Information
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Job type
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Full Name
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D.O.B
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Contact number
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Home Address
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Email address
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Have you had a medical in the past 3 year
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Conducted on
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Prepared by
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Location
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N.I Number
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UTR Number
Qualification's & Experience
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Cadent I.D
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Driving Licence (picture both sides) (add expiry date in notes)
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Driving licence number
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Do you have an EUSR / SHEA GAS
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EUSR / SHEA GAS number & Expiry date
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Main Layer
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Service Layer
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Trainee
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NCO2 main layer 400mm (add picture) (add expiry date in notes)
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NCO2 Service layer 355mm (add picture) (add expiry date in notes)
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NCO2 Main Layer 180mm (add picture) (add expiry date in notes)
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NCO2 Service Layer (add picture) (add expiry date in notes)
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NCO 1 (add picture) (add expiry date in notes)
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NCO Trainee (add picture) (add expiry date in notes)
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Do you have a Breathing Apparatus Face fit certificate (add picture)
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Have you conducted a Face fit Test for dust mask (add picture)
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Street works (add picture)
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Pick up driver
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Grab driver
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Grab driver assistant
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Support driver
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White topper
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Driving Licence Expiry date
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Passport identification
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Do you drive a company van
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Vehicle registration number
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Employment type
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Week end availability (add note with availability)
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Any additional qualification's (add picture & expiry date in notes)
Additional General Health Question's
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Have you thoroughly reviewed the Company rules (site staff) and the accompanying general health questionnaire sheet? Do you agree with and fully understand the company's requirements? Please note that non-compliance may lead to an investigation and immediate dismissal.
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Have you filled out the General Health Questionnaire
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Do you have a second job, or any other work commitments
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How many hours do you work
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Do you feel that you get enough sleep and rest (add in notes)
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Do you have other commitments which we need to be aware of, run a charity, help outs etc.
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You understand that it is strictly prohibited for any site personnel to use drugs or consume alcohol before or during their duties on the site. Reporting for duty while under the influence of alcohol or drugs is also strictly forbidden.<br><br>Random drug and alcohol tests may be conducted at any time, and your full cooperation is expected if requested. Non-compliance with these rules may result in an investigation and immediate dismissal.
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PRINT NAME AND SIGN (for the agreements to the terms above) (You understand that it is strictly prohibited for any site personnel to use drugs or consume alcohol before or during their duties on the site. Reporting for duty while under the influence of alcohol or drugs is also strictly forbidden. Random drug and alcohol tests may be conducted at any time, and your full cooperation is expected if requested. Non-compliance with these rules may result in an investigation and immediate dismissal.)
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Is any additional support required (please state in notes)
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All risk assessment's, health and safety, company data, and privacy policies, your rights as a employee/sub contractor, have been explained and given to you
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To your knowledge, are you fit to perform the duties you are employed to carry out. (if no please give details in notes).
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You provide your consent to Moran Pipelines for the storage and disclosure of your personal data to third parties. Moran Pipelines will use and share your personal data with third parties solely for the purpose of conducting essential functions necessary for the company, its clients, and to comply with legal requirements. Some of these third parties may include (but are not limited to) Experian or DBS, external payroll and tax services, DVLA (for license checks), HMRC, clients, external Health and Safety organizations, external administrators, health surveillance providers, training companies, and vehicle leasing companies.<br><br>For more detailed information, please refer to the Company's Data Protection and Privacy policies. By agreeing, you take full responsibility and liability for all tasks performed, utilizing your experience and knowledge as a Registered professional who adheres to British Standards, follows all Gas Safe technical bulletins, safety alerts, and industry standard updates. You are also responsible for overseeing and ensuring the health and safety of yourself, the Company, and the public
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I confirm that the responses to the questions above are accurate to the best of my knowledge. I also consent to undergo a medical examination or health surveillance, if deemed necessary by the company, both before and during my employment, whether as a PAYEE or SUB-CONTRACTOR. (Print Name and Sign)
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Director to review and sign (print name and sign)
