Professional Documents
Culture Documents
Interveiw Pack
Interveiw Pack
Interveiw Pack
INFORMATION SHEET
Personal Details
Title: First Name: Middle Name: Surname:
Mr Luigi Ionut Burtila
Current address Number & Street:
—
44 Kingfisher Street
Town & City: Date of Birth.
Preston 06.04.1998
County: Nationality AT BIRTH:
Lancashire Romanian
Postcode: National Insurance number:
PR1 6TR SZ652181B
Telephone Number: Email address:
07909309240 burtila.beec@outlook.com
Town & Country of birth: Mothers FULL maiden name: (first & second Name)
DISCLAIMER
This role is not 'exempt' from the Rehabilitation of Offenders Act. We only ask applicants to disclose convictions which are
not yet ‘spent' under the Rehabilitation of Offenders Act 1974. If you are not sure whether your convictions are spent please
contact Nacro for further advice.
DECLARATION
I declare that the information provided on this form is correct. I understand that the declaration of a criminal record will not
necessarily event me from providing services to Deva Services Ltd
FOR OFFICIAL USE ONLY Date received. Date Accurate Check Run:
Postcode: Postcode:
From (Month/Year) From (Month/Year)
Postcode: Postcode:
From (Month/Year) From (Month/Year)
Postcode: Postcode:
From (Month/Year) From (Month/Year)
Please confirm your fitness to provide services listed below by ticking each section and signing and dating the form.
DECLARATION
I am physically fit and able to fulfil the demands of a multi-drop courier
I am not taking any medication that will hinder my ability to drive or manipulate consignments in a safe manner.
I have no medical conditions that will hinder my ability to drive or manipulate consignments in a safe manner.
I will comply with all manual handling guidelines and not place myself in danger by using unsafe working practices
I have no mental or physical conditions that have not been reported to the DVLA which could affect my ability to drive safely.
I will inform Deva Services if my ability to safely drive or handle consignments changes in the future
During the course of your work/time at Amazon.co.uk Limited and "us"), you will be invited to visit our premises, where you
may receive information relating to Amazon that is not known to the general public and is confidential and important to us. We
call this our "Confidential Information". Our Confidential Information includes, among other things:
I understand and agree to abide by the promises I make in this agreement to protect Amazon's Confidential Information. I agree that my
promises also apply for the benefit of other Amazon companies.
Name Date Signature
I acknowledge that Deva Services Ltd has paid for my DBS check on my behalf at a cost of £49.
I agree to repay that by deduction from my weekly invoice in five equal instalments of £9-80 per week
until fully repaid.
Our policy is designed to ensure that no persons under the influence of illegal drugs or alcohol does supply or
render services to Deva Services Ltd nor operate a vehicle on behalf of Deva Services Ltd.
4. Random Screening
Whilst contracting to or under the employ of Deva Services Ltd there shall be a continued requirement for each
individual to agree to undertake random drug & alcohol screening tests for the purpose of verifying compliance
with this policy when requested by either a representative of Deva Services Ltd or a representative of our client
at whose premises the services are being rendered or supplied.
5. Testing process
All screening tests undertaken by any individual in line with this policy shall be conducted at the expense of Deva
Services Ltd by a suitably qualified & authorised independent Toxicologist on behalf of the third party appointed
by either Deva Services Ltd or a client of Deva Services Ltd to conduct such screening tests.
Results of all screening tests shall be available to the donor once they are made available to Deva Services Ltd
5. Non-Negative result
Should the result of any screening test undertaken be 'Non-Negative' any employee shall be immediately
suspended from any duties pending an investigation in line with our disciplinary procedure.
Should the result of any screening test undertaken be 'Non-Negative' any contractor will be required to reimburse
Deva Services Ltd for the cost of the screening test and any agreement or contract for services immediately
terminated.
6. Right to appeal
The donor shall have the right to appeal where in the situation that the onsite testing equipment may be defective;
samples will then be sent to an approved Laboratory. Further costs/penalties may be incurred subject to result.
I understand that only duly-authorised Company officers, employees, and agents will have access to information furnished or
obtained in connection with the test; that they will maintain and protect the confidentiality of such information to the greatest
extent possible; and that they will share such information only to the extent necessary to make SLA decisions and to respond
to inquiries or notices from government entities.
I will hold harmless Deva Services Ltd, its company contracted business partners, and any testing laboratory & collection officer
the Company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might
result from such testing, including loss of work or any other kind of adverse job action that might arise as a result of the drug
or alcohol test, even if a Deva Services Ltd or laboratory representative makes an error in the administration or analysis of the
test or the reporting of the results. I will further hold harmless Deva Services Ltd, its Sample collection officer, and any testing
laboratory that Deva Services Ltd might use for any alleged harm to me that might result from the release or use of information
or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this
policy and the procedures as explained in the paragraph above.
This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any
questions about the test or the policy, they will be answered.
I UNDERSTAND THAT DEVA SERVICES LTD WILL REQUIRE A DRUG SCREEN AND/OR ALCOHOL TEST UNDER THIS POLICY
WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE
INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT. ALSO, I UNDERSTAND THAT I WILL
BE SUBJECT TO RANDOM DRUG SCREEN AND/OR ALCHOL TEST UNDER THIS POLICY AND I AGREE TO SUBMIT TO ANY SUCH
TEST.
Data Protection
Within the terms of the UK Data Protection Act (DPA) we are required to inform you of the information that we
collect about you. Some of the information is regarded as sensitive data as defined in the DPA.
The test result, any medical information you have disclosed and the reason for the test are of sensitive nature.
The fact that you have been tested is not regarded as sensitive information.
__________________________________ 01.08.2023
__________________
Signature of Delivery Associate Date
Luigi Burtila
__________________________________
Delivery Associate Name - Printed
__________________________________ __________________
Deva Services Ltd Representative Date
Deva Services does not discriminate on the basis of colour, ethnicity, gender, sexual orientation or
disability.
Please read the following carefully and sign and the end to confirm that you understand and agree.
This policy applies to all employees and anyone providing services to Deva Services
Luigi Burtila
I _______________________________ (Contractor Driver) declare that I hold a valid foreign driving license and am
legal to drive in the UK.
If I have an accident during providing services to Deva Services , I declare that I am completely liable for any
injuries, damage or ruined load that I am carrying.
DA must switch to a UK licence within 12 months of commencement of services with Deva Services .
Applicant
01.08.2023
Signature............................................................. Date.............................................................
Luigi Burtila
Print Name............................................................. Time.............................................................
Manager
Signature............................................................. Date.............................................................
11 05 2016
01.08.2023