Driving Application Form Full Name (Including Surname) Address Postcode Telephone Email Address Email Date of Birth National Insurance Number Do you have any Criminal Convictions? Please Select Yes No Please list any details of Criminal Convictions we legally need to be made aware of Please list any other medical conditions that may affect you undertaking this type of work. How did you hear about us? Please Select Search Engine Word of Mouth Advert Other Driving License Details Licence No: Issued: Expiry: Driving Categories: Endorsements: Availability (Please tick as applicable) Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Saturday Sunday Employment History (Please tick as applicable) Refrigerated Box/Container Curtain Sides Wagon & Drag Tipper Ropes/Sheets Low Loader Roll On Roll Off Trunking European Plant Skip Refuse Van/Courier HIAB Licence ADR Licence Forklift C/Bal Licence Forklift Reach Licence Willing to do (Please tick as applicable) Supermarket Multi Drop Low Multi Drop High Cages/Handball Nights Out Tramping Please list any companies you have work for via agency. Next of Kin Details (Name, Number and Relation) Please supply details of Limited Company if applicable Bank Details Legal Obligations I agree that in line with data protection, I confirm I am happy for you to share my personal data such as name, contact details, address with clients, and bank details with our payroll company. I agree that the WTD regulations 1998, requires the company to limit my working hours to 48 per week. I may agree to opt out. The company proposes an agreement with you that will apply until terminated by notice Declaration I declare that the information I have given on all pages of this application form are true and correct. I have received a copy of, read and had explained to me the Contract for Services and agree to be bound by it provisions. Whilst I am working for a client of Merit I am under the direction and control of that client just as if I were employed by them. If I am engaged in work subject to EU driver’s rules, and I work for any other company not through Merit I must declare my driving hours to Merit. If I am engaged in work subject to EU driver’s rules, I am responsible for ensuring that I do not exceed the working hours as dictated by the EU Working Time Directive and if I do not declare these hours to Merit then I am responsible for any legal action that may occur. I acknowledge that Merit can only pay me for hours worked and not for breaks or travelling time, as confirmed by a timesheet signed by the client and myself. I confirm that I am responsible for conducting myself in a correct and professional manner and will abide by all relevant laws, by-laws and regulations of the client for whom I am working. Where appropriate, I will download or return tachograph charts to the vehicle operator within the specified time. I have noted my work history above, covering at least the last five years, together with the details of any unspent criminal convictions or offences pending, as well as details of any physical or mental disability which may affect my work I confirm that I am responsible for the Health and safety of the vehicle, and will ensure the safe transport of loads. I hereby authorise Merit to disclose my telephone number to any client for whom I may be working in order for contact during the working day. Merit has an insurance policy in place to protect drivers and vehicles from accidental and wilful damage when on Assignment with a Merit client. Drivers in relation to a claim on Merit insurance will be liable for payment of the excess on the policy, if at fault. I confirm that I understand that in the instance of a claim against Merit’s Negligence Insurance that occurs through any fault of my own, I will be liable to make payment for any applicable policy excess. I authorise Merit to conduct monthly (or as required) online checks on my driving licence. I confirm that I am: Over 21 years or age Hold a full licence applicable to the vehicle I will be driving Have worked as a driver for at least 45 days in the last 6 months Do not have more than 6 points on my licence in acceptable endorsements types as listed above I confirm that I understand that in the instance of a claim against Merit Negligence Insurance that occurs through any inaction or action on my behalf when on Assignment / driving for a client of Merit, I will be liable to make payment for any applicable policy excess. I agree Mobile Phone Use Using ANY mobile phone when driving is dangerous. Using a handheld mobile phone when driving is illegal. The Law It’s illegal to use a handheld mobile when driving. This includes using your phone to: Follow a Map Use Social Media Check Email Read or Send Texts This also applies when you are sat at traffic lights or stuck in traffic. You can only use a handheld phone in a car if you are safely parked or need to call 999 in an emergency. The Consequences If you are caught using a handheld phone whilst driving, you will get 6 penalty points on your licence and a fine of £200. Points on your licence will result in higher insurance costs. Penalties for driving carelessly or dangerously when using a mobile phone can include a large fine, disqualification, and up to two years imprisonment. What to do: Do not use hand held mobile at any time If you use a hands free set, ensure you are in full control of your vehicle at all times If you must use your hand held mobile, you must park safely before doing so Working with Merit When on assignment with Merit, you are bound by the relevant laws concerning mobile phone use. If you are found to be using your phone whilst on assignment with Merit clients, you will be subject to disciplinary action, up to and including termination of assignment or contract. I agree Tick if you are you Human? Submit