EmailMe Form - Centrebus Group Driver Application

I am applying as an experienced bus driver
Which depot are you applying to? *
What is your email address? *
Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
*

Home Telephone:

Mobile Telephone:
Date Of Birth
MM / DD / YYYY
Sex
Driving Licence Information: *

When did you pass your PVC Licence test?

Is your licence clean? Give details of any points.
Licence Entitlement: *
Category D
Category D1
Manual Car Licence
Automatic Car Licence
Do you hold a valid CPC qualification? *
Yes
No
Have you been involved in any road traffic incidents in the last 2 years, either whilst driving at work or in your own personal time? *
No
Yes
If yes, please provide details.
Health Questionnaire
Please answer the questions below. Write YES or NO and give further details if required.

Home Telephone:
Mobile Telephone:

When did you pass your PVC Licence test?
Is your licence clean? Give details of any points.

Give details of any criminal convictions in the past 5 years, together with ANY which have resulted in a prison sentence. If none, you must write NONE here (Exclude those spent under Rehabilitation of Offenders Act 1974)

Are you eligible to live and work in the UK in accordance with the Asylum and Immigration Act 1996?
Yes
No
Further information here:
Have you in the past 10 years had a period of illness resulting in a long-term (more than 4 weeks) absence from work?
Yes
No
Further information here:
Are you willing to undergo a medical examination?
Yes
No
Further information here:
Can you provide a specified document such as Passport, P60, or UK Birth Certificate?
Yes
No
Further information here:

Are you generally in good health?
Are you receiving medical treatment for any condition?
Are you registered disabled or do you suffer otherwise from any disability?
Do you have outside commitments that could limit your working hours, such as being a JP, Councillor in local government or a member of the TA?

Work Availability: *

If currently employed, how much notice will you have to give your current employer?

Do you have existing holiday commitments? If YES, please give all details.
Education and Skiils:

Name of Establishment

Dates Attended

Qualifications Obtained
Name of Establishment

Dates Attended

Qualifications Obtained
Please give details of other skills and qualifications you have obtained.
Employment: *

Are you currently employed? If NO please give reason.

Have you ever been dismissedby an employer? If YES please give details of what happened.
Please give details of your past employment. Start with your crrent or last employer first. Please show all driving positions held previously. *

Company Name

Address

Position

Rate of Pay

Dates
Company Name

Address

Position

Rate of Pay

Dates
Do you ave any Part-time or evening jobs that you intend to continue? If YES give details.
References: *

1) Name:

Address:

Telephone:

How do you know this referee?
2) Name:

Address:

Telephone:

How do you know this referee?

Please give the name and address of two people that we may contact for references. One reference must be from a previous employer.
Signature
Clear
Date
MM / DD / YYYY
*Consent under the Data Protection Act 1998 - the information given to Centrebus Ltd in this form will be processed only by Centrebus Ltd for the purpose of considering you application for employment. If you are successful in your application this form and the information in it will be retained for such times as you are an employee and for up to 6 years after the end of your employment. Otherwise, this form will only be retained by Centrebus Ltd for so long as it is required in connection with your application. * By signing this consent you give our express consent to retain and process all the information contained in this form.
Signature
Clear
Date
MM / DD / YYYY
Health Questionare

Ref. No

Date:

Position offered (subject to satisfactory health checks)
If the answer is yes to any of the questions on this form, please give full details in the space provided of the dates, duration and outcome of the illness or condition. If we have any concerns about your fittness for work, employment will be subject to satisfactory medical reports.
Tuberculosis, asthma, bronchitis or chest problems?
Yes
No
Additional Information to Yes response:
Digestive or bowel disease?
Yes
No
Additional Information to Yes response:
Typhoid, paratyphoid or other infectious disease?
Yes
No
Additional Information to Yes response:
Back trouble?
Yes
No
Additional Information to Yes response:
Rheumatism or arthritis?
Yes
No
Additional Information to Yes response:
Depression, mental illness or nervous breakdown?
Yes
No
Additional Information to Yes response:
Blackouts, fits or attacks of giddiness?
Yes
No
Additional Information to Yes response:
Chest pain, heart condition or raised blood pressure?
Yes
No
Additional Information to Yes response:
Diabetes, thyroid or other gland trouble?
Yes
No
Additional Information to Yes response:
Bladder or kidney problems?
Yes
No
Additional Information to Yes response:
Dermatitis or skin trouble?
Yes
No
Additional Information to Yes response:
Vision or Hearing problems?
Yes
No
Additional Information to Yes response:
Varicose veins?
Yes
No
Additional Information to Yes response:
Any other accident, operation or illness?
Yes
No
Additional Information to Yes response:
Have you reason to believe you may be infected with any communicable disease?
Yes
No
Additional Information to Yes response:
Any other current or recent medical condition or treatment which might affect your attendance or performance at work?
Yes
No
Additional Information to Yes response:
Do you intend to work night duties on a regular basis?
Yes
No
Additional Information to Yes response:
Any illness or medical condition that prevented you from attending work on your normal duties or activities for more than one week during the past year?
Yes
No
Additional Information to Yes response:
Any physical or mental impairment which has a substantial and long-term effect on your ability to carry out day to day activities? If yes, please specify any special adjustments required in relation to work.
Yes
No
Additional Information to Yes response:
Do you smoke?
Yes
No
If yes, how many per day?
How many units of alcohol do you drink per week? (1 unit = 1/2 pint beer = 1 glass of wine = 1 single whisky)
I do not drink
Yes I do
If yes, how many units per day?
Equal Oppurtunities
We are an equal opportunity employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment because of age, disability, gender reassignment, marriage and civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation. Our recruitment selection criteria and procedures (including the areas or media sources which are used in the recruitment process) are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities and that no applicant or employee is disadvantaged by provisions, criteria or practices which cannot be shown to be justified. To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, would you please provide the following information:
Position applied for:
Ethnicity & Sex
I would describe my ethnic group and sex as : (Please tick one box for your ethnic group & one box for your sex).
A)White
English
Scottish
Welsh
Irish
Any other White background, please specify
B) Mixed
White & Caribbean
White & Black African
White & Asian
Any other Mixed background, please specify
C)Asian, Asian British, Asian English, Asian Scottish or Asian Welsh
Indian
Pakistani
Bangladeshi
Any other Asian background, please specify
D) Black, Black British, Black English, Black Scottish or Black Welsh
Caribbean
African
Any other Black background, please specify
E) Chinese, Chinese British, Chinese English, Chinese Scottish, Chinese Welsh or other Ethnic Group
Chinese
Any other background, please specify
F) Sex
Female
Male
Name
First Last
Declaration
I declare that the information I have given on this form is correct and that any misrepresentation by me may be sufficient grounds for my dismissal if i am employed. I give my permission for my previous employers and any references to be contacted.
Signature
Clear
Date Time
MM / DD / YYYY

If currently employed, how much notice will you have to give your current employer?
Do you have existing holiday commitments? If YES, please give all details.

Are you currently employed? If NO please give reason.
Have you ever been dismissedby an employer? If YES please give details of what happened.

Ref. No
Date:
Position offered (subject to satisfactory health checks)

Name of Establishment
Dates Attended
Qualifications Obtained

Name of Establishment
Dates Attended
Qualifications Obtained

Company Name
Address
Position
Rate of Pay
Dates

Company Name
Address
Position
Rate of Pay
Dates

Health Questionnaire

Equal Oppurtunities

Ethnicity & Sex

Declaration