Duty of care

Drivers Pre-employment Check List

To Be Completed By The Applicant

Applicant’s name: ________________________   Driver Number: _________________________________

Address: ____________________________________________________________________________

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:

  1. The applicant does not have a DVLA notifiable medical condition.
  2. All licences are in the name of the applicant.
  3. All licences are valid for the country in which the applicant is      resident.
  4. All licences are valid for the group(s) stated.
  5. 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: _______________________________________

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