Parking Permit Application Form

Parking Permit Application
Employer
What is the name of your employer?*
Please select the name of the organisation that employs you. For example, if you are employed by another organisation but working here on a contract, please do not select UHS. Instead, select the organisation that directly employs you. Only choose UHS if you have a UHS assignment number.
Employer Name*

Your Details
Title
Name*

First NameLast Name
UHS Assignment Number *
If not applicable, please enter 9999
Employee Number (non UHS)
Pay Grade
Job Title*
Contact Telephone Number*
Mobile
Optional
Work Email (please enter twice)*

Confirmation Emailexample@uhs.nhs.uk. If you do not have a UHS email address, please use your organisation’s email or a personal email address
Alternative Email (please enter twice)

Confirmation EmailOptional

Are you a returning member of staff?*

YesNo
Old permit number (if known)
Are you a disabled blue badge holder?*

YesNo
Are you applying for a permit at SGH/PAH or RSH?*

SGH/PAHRSH
The post code you usually commute to work from*
Do not put a space into your post code

Eligibility Question (1)
Are you required to leave the main hospital site between 7am and 9pm using your own car to carry out your duties at UHS?*

YesNo
On average, what percentage of your working days are you required to leave the main hospital site between 7am and 9pm using your own car to carry out your duties at UHS ?*

Less than 20%20%-39%40%-59%60% to 100%

Eligibility Question (2)
Are you rostered to work a 12 hour shift to carry out your duties at UHS?

YesNo
On average, what is the percentage of your working days are you rostered to work a 12 hour shift to carry out your duties at UHS?*

Less than 20%20%-39%40%-59%60% to 100%

Eligibility Question (3)
Are you ever rostered to start work before 7am or finish work after 9pm to carry out your duties at UHS?

YesNo
On average, what percentage of your working days are you rostered to start work before 7am or finish work after 9pm to carry out your duties at UHS ?*

Less than 20%20%-39%40%-59%60% to 100%

Your Vehicles
Vehicle 1 - Make*
Vehicle 1 - Model*
Vehicle 1 - Registration Number*
Vehicle 2 - Make
Vehicle 2 - Model
Vehicle 2 - Registration Number
Proof of Ownership (optional)

Browse Files
Please upload a copy of your V5 form proving ownership of the vehicles. You may be asked to bring a copy of your V5 to the Car Parking office. Cancelof

6 Declaration
Is there any other relevant information you would like to include in your application?

0/250
*

I consent that my data can be used for the purpose of car parking permit eligibility
*

I confirm that the information given in this form is to the best of my knowlege true, complete and accurate.
Your application will need to be approved by your manager prior to processing. Please enter their email address:*
Your manager will receive a copy of your application which will need to be approved by forwarding a copy from their email address to permitapplications@uhs.nhs.uk

	Number of Days worked
Number of days you leave main site		1	2	3	4	5
	1	100%	50%	33%	25	20%
	2		100%	67%	50%	40%
	3			100%	75%	60%
	4				100%	80%
	5					100%

	Number of Days worked
Number of days you work 12 hrs shifts		1	2	3	4	5
	1	100%	50%	33%	25	20%
	2		100%	67%	50%	40%
	3			100%	75%	60%
	4				100%	80%
	5					100%

	Number of Days worked
Number of day s starting before 7am or finish after 9pm		1	2	3	4	5
	1	100%	50%	33%	25	20%
	2		100%	67%	50%	40%
	3			100%	75%	60%
	4				100%	80%
	5					100%

Parking Permit Application