CONFIDENTIAL

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)

Town First Name Surname

Craiova Mirela Burtila
Emergency Contact:
Name: Tel No: Relationship
Cristi Burtila +44 7468 989473 Brother

Criminal Record Disclaimer

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.

Do you have any 'unspent' convictions? Yes No

If "Yes" provide details below:

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

Name Date Signature

Luigi Burtila 01.08.2023

FOR OFFICIAL USE ONLY Date received. Date Accurate Check Run:

DSP Name Accurate Background Check Ref No. POC Name

Deva Services Ltd

Interview Pack May 21

 SEVEN YEAR Address History
Provide details of all addresses for the past 7 years
Current Address: 44 Kingfisher Street

Postcode: PR1 6TR

Postcode:
From (Month/Year) From (Month/Year)
03.2020
Until (Month/Year) until (Month/Year)
08.2023

Postcode: PR1 5SD Postcode:

From (Month/Year) From (MonthfYear)
03.2016
Until (Month/Year) Until (Month/Year)
03.2020

Postcode: Postcode:
From (Month/Year) From (Month/Year)

Until (Month/Year) Until (Month/Year)

Postcode: Postcode:
From (Month/Year) From (Month/Year)

Until (Month/Year) Until (Month/Year)

Postcode: Postcode:
From (Month/Year) From (Month/Year)

Until (Month/Year) Until (Month/Year))

Interview Pack May 21

 Driving Licence Check
DECLARATION
I hereby give Deva Services Limited permission to check the details of my driving licence with the DVLA every 3 months
(quarterly).

Name Date Signature

Luigi Burtila 01.08.2023

FOR OFFICAL USE ONLY Deva Services DVLA Check Declaration

DECLARATION
I declare that a DVLA check has been carried out on the above named individual, in the presence of the above
mentioned individual on by the undersigned Deva Services representative.
I can also confirm that all checks are compliant to Amazon standards.

Deva Services representative name Date Deva Services representative Signature

Medical Fitness Declaration

All couriers wishing to provide services must be medically fit enough to undertake the role as a multi-drop courier. The core role involves a
significant amount of driving and the safe manual handling, manipulation, sorting and delivery of large numbers of consignments.

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

Name Date Signature

Luigi Burtila 01.08.2023

Child Exploitation Policy

Please read the following carefully and sign and date to confirm that you understand and agree. This policy applies to all and anyone working
at or visiting Amazon's sites.
Only Authorised drivers may travel in a vehicle used to provide the services whilst the vehicle contains Amazon items. (For the avoidance of
doubt, passengers who are not authorised drivers may not travel in a vehicle at the same time as Amazon items). Animals & Children may
not travel in any vehicle at any time when it is being used to provide services

Name Date Signature

Interview Pack May 21

 Stop & Search Policy
Please read the following carefully and sign and date to confirm that you understand and agree. This policy applies to all and anyone working
at or visiting Amazon's sites.
Amazon reserves the right to search you and/or any of your property on its premises (this includes Amazon's car parks) and you agree that
Amazon may search you/and or your property:
• at any time, if Amazon honestly and reasonably believes or suspects that you may be in possession of, have destroyed, tampered with,
concealed or handled stolen goods or has evidence of any theft or attempted theft; or
• if it reasonably believes or suspects that you may have drugs and or alcohol and/or other inappropriate items in the workplace; or
• as part of its random searching policy; or when you enter or leave Amazon's premises.
Issued badges must be worn and displayed at all times onsite. Failure to comply with this may result in restricting your access to Amazon building.

Name Date Signature

Luigi Burtila 01.08.2023

UK Security Swipe Card and GPS Requirements

Our customer, Amazon.co.uk Limited ("Amazon"_) would like to issue all independent drivers with:
• a security swipe card ("Card"); and
• portable GPS enabled device(s) ("Delivery Device(s)").
As your safety and the safety of Amazon employees is of paramount importance to us we require you to keep this Card on you at all times
when at Amazon's premises (including the Distribution Points) or when performing the delivery services on their behalf.
As you would expect the Card is linked to Amazon's systems which allows them to know if you are in the Distribution Points, what time you
arrive at the Distribution Points to collect the Deliverables and what time you leave the Distribution Points having returned any undelivered
Deliverables and the Delivery Device, The Delivery Device, in addition to showing you your next delivery address and how to get to it, allows
them to see your progress through the designated delivery Planned Route and if Deliverables were successfully delivered.
The information provided by the Card and the Delivery Device is used by Amazon for a wide range of purposes relating to the provision of
the delivery services (from ensuring that Amazon have cleared a building in the event of a fire to keeping their customers informed of the
status of their delivery to verifying our bills to communicating with the emergency services so we and/or Amazon can help them get to you
quickly if you are involved in an accident).
As Amazon are part of the Amazon group, some or all of the information provided by the Card and the Delivery Device may be accessed
through systems that are operated by other companies within their group who are located outside of Europe (e.g. in the United States). The
provider of the Delivery Devices also hosts the system which they use to collate the information from such devices.
The information gathered through the Card is automatically deleted after three months. Other than as required to comply with UK Legislation,
all of the information captured by the Delivery Device is also deleted after three months.
If u lose either item lease immediately contact us and the Amazon Distribution Points manager.

I agree and understand:

I have read the information above or it has been read to me. I have had the opportunity to ask questions and my questions have been answered to m
satisfaction. I consent to the information specified above be in used in the manner and for the purposes specified above,

Name Date Signature

Interview Pack May 21

 Nondisclosure & Data Protection Agreements for Contractors

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:

• The way that we work

• The layout of our premises
• The technology that we use including computers and machinery
• That goods that we stock and the way that they are stored
• The people we work and interact with
• The people and companies who deliver to us and collect from us
• Any details about our customers, including their names, addresses and what they buy Anything to do with
finance
• Anything to do with advertising or marketing plans Anything that you hear
Our Confidential Information is very important to our business. It is vital to us that it does not become known
to other companies. We will take all legal steps necessary to protect our Confidential Information.

You must agree to the following commitments;

1. You will not disclose our Confidential Information to anyone or any company.
2. You will use our Confidential Information to make up your mind about working with-us.
3 You will notify us immediately if you discover that our Confidential Information has been disclosed, however it
happens.
4. All our Confidential Information will remain our property.
5. You will not trade stocks or shares based on our Confidential Information.
6. You will return any materials containing our Confidential Information to us if we ask you to.
7. You also agree that you will not disclose information to us that is confidential to you or anyone else

This is a legal agreement.

If a provision of this agreement is held invalid under any applicable law, such invalidity will not affect any other provision of this agreement
that can be given effect without the invalid provision. Further, all terms and conditions of this agreement will be deemed enforceable to the
fullest extent permissible under applicable law, and, when necessary, the court is requested to reform any and all terms or conditions to
give them such effect.
Amazon.co.uk is relying upon your promise to comply strictly with this agreement. Any violation of this agreement may cause substantial
and irreparable harm to Amazon.co.uk. Accordingly, without limiting any other available remedies, this agreement is specifically enforceable
by Amazon.co.uk.
Any failure by Amazon.co.uk to enforce your strict performance of any provision of this agreement will not constitute a waiver of
Amazon.co.uk's right to subsequently enforce such provision or any other provision of this agreement.

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

Luigi Burtila 01.08.2023

Interview Pack May 21

 DBS Background Check Repayment

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.

Name Date Signature

Luigi Burtila 01.08.2023

Interview Pack May 21

Interview Pack May 21
Interview Pack May 21
Interview Pack May 21
Drug & Alcohol testing policy
1. General principle
Deva Services Ltd continually strives to conduct our business activities in a way which will achieve the highest
possible standard of health and safety for our employees, contractors, clients and members of the public. As the
core of our business is based around road based transport we recognise that we can contribute to a safe, healthy
and productive work environment by adopting a zero tolerance policy on the use of alcohol & illegal drugs in the
workplace, preventing drug and alcohol problems, by raising awareness, by identifying problems at the earliest
stage and by offering support to those who have a problem.

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.

2. Who is covered by this policy?

This policy applies to all of our employees as well as subcontractors (including agency and self-employed),
consultants and employees of other organisations when working on our sites and premises or the sites and
premises of our clients on our behalf.

3. Employee/Contractor On-Boarding Screening

Before any individual may supply or render any services to Deva Services Ltd in any context either as employee,
subcontractor or personnel of a subcontractor a Drug & Alcohol screening test must be performed, and a negative
sample provided.

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.

Interview Pack May 21

DRUG AND ALCOHOL TESTING CONSENT FORM
I hereby agree, upon a request made under the drug/alcohol testing policy of Deva Services Ltd, to submit to a drug or alcohol
test and to furnish a sample of my urine, breath, and/or swab for analysis. I understand and agree that if I at any time refuse to
submit to a drug or alcohol test under SLA agreement, or if I otherwise fail to cooperate with the testing procedures, I will be
subject to immediate termination. I further authorise and give full permission to have the Company Alere Toxicology send the
specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under
the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Deva
Services Ltd and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally,
I authorise Deva Services Ltd to disclose any documentation relating to such test to any governmental entity involved in a legal
proceeding or investigation connected with the test.

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

Interview Pack May 21

 Self Employed Contractor
European Driving License Disclaimer

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.

I confirm that I am in the process of changing my license to a valid UK version.

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.

I agree to allow Deva Services to keep a copy of this declaration on file.

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.............................................................

Verification code ……………………………………………………….

Interview Pack May 21

 Luigi Burtila 06 04 1998

11 05 2016

01.08.2023

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Interview Pack May 21