Hinkley Point C SQEP

Name*
First Middle Last
Date of Birth*
MM slash DD slash YYYY
Home Address*
Street Address Address Line 2 City County Postcode Country
Home Phone Number*
(If you do not have an home phone / landline number please type N/A in the text box)
Mobile Phone Number*
(If you do not have an mobile phone number please type N/A in the text box.)
Email Address*
(If you do not have an email address please type N/A in the text box.)
National Insurance Number.*
Driving License?*
Car Owner?*
OVERALL SIZES (PPE):*
SHOE SIZE:*
Next of Kin
Please provide the details of who to contact in case of emergency
Next of Kin Name*
First Last
Next of Kin Address
Leave blank if same as your home address

Street Address Address Line 2 City County Postcode Country
Next of Kin (Emergency) Phone Number*
Relationship to you (the worker)*

Qualification Declaration
What is Your Trade or Skill*
e.g. Fitter, Electrician, Industrial Operative. WARNING - Failure to provide an accurate declaration of qualifications may result in disciplinary action. All candidates must rake original certificates with them to the first day of site induction.

QUALIFICATION DECLARATION*

QUALIFICATIONS/CERTIFICATES/SAFETY CARDS	AWARDING BODY	ISSUE DATE	EXPIRY DATE	CAN A COPY BE PROVIDED (YES/NO)

(To add additional qualifications please click the plus button on the right)

(To add additional qualifications please click the plus button on the right)*

QUALIFICATIONS	Approximate number of years experience	CAN A COPY BE PROVIDED (YES/NO)

(To add additional qualifications please click the plus button on the right)

If you need any additional space to put down your qualifications use the space below.
Please state any NVQs you hold and at what level-
Please state other relevant qualifications/tickets you hold & experience-
Please state any GCSEs that you have gained, e.g. Maths and English.*

EMPLOYMENT RECORD (MOST RECENT FIRST)*

START DATE	END DATE	EMPLOYER	DETAILS OF WORK UNDERTAKEN AND PROJECTS WORKED ON	CONTACT NAME, TEL NO & EMAIL

(To add additional employment records please click the plus button on the right)

Civil and Ground Worker Experience:
Do you have any civils or ground work experience?
- PIPE LAYING AND DRAINAGE
- DEEP DRAINAGE
- KERB LAYNG
- CONCRETE POURING AND PLACING
- CONCRETE FINISHING

If you answered yes to any of the above please elaborate below*

Specific experience	NVQ?	Please state approximate number of years experience below:	Experience & Additional Comments

REFERENCES: - PLEASE PROVIDE THREE WORKING REFERENCES
LOGICAL PERSONNEL SOLUTIONS POLICY STATES THAT ALL EMPLOYEES MUST PROVIDE A MINIMUM OF 3 WORK REFERENCES.

Company Name	Address	Contact and Position	EMAIL / TEL NO.

Company Name	Address	Contact and Position	EMAIL / TEL NO.

Company Name	Address	Contact and Position	EMAIL / TEL NO.

NUCLEAR INDUSTRY EXPERIENCE
CLEARANCE/VETTING NUMBER & CLEARANCE EXPIRY DATE (please leave blank if you are not yet cleared)
TYPE OF CLEARANCE E.G. MAGNOX, BE, AWE, BNFL, SELLAFIELD?*
DESCRIBE ANY OTHER DUTIES AND WORK UNDERTAKEN IN NUCLEAR FACILITIES:-
PLEASE LIST LOCATIONS YOU HAVE WORKED:-*

SQEP Health Assessment 2021
Do you suffer from the following:
- Diabetes
- Asthma or any other respiratory problems
- Back trouble of any description?
- Arthritis
- Epilepsy/fits/blackouts at any time
- Head Injury
- Dermatitis or any other skin disease
- Heart Trouble
- Strains/Sprains injury or a weakness of the joints
- Dyslexia
- Eye or Ear Trouble
- Any other Disease or Illness not mentioned above
- None of the above
If you answered yes to any of the above please provide further details below:-
Do you know of any health factors, physical or otherwise that may prevent you from undertaking work with Logical Personnel?*
Are you currently taking any medication?
If you selected yes, please specify:
Have you ever failed a drugs and alcohol test for a previous employer?
If you selected yes, please provide further details:
The above answers are true and correct to the best of my knowledge.
Sign*
Print Name*
-*
Date*
MM slash DD slash YYYY

LPS - Policies and Procedures
The following policies have been briefed to you as part of your induction, these will also be emailed to you for your records, please tick/check to confirm you have understood the policies, procedures and instruction given to you by your Logical PS Energy representative:*
Policies and Procedures Agreement*
I acknowledge that I have read and understood the linked LPS Policies and Procedures in their entirety, and agree to be bound by terms to abide by them for the duration of my time working on site at Hinkley Point C.
Diversity Monitoring Form
Logical Personnel Solutions Limited will treat everyone equally irrespective of sex, sexual orientation, gender reassignment, marital or civil partnership status, age, disability, colour, race, nationality, ethnic or national origin, religion or belief, political beliefs or membership or non-membership of a Trade Union or spent convictions.
Which ethnic group do you most identify with?*

e. g. British If you would prefer not to say please state so.
What is your religion or belief?*

e. g. Protestant If you would prefer not to say please state so.
Disability
A disabled person is defined in the Disability Discrimination Act as someone with a physical or mental impairment that has a substantial and long term impact on their ability to carry out day to day activities. This includes progressive and long term conditions from the point of diagnosis such as HIV, Multiple Sclerosis or cancer.
a) Having read the definition above, do you consider yourself to be disabled?*
b) If you answered yes, can you please indicate the day to day activities affected by your disability. (Tick as many as applicable)
- Eyesight
- Hearing
- Speech
- Mobility
- Progressive condition
- Manual Dexterity
- Physical coordination
- Ability to learn or understand, or memory
- Ability to lift, carry or move everyday objects
If you wish, please state your disability here:

We will try to provide access, equipment or other practical support to people with disabilities.
Permission to work in the UK
Do you have immigration permission to work in the UK?
In line with UKBA guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by [insert name of agency] for temporary work.
Declaration
I understand that the information I have provided above will be recorded and processed by HR manually and/or electronically in accordance with the Data Protection Act 1998 and the data protection principles contained therein.
Name*
First Last
Signed*
Date*
MM slash DD slash YYYY

Criminal Convictions Declaration Form
Have you ever been convicted of a criminal offence?*
Do you have a court appearance pending or have you been charged by the Police for a criminal offence?*

If you answered YES to A or B above, please supply the following details

Date	Court	Details Of Offence	Sentence

I CERTIFY THAT:
I have read the Guidance Notes overleaf and have not withheld information that may affect my application for appointment. I understand that false information or omissions may lead to dismissal. The information supplied above may be verified by Logical.

Data Protection Act 1998
I consent to the information which I have provided on this form being used by the Human Resources Managers in the decision making process which may include requesting a criminal records check for certain posts.

If you are appointed to a post, this form is resealed in an envelope and filed in your personal file. If you are unsuccessful, the form will be retained in a sealed envelope, with the papers relating to the vacancy and kept for 6 months before being destroyed.

For more information on the Rehabilitation of Offenders Act 1974 please follow the link.
Date*
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

HPC SQEP

Step 1 of 7 - Personal Details

Next of Kin

Qualification Declaration

Civil and Ground Worker Experience:

REFERENCES: - PLEASE PROVIDE THREE WORKING REFERENCES

NUCLEAR INDUSTRY EXPERIENCE

SQEP Health Assessment 2021

The above answers are true and correct to the best of my knowledge.

LPS - Policies and Procedures

Diversity Monitoring Form

Disability

Permission to work in the UK

Declaration

Criminal Convictions Declaration Form