South Tees Staff Car Parking

Application for James Cook University Hospital (existing member of the car parking scheme)

2017 Renewal Form

Employer

South Tees Hospitals NHS Foundation TrustCarillion PLC

Lead Employer Trust (Deanery)Student

Other (please specify)……………………………………………………………………………………………..

Your Details

Name______Payroll Number ______

Address______

______

Postcode______

Number of hours worked per week ______Pay Band (payroll deductions)______

Contact telephone / bleep number______

Email address______

Your place of work

Ward/Department______Centre______

Do you use a blue badge when parking on site? YesNo

There are two options for car parking deductions normal payroll deductions or deductions via SMART a salary sacrifice scheme. Please read notes overleaf for information on the SMART parking deductions.

Please deduct car parking charges via the normal car parking deductions, I sign to agree and abide by the terms and conditions set out in the car parking scheme overleaf, without SMART benefits

Signed______Dated______

Please deduct car parking charges via the Salary sacrifice scheme (SMART), by signing below I agree to the variation in terms and conditions of your employment described in the Terms and conditions and I agree to abide by the conditions of the WITH SMART Benefits arrangement. I hereby authorise the Trust to reduce my salary accordingly and in the event of leaving the Trust to adjust any excess or outstanding car parking permits form my net final salary. I also agree to the Terms and Conditions of the car parking scheme overleaf.

Signed______Dated______

Car details

Registration______Make______

Registration______Make______

OFFICE USE ONLY

Permit number ______Date sent to payroll______

Receipt number______£______Expiry date______

Inputted by______Prissick access Given______

TERMS AND CONDITIONS OF THE JAMES COOK UNIVERSITY HOSPITALS CAR PARKING SCHEME

  1. I agree to pay the car parking charges as set out by the Trust, and to have the payment deducted from my salary or to pay the fee set out for cash payers.
  2. I agree if I lose my permit I will pay a £10 replacement charge.
  3. I agree that a £10.00 deposit is required for the barrier access fob and a replacement fee will apply if this fob is lost/stolen.
  4. I agree that if I register two cars into the scheme I will transfer the permit to the car I am bringing onto site.
  5. I agree to only park in designated car parks for staff, and will not park in the Visitor’s car park.
  6. I agree to park in a designated car parking space, displaying my permit and not on yellow or red lines, if I am found to be parkingincorrectlyI understand I may be subject to a £25 parking charge notice.
  7. I understand that because I am a member of the car parking scheme I will not be guaranteed a car parking space.
  8. The Trust will not be liable for any damage to cars that are brought onto site; I agree that my vehicle(s) are brought onto site at my own risk.
  9. I agree to move my car if instructed by the Security Department or the Travel Link Department.
  10. I agree to display my car parking permit/sticker at all times when I am on site.
  11. I agree that I will advise the Travel Link Department know of any changes in details, work, personal and car details.
  12. I agree that when I leave my employment with the Trust I will return my car parking permit and any barrier access fob, I understand that the day I return my permit and barrier fob my payments will be suspended.
  13. If payments cannot be taken from my salary, I agree to pay the relevant charge and re-new my permit if necessary before the expiry date.
  14. I understand South Tees Hospitals NHS Foundation Trust is a no smoking site, and agree to comply with the policy and not to smoke in my vehicle when I am on any Trust premises.
  15. I understand that not complying with the Terms and Conditions set out in the car parking scheme could result in my Centre Manager being informed and disciplinary action could be taken against me.
  16. I understand that my car parking permit must not be handed to anyone else as my permit is registered to my name while working on site.

Car Sharing (as well as the above)

  1. I understand to be eligible for car sharing; the two people car sharing cannot live at the same address.
  2. I understand that the two staff members must already be in the car parking scheme & be able to surrender two different permits for one new car sharing permit.
  3. I understand that we must actively car share as much as possible (preferably 4 out 5 days- Full time, 3 out of 4 days or 2 out of 3 days- Part time).