)………………………... ADDRESS……………………………………………………………………. ………………………………………………………………………………... TELEPHONE NO: (HOME) ………………………………………………... MOBILE NO: ………………………………………………………………... DATE OF BIRTH …………………………………………………………… MARITAL STATUS ………………………………………………………… DEPENDANTS………………….AGES……………………………………. NATIONAL INSURANCE NO ……………………………………………... DRIVING LICENCE NO (COPY REQUIRED) ……………………………. TYPE OF LICENCE (FULL/HGV)……………DATE PASSED ………….. DETAILS ON ANY CONVICTIONS ………………………………………. ………………………………………………………………………………... DO YOU HAVE YOUR OWN TRANSPORT……………………………… HAVE YOU GOT A CRIMINAL RECORD.……………………………….. IF YES GIVE DETAILS ……………………………………………………. ………………………………………………………………………………... ARE YOU REGISTERED DISABLED …………………………………….. HAVE YOU ANY HEALTH PROBLEMS ………………………………… ………………………………………………………………………………... NUMBER OF DAYS ILLNESS IN LAST 2 YEARS ……………………… EMERGENCY CONTACT …………………………………………………. NEXT OF KIN (NAME, ADDRESS, CONTACT NO:) ……………………. ………………………………………………………………………………... ………………………………………………………………………………... PREVIOUS EMPLOYMENT COMPANY ………………………………………………………………….. POSITION HELD……………………………………………………………. BRIEF DESCRIPTION OF DUTIES ……………………………………….. ………………………………………………………………………………... FROM ……………………………….. TO …………………………………. REASON FOR LEAVING ………………………………………………….. COMPANY ………………………………………………………………….. POSITION HELD …………………………………………………………… BRIEF DESCRIPTION OF DUTIES ……………………………………….. ………………………………………………………………………………... FROM ………………………………….TO………………………………… REASON FOR LEAVING ………………………………………………….. COMPANY ………………………………………………………………….. POSITION HELD …………………………………………………………… BRIEF DESCRIPTION OF DUTIES ……………………………………….. ………………………………………………………………………………... FROM …………………………………..TO ……………………………….. REASON FOR LEAVING ………………………………………………….. GIVE NAME, ADDRESS & TEL NO OF 2 REFERENCES: 1……………………………………………………………………………… ………………………………………………………………………………. ………………………………………………………………………………. 2………………………………………………………………………………. ………………………………………………………………………………... ………………………………………………………………………………... CAN WE CONTACT THE ABOVE FOR A REFERENCE: YES/NO ADDITIONAL INFORMATION (QUALIFICATIONS etc) ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... DECLARATION (TO BE SIGNED IN ALL CASES) I CONFIRM THAT THE INFORMATION GIVEN ON THIS FORM IS TO THE BEST OF MY KNOWLEDGE, TRUE AND COMPLETE. ANY FALSIFICATION MAY BE SUFFICIENT CAUSE FOR REJECTION OR DISMISSAL. SIGNED ………………………………… DATE…………………………… FOR OFFICE USE ONLY INTERVIEWED BY ……………………..DATE…………………………... COMMENTS: ……………………………………………………………….. ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... DRIVERS’ HOURS QUESTIONNAIRE QUESTION ANSWER (Tick One Box) 1. You start work at 0600 hours and drive for 2 hours, followed by one hour unloading. How many hours can you now drive before taking a break? 1½ hours 2 hours 4½ hours 2½ hours 2. After 2½ hours driving you stop for a 20 minute break and after further 2 hours driving, you take another break. How long does the second break need to be to comply with the law? 30 minutes 15 minutes 25 minutes 3. On any driving day, which charts must you have in your possession? Today’s Today’s + yesterday’s Current week + last Chart of last week Todays + Previous 28 calender days 4. A full daily rest is 11 hours but this may be reduced to? 10 hours 9 hours 8 hours 5. What is the maximum number of reduced rests you can take in any week? One Three Two 6. After how many days must you take a weekly rest? 6 5½ 7 7. The normal daily driving limit is 9 hours but this may be increased to a maximum of 10 hours. How many times per week? 3 times Once Twice 8. You must hand charts in within? 7 days 21 days 42 days 9. You must take a break of 45 minutes after? 4½ hours work 5¼ hours work 4½ hours driving 10.If you drive for 48 hours this week, how many hours can you drive next week? 56 hours 42 hours 48 hours 11. You start work at 0600 hours and finish at 2100 hours. You start the next day at 0800 hours. How many hours daily rest have you had? 11 hours 9 hours 10 hours 12. A normal weekly rest is 45 hours. When you are at home you may reduce this to? 40 hours 24 hours 36 hours 13. If you have a reduced weekly rest you must compensate by adding an equivalent number of hours to another rest period within? 1 week 3 weeks 2 weeks 14. What is the maximum penalty for a drivers’ hours offence? £2,500 £750 £1,000 15. Complete the centre field area of the attached chart as it might appear at the end of your working day: Driver’s Name: ………………………………………….. Date: …………………………………………
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