Driver Application Form
This form is to be completed by all CRL employees and additional drivers who drive CRL vehicles. This form will
be held on employee’s personnel file and/or within fleet management records as applicable.
Form Number HRF04 Version V1
Relevant Policy HR06 Company car and allowance policy
Personal details
Forename: Surname:
Driver License Details
License number: Groups/Categories:
Valid from: Valid to:
How many years have you been driving for?:
How regularly do you drive?: ☐Daily ☐Once a week ☐Occasional
Digital Tachograph Driver Card (if applicable)
Serial number: Medical due:
Valid from: Valid to:
How many years have you been driving LGV/HGV for?:
Driver Qualification (CPC) (if applicable)
Do you hold a valid CPC? ☐Yes ☐ No
If you have answered Yes:
Serial number:
Valid from: Valid to:
If you have answered No:
How many hours training have you completed:
Accidents
Have you had any ‘at fault’ road traffic accidents in the past five years? ☐Yes ☐ No
If Yes, please give details:
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Driving Bans/Convictions/Points
Have you been banned from driving in the last five years? ☐Yes ☐ No
If Yes, please give details:
Do you have any motoring convictions/points on your licence? ☐Yes ☐ No
If Yes, complete the following:
Applications with DR endorsements or 6 or more points will not be considered
Date Offence Endorsement Code Fine/Points/Suspension etc
Medical (employees only)
Please note that you may be required to undergo a medical examination, which may include a drug and alcohol test before any
offer of employment can be confirmed. A disability or health problem does not preclude full consideration for the job, and
applications are welcome from people with disabilities.
Are you currently taking any prescribed or non-prescribed drugs or medication? ☐Yes ☐ No
If Yes, please give details:
Do you have a DVLA notifiable condition? ☐Yes ☐ No
Do you require glasses/corrective lenses for driving? ☐Yes ☐ No
Does the code for wearing glasses (01) show on your license? ☐Yes ☐ No
Do you wear a hearing aid when you drive? ☐Yes ☐ No
If yes, have you informed the DVLA? ☐Yes ☐ No
Does the code for wearing a hearing aid (02) show on your license? ☐Yes ☐ No
Are you aware of any reason(s) which may impact on your ability to drive distances? ☐Yes ☐ No
Declaration
I confirm that to the best of my knowledge all information I have given in my application is correct.
I confirm that I have produced my most recent license.
I confirm I do not have any pending convictions, endorsements or disqualifications
I confirm I will inform Countrystyle of any road traffic accidents, convictions, endorsements or disqualifications
I receive whilst employed by Countrystyle and/or using a Countrystyle vehicle.
I have had no change in my health, which could affect my entitlement to drive ANY vehicle and will notify
Countrystyle/DVLA of any future change.
I give Countrystyle my consent to using my personal data for personnel, management and monitoring
purposes.
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Signature: Date:
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