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About You

National Insurance Number *

Name * Trading Name (if Applicable)

Address *

Town

City *

Postcode *

Email *

Home Telephone *

Mobile Telephone *

Next of Kin Name *

Next of Kin Telephone *

Relationship to you *

Are there any restrictions on you taking up employment in the UK? *

Training & Work History

Declarations

Have you been suspended from training for any reason in the past 10 years?*

Voss Training Services Ltd, ask you to disclose any pjysical or mental conditions which may impair your training or operating ability (Diabetes, Heart Condition etc)

Are there any past prosecutions or court hearings relating to general Health and Safety, your conduct in a workplace or training work carried out by you?

Declaration (Please read carefully)

1.	In signing below I agree to return all associated training records to Voss training Services Ltd immediately after training is completed.
2.	In signing below I agree to comply with all current legislation including Working Time Directive.
3.	In signing below I agree to inform Voss training Services Ltd immediately of any changes whether health related or criminal convictions which may arise now or in the future.
4.	In signing below I accept that any Health & Safety breaches are my responsibility whilst operating or training on vehicles or other equipment.
5.	I agree that any costs associated as a result of (4) above may be deducted by Voss training Services Ltd.
6.	In signing I understand that any lifting equipment which includes vehicle tail lifts come under PUWER regulations and as such agree to have received adequate formal training prior to any use or providing training. 
7.	In signing below I understand that any changes in my personal circumstances may affect my ability to either operate vehicles or equipment and may affect my entitlement to operate or provide training. 
8.	In signing below I agree that I understand that it is my responsibility to inform Voss training Services Ltd and any relevant governing bodies or authorities immediately if changes occur. 
9.	In signing below I understand that failure to notify any changes, or omissions made in this declaration may affect any insurance covering third parties, vehicles, equipment, property or myself.
10.	In signing below I state that information supplied throughout this application document is true and accurate.

Criminal Record: Please note any criminal convictions except those 'spent' under the rehabilitation of offenders act 1974. If None please state by checking the box. In certain circumstances a contract may be dependent upon obtaining a satisfactory basic disclosure from the criminal records bereau / Scottish criminal records office.

Do you have any physical or mental impairment which has a substantial or long term effect on your ability to carry out day to day activities?

Do you require any special arrangements for work associated with any impairment?

Do you have any diseases, disorders, allergies, muscular or musuloskeletal injuries from which you have suffered or do suffer?

Do you currently or regularly receive or take any form of medicine, drugs or treatment?

If answered yes to any of the above, please give details

General Declaration (Please read carefully)

1.	In signing below I confirm that all information supplied is complete and accurate, I accept any untrue or misleading information given may result in termination of any work or contract offered or in place.
2.	Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. 
3.	In signing below I agree that Voss Training Services Ltd reserves the right to require me to undergo a medical examination.
4.	In signing below I agree that this information will be retained in my personnel file during employment and for up to seven years thereafter and understand that information will be processed in accordance with the Data Protection Act.
5.	In signing below I agree that I may be subject to random drink or drugs testing in line with client policies.
6.	In signing below I understand that it is my responsibility to adhere to all aspects of Health & Safety at work act 1974, and in line with client and Voss Training Services Ltd Health & Safety policies.
7.	In signing I understand that any lifting equipment including vehicle tail lifts, Lift Trucks & Access Equipment come under PUWER regulations and as such agree to have received adequate formal training prior to any use or in the case of training my certification for the training being delivered is up to date and valid. 
8.	In signing below I agree that should I be successful in this application, I will if required, apply to the Criminal Records Bureau / Scottish Criminal Records Office for a basic disclosure. I understand that should I fail to do so, or should the disclosure not to be the satisfaction of the company any offer of work may be withdrawn or my contract terminated.
9.	In signing below I understand that failure to notify any future changes, or omissions made in this declaration may affect any insurance covering third parties, vehicles, equipment, property or myself.

Digital Signature: Please enter your name in the box below to digitally sign this application.

Whether looking for work or becoming a new instructor, Voss can help. We are always looking for experienced instructors throughout the UK. We also have an accredited instructor training facility, whether you are new to the industry or need to renew your existing entitlement.

Links

Driver UK

Wevu

Contact Us

Address:: 106 Woodside Business Park
: Shore Road
: Birkenhead
: CH41 1EP
Phone:: 0151 650 6600
Fax:: 0151 650 6606
E-mail:: admin@vosstraining.co.uk

Company Name	Type of Work	From	To	Reason for Leaving

Accrediting Body	Check	Training Category	Notes, comments or specific machine types
		Counterbalance
		Reach
		POET (Low Level)
		POET (Medium Level)
		POET (High Level)
		Container Lifter
		Scissor Lift
		SPB/Cherry Picker
		Escape from Height
		Harness Training
		Harness Instructor Training
		HIAB
		Tow Truck Novice
		VNA Man-Up
		VNA Man-Down
		Order Picker
		Skidsteer
		Sideloader
		Pivot Steer (Flexi/Bendi)
		Telescopic Handler (Rough Terrain)
		Rough Terrain Masted
		Vehicle Mounted Lift Truck (Moffat mounty)
		Telescopic Handler (Industrial)
		Crane (All Categories)
		Shunter
		Plant Machinery
		Operator Instructor
		Train the Trainer
		Slinger/Signaler
		Banksman/Reversing of Vehicles
		Manual Handling
		Driver CPC Module 1
		Driver CPC Module 2
		Driver CPC Module 3a
		Driver CPC Module 3b
		Driver CPC Module 4
		Driver CPC Module 5
		SAFED
		Digital Tachograph
		LTSA (Supervisor/Manager)
		LTSA (Operator)
		CIEH Health and Safety Level 2
		Site Consultancy
		1 Day Emergency First Aid at Work
		First Aid 2 Day
		First Aid 3 Day
		First Aid 1/2 Day Defibrilator
		Fire Warden
		Fire Extinguisher
		Ladder Training
		Abrasive Wheels
		Small Petrol Engined Hand Tools (Agricultural)
		PASMA Tower
		Confined Space
		Breathing Apparatus