Application for a Full or 30 Day Temporary Identity Pass

Transcription

1 Application for a Full or 30 Day Temporary Identity Pass Full, Landside or 30 day temporary ID passes will only be issued to persons who require access to relevant areas of the airport for legitimate operational reasons in connection with their terms of employment. Application forms and supporting documentation for Full Identity Passes should be submitted in advance, to allow for Security vetting to take place. Please indicate which type of ID pass you are requesting: Tick 30 Day Pass (30 days maximum) Days Tick Full Pass (60 months maximum) Supply references covering the previous 12 months employment history including any references covering employment and gap periods & complete security interview Supply references covering the previous 5 years employment history including any references covering employment, education or gap periods & complete security interview Months Tick Landside Pass (60 months maximum ) Months You are not required to complete reference section as there is no requirement for references to be submitted for a Landside ID Pass. Complete security interview To knowingly give false information in connection with this application for an ID pass, by either the Authorised Signatory, trained interviewer, ID pass applicant or anyone providing references for the applicant, is an offence under the Aviation Security Act 1982 as amended by the Aviation and Maritime Security Act In the interest of national security and for the purposes of prevention and detection of crime, information regarding ID pass authorisation, applicant data and ID pass usage may be disclosed to the police and other relevant control authorities. This application form must be completed in full and signed by the Authorised Signatory. Failure to complete any part of this application form, or failure to provide the required supporting documentation, will mean that the ID pass cannot be issued, the application form may be rejected and a charge incurred for rejection. Section 1: Applicants Information Company Prefix: Surname: Date of Birth: Gender: Previous Surname: Previous Airport ID held? (please circle) or Home Address: ID Number: Forenames: Place of Birth: Nationality: Previous Forename: Airport of issue (LHR etc) Contact number: Job Title: Department: If contracted please enter company name: National Insurance number: Paid in the UK Proof of NI provided (please circle) Paid Overseas NI Card P45 P60

2 Section 2 - Proof of identity Proof of Identity A valid, recognised form of identification from the following list must be provided at the time of the pass issue. Failure to supply a Valid recognised form of identification will result in the issue of this pass being refused. British Nationals Valid Full Passport Valid UK Photographic Driving Licence Valid UK Police, HMRC warrant card EEA Nationals Valid Full Passport Valid National Identity Card. n EEA Nationals Valid Full Passport and (unless visiting) an original Home Office document or visa confirming the named individual s (ID pass applicant s) right to work and live in the UK ID Number - (enter serial number as appropriate) Type of ID presented (tick below) Driving Licence Passport National Identity Card NI proof inc number Visa Type Visa Issue Date / / Visa ref number: Visa Expiry Date Workers registration Document number: Issue date: Name of Company WRS was issued for: Date of General Security Awareness training (GSAT) UK - Security Clearance CTC or CRC (please circle) CTC issue date CTC expiry date CRC issue date CRC number Overseas - Security Clearance CRC (Applicant will require clearance from all states in which they have been resident for 6 months or more in the last 5 years) Country CRC issue date CRC number Country CRC issue date CRC number Country CRC issue date CRC number

3 Section 3: Reference Information - Photocopy this page if additional references included Full ID Pass 30 day ID Pass Dates Type of References Full ID Pass References must cover previous 5 years without gaps Reference must cover previous 12 months without gaps References must be listed in chronological order ( most recent first) Employment Gap Personal Education Benefit / Inland revenue etc References must cover previous 5 years without gaps Date of employment with Sponsoring Company: Type of Reference: Date from: Date to: Name of Referee: Occupation: Address: Mobile number : address: Daytime Phone number: Fax Number Type of Reference: Date from: Date to: Name of Referee: Occupation: Address: Mobile number : address Daytime Phone number: Fax Number Type of Reference: Date from: Date to: Name of Referee: Occupation: Address: Mobile number : Daytime Phone number address: Fax Number

4 Section 4: Security Interview Declaration Must be completed for all Pass types To be completed fully with applicant during Security Interview Q1: Have you ever been issued with an ID Pass that allows access into Gatwick Airport or any UK Airport? Give approximate date / / Pass type: Temporary or Permanent What Airport was the pass issued from Q2: Have you submitted a UK and/or Overseas CRC disclosure or details of higher clearance for Vetting by the ID vetting team? Give date CRC / CTC was issued / / CRC Disclosure number Q3: Do you give consent for the Authorised Signatory to retain your CTC / CRC disclosure certificate for presentation to the ID Centre or the purpose of the issue of a full identity pass with access? Q4: Do you have any disqualifying criminal offences Q5: Are these disqualifying offences treated as spent, under the Rehabilitation of Offenders Act 1974 Q6: Have you declared these to your employer? Q7: Do you have any pending charges / convictions i.e. waiting to attend court Q8: Do you agree that the ID Centre and employer may approach your former employers, education establishments, government agencies or personal referees to verify the information disclosed in your application for an ID pass? Q9: Are you aware that any misrepresentation of the facts disclosed to your employer or the ID Centre is grounds for refusal or withdrawing of either your ID Application or ID Pass, and may result in criminal charges being brought against yourself or any individuals associated with this application? Q10: Have you provided an acceptable proof of ID (with right to work if applicable)? Q11: Have you provided proof of National Insurance number - (if applicable)? Please note - All ID documents shown as part of this Security Interview, must be the same documents that are submitted for reference checks and also presented to the ID Centre when attending for ID Pass issue Applicant s signature - To be completed at time of Interview Applicant s Name Applicant s signature Date signed Interviewer full name Position in Company Date signed Interviewer Signature

5 Section 5: Access Requirements Please complete this section fully to ensure correct pass type and access are given to Applicant Card Format (if known) CV Level (if known) Zones (if known) Ops status (door hold facility)? Pin number required? Tools of the trade (T Pass) required? Staff parking required? - Complete section 6 fully B H J M R W X Y Z (please circle) Electric Vehicle Permit (EV) required? Date EV licence issued / / Date EV licence expires / / Card Format and Zone requirements: Landside White Pass WA1 n-security restricted areas Yellow YA2 Custom Hall (MIB & Co mail only GA9) Please tick as appropriate zones required zones required 2 Flying staff / Aircrew Blue hatched BA All areas Red (Restricted issue only) 7 Internal Airside - Green or External & Internal Airside - Blue 1 Lounge & Piers 2 Baggage Reclaim 3 *Baggage Make Up 4 Ramp / Apron 5 Aircraft & Footprint 6 All other external areas i.e. runways Other areas - Office blocks etc *Important If zone 3 is required please give reasons. Failure to complete section will result in Zone 3 being omitted from ID Pass.

6 Section 6: Tools of the trade to be fully completed by Authorised signatory and issued in conjunction with Gatwick Airport Direction (GAD/F16/12) Tools of The Trade Pass required? (T Pass) Categories Please tick required categories in order for the correct T pass to be issued for access to critical parts S - Sharps Items designed for chopping, cutting piercing etc. Box cutters Knives with blades of more than 3 cm Scissors with blades of more than 3 cm Stanley knives Tools with blades Sharp implements i.e. chisel etc. W Workman s tools (Large or Small) Workmen s tools capable of being used either to cause serious injury or to threaten the safety of aircraft or person, Crowbars Drills and drill bits, including cordless portable power drills Blowtorches bolt guns and nail guns Blunt instruments Spanners, hammers, engineering, electrical, plumbing, mechanical and building tools etc. L Liquids: Work Related Liquids used for the general servicing, cleaning, repair and maintenance of the airport including: Cleaning chemicals Grease Sealants Cutting oxygen Petrol Paints / thinners etc. F Firearms and Ammunition (Bird Hazard Management) Specialist equipment used by appropriate departments e.g. Airfield or Engineering. These items include Firearm (Sako Quad Bolt Action Rifle) Shotgun and Air Rifles Pyrotechnic Cartridge Pistols Shotgun Cartridges Live Ammunition Rounds Air Rifle Pellets Pyrotechnic Bird Scaring Cartridges (Blanks, Long Range Projectile, Screech Shells) Telescopic Sights Office Use Only T pass issued or (please circle) (If - please give reason) T pass Categories S W L F (please circle) T Pass Issue Date Serial number of T pass T pass Expiry Date IDC Staff name:

7 Section 7 - Authorised Signatory s Declaration To be signed by the Authorised Signatory after the application form has been fully completed As the Authorised Signatory, I can confirm that the recruitment / interview procedures adopted when employing the person named on this application comply with the current Security directions and guidelines issued by Gatwick Airport Ltd, and where applicable, that satisfactory references have been received and submitted to the ID Centre. In the light of these references and the subsequent vetting procedures I have followed, I confirm that the individual named is a suitable person to be issued with an ID pass to work unescorted in the restricted zones, controlled areas and/or landside areas of Gatwick airport. I also confirm that, to the best of my knowledge, there is nothing known about the person named in this form which suggests a lack of integrity or otherwise reflects adversely upon their suitability to hold an airport pass allowing access to sensitive areas of Gatwick airport. I understand that all supporting documentation such as original references, and records regarding the issue of an ID pass, must be retained and are subject to Gatwick Security or Department for Transport audit. I understand that Gatwick Airport Ltd has the right to refuse the issue of an ID pass where the submitted documentation does not meet the required criteria. I request that access be given as indicated, and I confirm that the applicant is required to access these areas in order that he/she can carry out duties on behalf of the company or organisation authorising the ID pass. I agree that, when the ID pass is no longer required for the given purpose, I shall arrange for its return to the ID Centre within 60 days of the pass no longer being required, and that failure to do so may result in a further administration charge being made. I agree that the issuing entity shall be notified immediately of the loss, theft or failure to return the ID card. By authorising the issue of this ID pass I agree that the company I am representing will pay the published charges associated with the issue of ID passes and staff car parking. I am aware of the health and safety and fire training requirements for persons employed within the airport environment, and will ensure that appropriate fire training is provided within 1 month of ID pass issue, and annually thereafter. NB: Signatory to delete as appropriate - The applicant has completed a recognised GSAT course within the last 5 years / has received or will receive training in accordance with Direction 12 (a-g) / is employed by an approved authority / has received a copy of the leaflet Security is everyone s responsibility in the last 5 years (Controlled Area/Landside pass only) Company Address: Job Title: Mobile number : address: Fax Number: Authorised Signatory Name: Signature Date of signing / / Section 8- Applicant s Declaration (sign this declaration in the presence of the ID Centre staff.) Data Protection Act 1998 Gatwick Airport Ltd is registered under the Data Protection Act 1998 The information provided on this application form is required by Gatwick Airport Ltd to meet the requirements of the Aviation Security Act 1982, as amended by the Aviation and Maritime Security Act 1990, and government directions. Checks will be made by the applicant s employer and Gatwick Airport Ltd to verify the information provided. This will involve seeking additional information from third parties such as previous employers. The information provided along with a copy of your identity document will be stored on a database and will be safeguarded against unauthorised access. Personal data may be disclosed to Police and other control authorities in the interest of national security and for the prevention and detection of crime. Information on ID pass use may be made available to the applicant s employer. Information provided may be analysed and used for research purposes, which may include, for example, surface transport opportunities, and you may be contacted at your home address for this purpose. Please sign this application form below in the presence of the ID Centre staff in order to confirm the following: 1. I confirm that the information contained on this application form is complete and accurate. 2: I confirm the ID pass will only be used whilst on duty and is not transferable to another employee at any time 3: I agree that the loss or theft of my ID will be reported immediately to the ID Centre or my employer. 4: I agree to abide by the terms and conditions of the issue of an ID pass and have been made fully aware of my responsibilities as an ID pass holder. I understand that failure to comply with airport by-laws, Gatwick Airport Directives and Instructions and security notices may result in disciplinary action or withdrawal of my ID pass 5. I confirm that I have been made aware of the Gatwick Airport Directions for Tools of the Trade and agree to abide by the rules surrounding the carrying of Tools into the Critical parts of the airport either on person or within a vehicle Applicant s signature Date of signing / /

8 Section 9 - ID Application Check Sheet This check sheet must be fully completed and remain with the pass application form when submitted to the ID Centre. Application details Company Prefix: ID Pass number: Name of applicant : Has applicant held a previous Gatwick ID Pass? If yes please provide previous details (e.g. prefix & ) Application Checklist Application form fully completed including Security Interview for all ID Pass types? 5 year or 12 months references included where applicable? n EEA applicants must provide proof of right to work documents; these will be checked by ID Centre at Pass issue Valid CRC included overseas CRC (where applicable) (Valid for 10 weeks from issue date only)? Valid CTC details must be included where applicable? (Valid for 10 weeks from issue date only)? General Security Awareness Training (GSAT) certificate supplied or declaration with training date signed? Office Use only Application Passed Vetting or (please circle) Application Rejected Finance code to be used Rejection 1 Rejection 2 IDC staff name Date 30 Day Full Pass Pass Issued or (please circle) Pass Issued or (please circle) Card Format: Card Format: CV Level : CV Level : Finance code allocated ID Issue Date / / ID Expiry Date / / Car Park added or (please circle) IDC Staff name Finance code allocated ID Issue Date / / ID Expiry Date / / Car Park added or (please circle) IDC Staff name Date: / / Date: / /