Duty of care
Drivers Pre-employment Check List
To Be Completed By The Applicant
Applicant’s name: ________________________ Driver Number: _________________________________
Tel: _____________ Email: ________________________ Date of birth: ________________________
I hold the following driving licence(s):
|Type (Car/LGV/PCV)||Licence/Permit No.||Issued by||Expiry date|
In the past 5 years I have been involved in the following motor vehicle accidents and/or have committed the following traffic violation(s):
|Date||Accident / Traffic Violation||Location||Penalty|
I do / do not have a DVLA notifiable medical condition.
(circle as appropriate)
Permission is granted to __________________________________ to refer to the appropriate Licensing Authority and/or to my previous employer(s).
Date: ___________________ Applicant’s signature: _________________________________________
To Be Completed By The Interviewer
I have examined the applicant’s medical history and driving licence(s) as listed above and confirm that:
- The applicant does not have a DVLA notifiable medical condition.
- All licences are in the name of the applicant.
- All licences are valid for the country in which the applicant is resident.
- All licences are valid for the group(s) stated.
- A copy has been made and is attached.
Each licence has the following restrictions: __________________________________________________
Total number of penalty points currently in force: _________
Date: ___________________ Interviewer’s signature: _______________________________________