First Drivers Online

Please tick the relevant categories.	LGV 1 (C+E) LGV 2 (C) PVC NON LGV
Licence Expiry Date
LGV:
Ordinary:
Driving Licence Number:

How long have you held your licence LGV/NLGV? In Years:
Date Issued:		When did you last drive LGV?

Have you ever been convicted of a driving offence?	Yes No
If yes please give details:

Are you or have you suffered from illness that has or may cause problems with driving?	Yes No
If yes please give details:

Have you ever been disqualified from driving?	Yes No
If yes please give conviction details.


ADR	Yes No	Categories Covered:
HIAB	Yes No	Categories Covered:
FORKLIFT	Yes No	Categories Covered:
CITB / RITB Certificate Number:

Please tick the relevant categories:
Artic	Rigid 17 TON	Rigid 28 TON	Draw-Bar
6 Wheeler	8 Wheeler	7.5 TON (with tacho)	Transit Luton
PCV (PSC)

Operations Experience:
Multidrop	Flat Beds	Wag & Drag	Tautliner
Tippers	Trucking	Shunting	Tanker
Steel	Timber	Abnormal Loads	Gas
Skips	Road Sweeps	Tarmac	Removals
Building Supplies	Roll On/Off	Livestock	Chains
Recovery	Concrete	Rope N Steel	Straps
Shop Deliveries	Milk Farm Collections	Refuse	Low Loaders

Equipment Operations
Demounts	HIAB	Heavy Plant	Fridges
Rear End Loaders	Tail Lift	Blowers	Winches

	Medical History Strictly Confidential
1.	Are you in good health?	Yes No
2.	Have you in the past or currently suffer from any of the following?
	Eye complaints or any defects in vision.	Yes No
	Back injury, strain or slipped disk	Yes No
	Diabetes	Yes No
	Heart disease/Angina	Yes No
	Fits or fainting attacks	Yes No
	Chest problems	Yes No
	High or low blood pressure	Yes No
	Rheumatism or Arthritis	Yes No

3.	Have you in the past or do you currently have any other temporary disabilities or illness?	Yes No
4.	Have you had any hospital investigations/admissions?	Yes No
5.	Do you take regular medication or are you currently on treatment?	Yes No
6.	Are you registered disabled?	Yes No

	If you have answered YES to any of the above questions, please give details:


7.	Are there any disabilities which may affect your applications?	Yes No
	a) Any reasonable adjustments which you feel should be made to the recruitment process to assist you in your application for the job?	Yes No
	b) Any reasonable adjustments which you feel should be made to the job itself which would enable you to carry out the job?	Yes No

	If you answered YES to any of the above questions please give details:

	TACHOGRAPH QUESTIONNAIRE
1.	Drivers who drive vehicles over KG, gross weight, are subject to driver’s hours and Tachograph regulations.
2.	How many completed Tachograph carts should you carry with you whilst on a driving duty?
3.	Completed Tachograph charts must be returned to the operator’s licence within how many days?
4.	Breach of Hours and Tachograph regulations can lead to a maximum fine of £ and the loss of your licence.
5.	In any 24-hour period a driver must have the daily rest of at least consecutive hours. This may be reduced on three days a week to not less than hours. This reduction must be made up for the end for the third following week.
6.	During the course of a days work, the maximum accumulated driving time without a break is hours. This break must total a minimum of minutes.
7.	The maximum daily driving limit is hours, this may be extended to hours on no more than days a week.
8.	The maximum fortnightly driving time is hours.
9.	What action should be taken if your Tachograph breaks down whilst you are away from base?

10.	Please fill in what the below lines indicate. A B C D

First Personnel Services plc

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