Rail Application Pack

Step 1 of 13

Your Personal Details

Please provide your personal contact details.

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City Postcode

Date of birth(Required)

Day

Month

Year

Where did you hear about us?(Required)

What is their name

Please give details

Nationality(Required)

Right To Work Sharcode

National Insurance Number(Required)

Do you hold a valid PTS number?(Required)

Yes

PTS Number

Do you have a valid UK Driving Licence?(Required)

Yes

Do you have your own transport?(Required)

Yes

Your Emergency Contact

Name(Required)

First Last

Phone Number(Required)

Relationship to you?(Required)

Your Compentencies

PTS AC

Valid

Expired

PTS DCCR

Valid

Expired

OLEC 1

Valid

Expired

OLEC 2

Valid

Expired

OLEC 3

Valid

Expired

PICOP

Valid

Expired

Site Warden

Valid

Expired

SWL 1

Valid

Expired

SWL 2

Valid

Expired

Valid

Expired

Nominated Person

Valid

Expired

Valid

Expired

Engineering Supervisor

Valid

Expired

Point Operator

Valid

Expired

Crane Controller

Valid

Expired

Machine Controller

Valid

Expired

CPL

Valid

Expired

Hand Back Engineer

Valid

Expired

Plant Operator

Valid

Expired

Plant Fitter

Valid

Expired

COSS

Valid

Expired

IWA

Valid

Expired

SSOWP

Valid

Expired

Rail Saw

Valid

Expired

Iron Man

Valid

Expired

Impact Wrench

Valid

Expired

Rail Drill

Valid

Expired

Hand Tools

Valid

Expired

Cembre Fastclip / AP11

Valid

Expired

Robel Clipper

Valid

Expired

CAT & Genny

Valid

Expired

Tripple Wacker

Valid

Expired

First Aid

Valid

Expired

Site Manager (SMSTS)

Valid

Expired

Site Supervisor (SSSTS)

Valid

Expired

CSCS

Valid

Expired

CPCS

Valid

Expired

Please provide any other competencies not listed above

Your Work Experience

No of years’ experience working on the Rail Network(Required)

Rail Disciplines Worked

Please check all appropriate.

P Way

Yes

Telecomms

Yes

Rolling Stock

Yes

Civil/Construction

Yes

Signal Engineering

Yes

Railway Operations

Yes

On Track Plant

Yes

Train Driving

Yes

Plant & Elect Services

Yes

Power Systems (OHLE)

Yes

Other Disciplines

Yes

If ‘Yes’ please specify below.

Other disciplines continued

Professional Status

Please check all appropriate

General Labourer

Yes

Engineer

Yes

Trackman

Yes

Foreman

Yes

Trade / Skilled Labour

Yes

Foreman / Ganger

Yes

Technician

Yes

Manager

Yes

Last Position Held

Railway

Other

Date from

Month

Day

Year

Date to

Month

Day

Year

Company Name

Company Address

Street Address Address Line 2 City ZIP / Postal Code

Supervisor/Manager Name

Contact Number

Reason for Leaving

Nature of Work

Any medical reason/disability, which could prevent you from working on the Rail infrastructure?

Yes

If yes, please specify

Have you ever been removed from the Rail infrastructure in the course of working duties?

Yes

If Yes, please specify

Additional Qualifications & Skills

CSCS Number

CPCS Number

Training Courses Attended and Certificates Held

Pay Details

All payments will be made to applicants via the Pendulum contracting service, if you have any queries over payroll please contact them directly on 0333 0066 296.

Please tick how you wish to be paid? (CIS is dependent on end client)

Umbrella

CIS

Our Policies

Please download and read the below

TLL POL 01 – Health & Safety Policy

TLL POL 02 – Environmental Policy

TLL POL 03 – Quality Policy

TLL POL 04 – Drugs & Alcohol Policy

TLL POL 05 – Working Hours Policy

TLL POL 06 – Worksafe Policy

TLL POL 07 – Social Media Policy

TLL POL 08 – Equality & Diversity Policy

TLL POL 09 – Lone Working Policy

TLL POL 10 – Code of Bus Ethics & Conduct

TLL POL 11 – Corporate Social Responsibility Policy

TLL POL 12 – Data Protection Policy

TLL POL 13 – Sustainability Policy & Plan

TLL POL 14 – Statement Pursuant to the Modern Slavery Act

TLL POL 15 – Logistical Planning Policy

TLL POL 16 – Bribery Policy

Consent

I confirm i have read and understood all the policies and procedures above

Sign

Medical Self Certification

Alertness and reasonable physical fitness are essential for duties which may interact with moving trains. It is, therefore, important to be accurate with your answers to this questionnaire, although trivial matters should be ignored (e.g. transient dizziness while gardening two years ago). When you declare NO, you are accepting a degree of responsibility for your safety . Please study this list and sign the declaration at the bottom:

Do you suffer from blood pressure problems (high or low) that are not controlled by medication?

Yes

Do you presently suffer depression, anxiety, panic attacks or other stress related illness requiring medication or other form of treatment?

Yes

Do you suffer from diabetes controlled by insulin or sulphonylureas tablets?

Yes

Do you suffer from epilepsy or fits?

Yes

Have you ever suffered blackouts, unsteadiness, recurrent dizziness or any condition which may cause sudden collapse, impairment of balance or co-ordination or incapacity?

Yes

Are you taking any medication that is giving you dizziness or drowsiness?

Yes

Do you get discomfort or paint in the chest (such as angina) or shortness of breath on exercise (e.g. climbing a single flight of stairs)?

Yes

Do you suffer any health problems that would render difficulty in moving rapidly over short distances on foot, includes on slopes, steps or rough ground?

Yes

Would you have difficulty in looking over either shoulder?

Yes

Do you have difficulty with your eyesight or difficulty correctly identifying colours? (other than wearing glasses or contact lenses where required)?

Yes

Do you wear glasses or contact lenses?

Yes

Do you have difficulty hearing normal conversation?

Yes

Are you taking any medication that is causing you dizziness or drowsiness?

Yes

Have you had any illness related to alcohol during the last 12 months?

Yes

Have you used any drug of abuse (not alcohol or tobacco) within the last 12 months?

Yes

Do you have vibration white finger?

Yes

Have you worked with lead / asbestos?

Yes

Have you had any chest related illness in the last 12 months?

Yes

Have you had any back injuries in the last 12 months?

Yes

Declaration(Required)

I declare that the information I have provided above is true and accurate & I will inform my employer of any change to my health which may affect my ability to perform my duties:(Required)

Sign

Date

DD slash MM slash YYYY

Compliance manager
image description

Date

DD slash MM slash YYYY

Eyesight Declaration

ALL EMPLOYEES ARE REQUIRED TO RETURN A COMPLETED/SIGNED COPY OF THIS Declaration.

• Part of the medical examination involves an eyesight test. If you needed to wear contact lenses or glasses to pass this test then you must always wear them when on or near the track or the lineside.

• In addition, people who wear contact lenses must carry a pair of spectacles with them at all times when on site. Audits will be carried out on site to ensure compliance.

• If you are in any doubt as to the requirements of this memo/policy please contact Training Lives for clarification.

Do You Wear Glasses?(Required)

Yes

Do You Need To Wear Glasses To Reach The Required Standard?(Required)

Yes

Do You Wear Contact Lenses?(Required)

Yes

Do You Carry A Spare Pair Of Glasses At All Times When On Site?(Required)

Yes

Sign

Date

DD slash MM slash YYYY

Compliance manager
image description

Date

DD slash MM slash YYYY

Consent(Required)

I acknowledge receipt of this memo regarding medical standards and confirm that I understand and will comply with this policy.(Required)

Declarations continued

I confirm that the information disclosed in this registration form is relevant and correct and can be verified by references from previous employers and/or any professional bodies or character reference specified.

I also undertake to inform Training Lives of the outcome of all introductions/interviews to companies or agents. I understand that information I have disclosed may be held within a computer database.

I hereby give my permission for information I have disclosed to be divulged to companies or agents as deemed necessary by Training Lives in relation to my application for work.

Pursuant to the Rehabilitation of Offenders Act

Do you have any unspent or pending convictions at this time?(Required)

Yes

If you answered yes to the above please provide detail below

Consent(Required)

I confirm i will inform Training Lives of any prosecution that may occur whilst they hold my details.(Required)

Equal Opportunities

Do you consider yourself to have a disability within the terms of the Equality Act 2010?(Required)

Yes

If yes, please state below

Training Lives is dedicated to offering equal opportunities for all work seekers and shall adhere to such a policy at all times and will review on an on-going basis on all aspects of recruitment to avoid unlawful or illegal undesirable discrimination.

We will treat everyone equally irrespective 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 and we place an obligation upon all staff to respect and act in accordance with this policy.

Training Lives shall not discriminate unlawfully when deciding which candidate is submitted for a vacancy or assignment, or in any terms of engagement for workers.

Training Lives will ensure that each candidate is assessed only in accordance with the candidate’s merits, qualifications, ability and experience to perform the relevant duties required by the particular vacancy.

Repayment of training costs

From time to time the company may pay for you to attend training courses. Inconsideration of this, you agree that if your employment terminates after the Company has incurred liability for the cost OR If you terminate your employment within 6 months of the last day of the training course, you will be liable to repay some or all of the fees, expenses and other costs associated with such training courses.

Data Protection

Training Lives would like consent to hold personal and special data about you in order that we can process your employment. You are entirely in control of your decision to give consent to my use of your data as requested in this form. There will be no repercussions if you choose to withhold consent. However without some data I may not be able to make a decision on your suitability for employment or comply with the law and therefore I may not be able to make an offer of employment or. We may also need to share your data with third party outside agencies such as clients and various health services.

I hereby freely give my employer consent to use and process my personal data relating to my employment (examples of which are listed above). I understand that I can ask to see this data to check its accuracy at any time via a subject access request. I understand that I can ask for a copy of the personal data held about me at any time, and that this request is free of charge

I understand that I can request that data that is no longer required to be held can be removed from my file and destroyed.I understand that you are the Data Controller for my employment and I can contact you directly if I have any questions or concerns about my data.

I understand that if I am dissatisfied with how you use my data, I can make a complaint to the government body in charge (Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF or online at (www.ICO.org.uk)

Signature

Date

DD dash MM dash YYYY

Induction and briefing

Whilst working on behalf of Training Lives at the premises of Clients of Training Lives you are required to work safely in accordance with the company’s policies, operating procedures and work instructions. Safety is of prime concern to Training Lives and your safe approach to work is a condition of your work with Training Lives.

You will be issued with a personal job description and organisation chart so that you know your job responsibilities, where you fit within the Client Company and the reporting line in relation to your position.

You are required to keep your Induction Pack as a reference tool for your personal health and safety responsibilities towards yourself and others. This pack also outlines the Training Lives health and safety procedures for all its workers.

Compliance with Training Lives Policies

As a Training Lives worker, you will be required to confirm receipt, acceptance and understanding of the Health & Safety, Working Hours, Drugs & Alcohol and WorkSafe policies.

Compliance with Safety Briefings

As a Training Lives worker, the company will ensure that you will receive COSS and Project Plan briefings. You will be required to sign confirmation of understanding and acceptance of these briefings

Competence Assessment

As part of the recruitment process you will be assessed in your competence. Any previous competency certification will be verified before your work with the company starts. You will be required to provide a photocopy of any previous certification, which will be verified with your previous employer and the issuing body. You will also be expected to pass a Drugs and Alcohol screening check.

Personal Track Safety (PTS) Handbook

Upon passing your PTS course you will receive a PTS handbook. You are required to sign and send the enclosed acknowledgement slip to Training Lives . You are required to keep safe your PTS Handbook and card.

Sentinel Network Rail Cards

You will be issued with a Personal Track Safety Sentinel Card, which you must keep on your person at all times when working on the railway infrastructure. Training Lives will hold a database of all current Sentinel Cards held by Training Lives workers. When Training Lives workers carry out Initial / refresher training Training Lives will ensure that the worker collects the new Network Rail card personally. Training Lives will ensure obsolete cards are handed over prior to issuing new Sentinel cards. You must ensure you swipe in / out, prior and at the end of each shift.

Hours Worked

Enclosed with this pack is the Training Lives Hours Worked Policy, with which you must confirm. You must not exceed the limit of hours in the policy. The company has a responsibility to ensure you do not exceed these hours without authorisation. Equally you must accept your own responsibility not to exceed these hours. If you plan to exceed these hours by working for Training Lives then you will be dismissed from your work with Training Lives , your certification withdrawn and Sentinel notified.

Drugs and Alcohol

You are responsible for personal compliance with the Training Lives Drugs and Alcohol Policy and for maintaining vigilance that other Training Lives workers and subcontractors do not come to work under the influence of drugs and alcohol. You must report others who appear to be under the influence. If you are found under the influence of drugs and alcohol you will be immediately dismissed from your work assignment with Training Lives your PTS card withdrawn and Sentinel notified.

Worksafe

You must only commence or continue to carry out work when you are confident in the safety of the system of work you are working under. Do not start work without a COSS briefing.

If you are already working and you think a situation is dangerous, cease work and report the situation to the person in charge for their review or you can contact CIRAS directly and pass on all relevant information. The person in charge will review the system of work. If the dispute continues over the safety of the system of work then the person in charge will consult with the regional manager / “on call” manager for further review.

If the Line Manager or “On Call” Manager fail to agree or provide an acceptable “Safe System of Work”, the disputed task or activity will not be undertaken until the HS&E Manager has been consulted.

Medical Fitness

As a Training Lives worker, you are responsible for informing Training Lives of any change in your medical condition as soon as the situation arises, and responding to notification of the need for medical re-examination when required. Training Lives will aim to give you one month’s notice of the need to be medically re-examined.

Contact Lenses

If you wear contact lenses you are to report this to the Training Lives . If you wear contact lenses on a railway project then you must carry a pair of prescription glasses with you at all times.

Personal Protective Equipment (PPE)

Training Lives will ensure that you have the PPE to carry out your role safely. This will include an induction into the safe wearing and use of PPE, and checks for proper fitting. You are to sign for the PPE issued to you and to keep it in safe, clean and in workable condition. If any PPE is damaged you are to inform Training Lives to ensure suitable replacement.

Monitoring and Auditing

Training Lives will randomly check your compliance with your responsibilities as a Training Lives worker. Training Lives will monitor you for your competence in your place of work. Further to this, clients and Network Rail will also audit Training Lives . You are to ensure that you work safely at all times. Equally you have a responsibility to monitor the competence of your work colleagues to ensure your and their own safe place of work.

Accident, Incident, and Near Miss Reporting

You must report any Accident, Incident or Near Miss that occurs in your work on the Railway Infrastructure to your on site line manager, the Client Representative and Training Lives directly. You must also complete, or get another to assist you in completing a Training Lives Accident and Incident Report or Near Miss Report immediately after the event occurring. Equally you must complete a Witness Report if witnessing such an event.

Incident Response Planning

When an incident occurs you should take immediate action directed to making the site safe, summon assistance, assess the circumstances and preserve the evidence. Always do the following: –

• Remain on site
• In the event of no client or Network Rail representative on site, secure the site
• Contact the site controller
• Advise the signaller ensuring the security of the line
• Do not speak to the media
• Preserve evidence and support the Rail Incident Officer within the limitations of their competencies.

Declaration(Required)

I have Read, understood and where appropriate will follow the above induction.

Name

First Last

Sign

Date

DD dash MM dash YYYY

Compliance manager
image description

Michael Richards

Date

DD dash MM dash YYYY

Contract of Sponsorship

This contract is between Training Lives Ltd

And

First Last

Sponsored Individual

Sentinel No:

Date
DD dash MM dash YYYY

GENERAL:

This Contract of Sponsorship is valid for a period of 1 year from date of signing.

Under the terms of this Contract, you as a Sponsored Individual will be employed by Training Lives LTD on a:(Required)

PRIMARY and SUB-SPONSOR RESPONSIBILITIES:

Training Lives, as the Sponsor putting you, as an individual to work, is responsible for the following (regardless of whether we are your Primary Sponsor or your Sub-Sponsor):

1.Providing the Safety Critical Equipment required to enable you to undertake your competencies trackside and ensuring that it is fit-for-purpose

2.Maintaining all records associated with any works undertaken by you on NRMI

3.Maintaining a minimum contracted insurance level for works undertaken by you

AS YOUR PRIMARY SPONSOR WE WILL:

1. Establish a ‘Contract of Sponsorship’ with each Individual we intend to Sponsor

2. Undertake checks of an Individual’s suitability to work on NRMI prior to engaging in a Contract of Sponsorship

3.. As part of the Contract of Sponsorship, provide you under your Contract of Sponsorship with:

• A valid Sentinel Smart Card
• An induction briefing which will include as a minimum the rules and responsibilities of the Sentinel Scheme
• Suitable PPE, so marked as to identify who you are working for when on NRMI, and suitable training to be able to use that protective equipment effectively
• Regular briefings on changes to standards, Rule Book updates and Sentinel Scheme Rule updates
• Training and assessment to ensure competence at required intervals
• Safety Critical Equipment to enable you to undertake your role (jointly with any Sub-Sponsor)
• Personal issue information such as handbooks and relevant information
• Advice, guidance or instruction on any restrictions based on medication and other medical fitness issues
• Mentoring support to develop your competence on an annual basis
• Clear contractual arrangements between the us as your Primary Sponsor and yourself, and whether Sub-Sponsors are permitted

4. Regardless of your employment status, as your Primary Sponsor through this Contract of Sponsorship will fulfill the role of your employer for the purposes of health and safety.

5. As your Primary Sponsor entering into the Contract of Sponsorship with yourself, we are also responsible for:

• Monitoring and management of your working hours under this Contract of Sponsorship. Shifts worked with Sub-Sponsors will be considered in the monitoring of working hours and the management of fatigue
• Agreeing any sub-sponsorship arrangements with yourself and to grant permission to any Sub- Sponsor to use your resources
• Enacting the Local Investigation process where any suspected breach of the Sentinel Scheme Rules becomes apparent
• Collating information from Sub-Sponsors to enable conclusion of the Local Investigation
• Maintaining records of Local Investigations and requesting a Formal Review where a Scheme Outcome is recommended following a Local Investigation
• Providing a reason for de-Sponsoring you
• Conducting a Local Investigation before de-Sponsoring you for any breach of the Sentinel Scheme Rules
• Collating and maintaining all records for yourself that are associated with this Contract of Sponsorship (as required by the Sentinel Management System). Including annual assessment of training & medical fitness
• Requesting a temporary Suspension or issuing a temporary Take Down of competence pending the conclusion of Local Investigation where appropriate

AS YOUR SUB-SPONSOR WE WILL:

1.As your Sub-sponsor, we will request permission to use you from you Primary Sponsor. We, as your Sub-sponsor must receive confirmation of sub-sponsorship status before resourcing you to work.

2. As your Sub-sponsor, we are responsible for providing all information to your Primary Sponsor to enable your Primary Sponsor to manage the overall safety of yourself. This includes, but is not limited to information on your working hours, safety incidents, competencies used and competence short-falls.

3. As your Sub-sponsor, we will notify your Primary Sponsor of any alleged breach of the Sentinel Scheme Rules as soon as is reasonably practicable after becoming aware of such allegation, and co-operate in collecting information and evidence to enable your Primary Sponsor to conduct a Local Investigation.

4. As your Sub-sponsor, we will co-operate with your Primary Sponsor in the management of working hours. Where a risk assessment has been conducted and extra working hours approved, this information will be provided to your Primary Sponsor.

YOU, AS A SENTINEL CARD HOLDER, WILL:

1. Carry your Sentinel Smart Card at all times while working on NRMI and will co-operate with your Primary Sponsor to keep the personal information held in the Sentinel Scheme Database and printed on the Sentinel Smart Card up to date.

2. Follow the rules of personal accountability for working safely on NRMI, including compliance with the Lifesaving Rules.

3. Have a responsibility to manage your Sponsor relationships

4. At all times when working on the NRMI, have a responsibility to:
• Know the identity of your Primary Sponsor
• Know which Sub-Sponsor you are working for (when you are not working for your Primary Sponsor)
• Provide the correct name of the Sponsor you are working for when booking into site

5. Be required to notify your Primary Sponsor if you no longer wish to be sponsored by them so that you can be de-sponsored. Change of sponsorship can be requested online through My Sentinel.

6. Be able to access your personal records on the Sentinel Scheme Database. This can be requested from your Primary Sponsor, or by direct access to the My Sentinel area of the Sentinel website.

7. Have a personal responsibility to comply with health and safety rules, including:

8. No Individual shall undertake or attempt to report for duty, if they have worked on NRMI within the preceding 12 hours (sometimes referred to as double-shifting), unless a risk assessment has been conducted by the Primary Sponsor and suitable controls implemented

9. No Individual shall exceed the maximum working hours determined by law, Network Rail requirements and the Sponsor

10. Every Individual has a responsibility to be fit for work, not fatigued by excessive travel, and not under the influence of drugs or alcohol. Individuals shall report anything that may affect their ability to work safely including medication, lack of equipment or personal circumstances

11. An Individual shall report for duty with the appropriate Personal Protective Equipment (PPE) to enable them to undertake their duties

12. No Individual shall undertake a task for which they are not competent, do not have the right equipment or the relevant information or local knowledge to complete safely

13. Individuals shall act in a safe manner at all times when on NRMI, and report any incident, close call or breach of the Sentinel Scheme Rules they are aware of

14. Individuals shall always carry their Sentinel card when on NRMI

15. Where accountable: undertaking 100% verification checks on sentinel smart cards before allowing Individuals to start work.

Signed

Name
First Last

Date
DD dash MM dash YYYY

Compliance manager

Michael Richards

Date
DD slash MM slash YYYY

Documents required

Please upload the following documents.

PTS

Drop files here or

Max. file size: 32 MB.

Driving licence

Drop files here or

Max. file size: 32 MB.

Passport

Drop files here or

Max. file size: 32 MB.

curriculum vitae (C.V)

Drop files here or

Max. file size: 32 MB.

National Insurance Number (NI)

Drop files here or

Max. file size: 32 MB.