If you are interested in applying for a position with our company, please fill out the following form and submit it.
Your Name (required)
Your Email (required)
Address
Home Phone Number
Mobile Number
Date of Birth
N I/PPS Number
What type of heavy goods licence do you hold?
On What date did you obtain it?
Who is the issuing authority?
Please state type of Heavy Goods Vehicle you have driven and for what periods
Ton
From
To
Employer Name
Employer Phone Number
Have you any health or physical defect, infirmity or condition which could impair your ability to drive i.e. vision or hearing : Yes No If YES, Please give details:
Do you have any endorsements/points on your licence? Yes No If YES, Please give details:
Have you ever been charged with any motor offences, if so, please give dates, nature of prosecutions and results of prosecutions: Yes No
Is any prosecution pending? Yes No
Remember: Your licence will be checked with the relevent Licensing Authority. Are you now or have been insured in your own name in respect of any motor vehicle? Yes No Name of insurers Policy Number Expiry date of policy Present No Claims Bonus Have you had any accidents, claims or losses in the past FIVE years in any vehicle driven by you? Yes No If YES, Please give details:
Drumcliffe, Ennis, Co. Clare Tel: 00353 65 68 44680 Fax: 00353 65 68 44707 Mobile: 00353 87 12 30081 patrick@irishtrucking.ie
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