Application Form Step 1 of 5 20% Job applying for/preferred job title*Title (Mr/Mrs/Miss/Ms/Other)Name* First Last Address Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email Phone Number*NI numberDo you have the right to take up employment in the UK?YesNoWould you like to submit a CV?YesNoPlease submit your CV hereAccepted file types: pdf, docx, doc. Please provide details of educational qualifications, vocational qualifications and other relevant training. Current and previous employment (covering the last 5 years starting with your most recent employment). Position/Job Title (please select)Name and address of employerMain dutiesEmployment Dates: Position/Job Title (please select)Name and address of employerMain dutiesEmployment Dates:Position/Job TitleName and address of employerMain dutiesEmployment Dates:Practical SkillsSummarise job skills acquired and specialist training receivedWhat qualities do you have which make you suitable for the job you are applying for? Have you been convicted of a criminal offence?*YesNoType of position applying for:*Driver (any)OfficeWarehouseOther It is an offence for a person to drive on a road, any vehicle otherwise than in accordance with a license authorizing them to drive it. I declare that I have provided details from my current license, and that I have no pending convictions, endorsements or disqualifications or medical conditions which prevent me from operating a HGV or other vehicle.Are you the holder of a HGV license?YesNoWhich license groups:Driving License numberDriving License expiry date MM DD YYYY Do you hold a full Driver Qualification Card (CPC)?YesNoCPC expiry date MM DD YYYY Do you hold a Digital Tachograph Card?YesNoTachography expiry date MM DD YYYY All lorry drivers in the UK are required to meet the DVLA medical standards for Group 2 Drivers. Since driving is an intrinsive part of the driver role, we need to ensure you are legally competent to operate a Heavy Goods Vehicle and associated equipment and requesting the following information is in line with Section 60(6) of the Equality Act 2010. If your application for employment is successful it will be a condition of your employment that you demonstrate your medical fitness for the role.Please select if you have any of the following: Chronic chest disorders, especially if night-time symptoms are troublesome Any heart condition, heart operation or circulatory disorders A pacemaker, defibrillator or anti-ventricular tachycardia device fitted Dependence on or misuse of alcohol, illicit drugs or chemical substances in the last 3 years Any severe psychiatric illness or mental disorder Attacks of disabling giddiness, fainting or blackouts Problems with back/neck/shoulder/knees/hips Fits, blackouts or epilepsy Major or minor stroke Diabetes controlled by insulin or tablets Any visual disability that effects either eye (excluding short/long sight or colour blindness) Severe head injury involving in-patient treatment at hospital Any medical condition requiring medication to strict timetable Any condition which causes difficulty sleeping Where did you hear about us?Event/Job FairFacebookInternet SearchJob boardLinkedInPoster/leafletTwitterWord of mouthOtherPlease state:*DeclarationI declare that the information I have given on this form is, to the best of my knowledge, true and complete. I understand that if it is subsequently discovered that any statement is false or misleading, or that I have withheld relevant information, my application may be disqualified or, if I have already been appointed, I may be dismissed. I hereby give consent to Kinaxia Logistics and all subsidiary companies to process the data supplied on this application form for the purpose of recruitment and selection. I accept that if my application is successful, this application will form part of my Personnel file and, in that case, I consent to the data on it being processes for all purposes in connection with my employment.* I consent Please note we will require at least two references which must include any employment you have had over the last 3 years. You will be contacted directly by us regarding these.NameThis field is for validation purposes and should be left unchanged.