Application Form – LCB/Contract Drivers
Personal Details / Surname......
First Name......
Address......
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Home phone number......
Mobile number......
National Insurance No......
Date of Birth......
Nationality & Passport No......
Copy of passport attached...... Yes...... No
If no passport, then provide photograph.
Next of Kin:
Relationship......
Name......
Address......
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Tel No......
Current State of Health
Are you aware of any current medical condition that may affect your ability to carry out your work? Please provide details below or in a separate note.
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Business Address / Business Name & Address
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Contractors/Sub contractors only / Address
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Postcode......
Telephone Number......
Driving Licence Details / Driving Licence Number
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Licence Expiry Date......
Groups covered by licence......
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Driving Licence Produced ?...... Yes...... No
Driving Licence Copied ? ...... Yes...... No
Applicants please note. If you answer the below box with a yes, we reserve the right to contact the Police Authorities in the United Kingdom, in order to confirm the information that you have supplied to us.
Disqualifications / Has applicant been disqualified from driving ?..... Yes...... No ?
If applicant has replied yes, provide details of current endorsements
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Convictions / Does the applicant have any previous Criminal or Driving convictions ?
Criminal...... Yes...... No......
Driving...... Yes...... No......
If applicant has replied yes, provide details below
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Proof of Address / Has this been provided? ...... Yes...... No......
If applicant has replied yes give details of evidence provided (e.g. utility bill) ......
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Vehicle To Be / Make
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Model......
C.C......
Colour......
Reg’N No......
Date First Register......
Taxed?...... Yes?.....No? Expiry Date......
M.O.T...... Yes?.....No? Expiry Date......
Insurance...... Yes?.....No? Expiry Date......
Goods in Transit Insurance...... Yes?....No?.....Expiry Date......
Copy of Insruance Certificate.....Yes?....No?....Expiry Date......
References
For Employed Drivers – Details of last 2 employers / Name
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Contact No......
Address......
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Employed As ?
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Dates of Employment
From......
To......
Reason for leaving......
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In the event that this application is successful, I understand and hereby confirm that whenever I attend any of the premises of London City Bond Limited or of their customers, I must at all times wear a High Visibility Vest/Jacket, and British standard safety boots.
I certify that the information given in this form is accurate and correct at the date shown below. If I am employed by, or contracted to work for, London City Bond Limited and it subsequently transpires that the information given above, as regards any Driving or Criminal Convictions, if found to be materially inaccurate, then I hereby accept that I may be liable to summary dismissal or my contract terminated.
I am willing for my previous employers to be contact in support of this application.
Signature of Applicant......
Name of Applicant (print) ......
Date ......
Signature of Interviewer ......
Name of interviewer (Manager or Nominee) ......
Date ......