Download Form 3 - London Stansted Airport

Form 3 – Stored ID Pass Form
This form can only be used with prior authorisation from the ID Centre. This form should be used for reactivating a
‘stored’ ID pass. A pass will be deemed to be ‘stored’ when an employee no longer has an operational need for it, but
may require it again at a later date which is before the expiry of the pass; e.g. seasonally retained cabin crew, student
holiday workers or employees on unpaid/sabbatical/ zero hours contracts, etc.
To knowingly give false information in connection with this ID pass by the Authorised Signatory, trained interviewer, pass applicant or anyone
providing references for the pass applicant is an offence under the Aviation Security Act 1982, as amended by the Aviation and Maritime Security
Act 1990.
Section 1: Applicant’s Information
Company prefix:
ID number:
Surname:
Forenames:
Applicant’s Declaration
Data Protection Act 1998: The information provided on this application form is required by London Stansted Airport in order to meet the
requirements of the Aviation Security Act 1982, as amended by the Aviation and Maritime Security Act 1990, and government directions. The
information provided 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, travel to work opportunities, and you may
be contacted at your home address for that purpose.
Applicant: Please sign this application form below in order to confirm the following:
1. I confirm tha the information containied in this application form is complete and accurate.
2. I agree to abide by thw terms and conditions of 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 bye-laws, Director’s Notices and security instructions may eresult in disciplinary
action or withdrawal of my ID pass.
3. I declare that I have no disqualifying criminal convictions other than that are treated as spent, undewr the Rehabilitation of Offenders Act,
1974.
Signed
Date

Form 3 – Stored ID Pass Form
Section 2: Reference Details (Please continue on a reference details continuation sheet (Form 2) if needed.)
Please list ALL references in chronological order (most recent first)
Date operational pass to be reinstated from:
DD MM YY
Please note: There must be a date entered to allow the pass to be reactivated. References are required, in accordance with the usual referencing
guuidelines (inc the 28 day rule), from when the employee returned thier passto the company to be stored and the date entered for reactivation.
Name of referee 1:
Occupation:
Company name:
Address:
Period reference covers:
Date from: Date to: For office use only
DD/MM/YY DD/MM/YY
Email address:
Daytime telephone
number:
Date of reference:
Type of reference:
(Employment/Gap/
Personal/Educational)
Fax no:
Mobile:
Date received:
DD/MM/YY
Name of referee 2:
Occupation:
Company name:
Address:
Period reference covers:
Date from: Date to: For office use only
DD/MM/YY DD/MM/YY
Email address:
Daytime telephone
number:
Date of reference:
Type of reference:
(Employment/Gap/
Personal/Educational)
Fax no:
Mobile:
Date received:
DD/MM/YY

Form 3 – Stored ID Pass Form
Section 3: Applicant’s Declaration (To be completed by the applicant at the time of the security interview)
1 I declare that I have no disqualifying criminal
convictions other than any that are treated as spent,
under the Rehabilitation of Offenders Act 1974, and
those declared to my employer.
2 I understand that any misrepresentation of the facts is a
ground for refusal of issue, or withdrawal of an ID Pass,
and may result in criminal charges being brought.
3 I agree that my employer and the ID Centre staff, may
approach my former employers, education
establishments, government agencies and personal
referees to verify the information provided.
4 I confirm I have the right to reside and work in the
United Kingdom.
Applicant’s Details
Name (please
print)
Signature
Date
Section 4: Access Requirements – please indicate requirements by circling the appropriate box
Does the applicant require the same access as previously? Yes No
If no, please complete the access requirements page on Form 4.
Authorised Signatory’s Declaration
(To be signed by the Authorised Signatory after the application form has been fully completed).
I, the undersigned, confirm that the individual named is a suitable person to be issued with an ID pass to work unescorted in the
security restricted areas, airside areas and/or landside areas of a Stansted Airport. I understand that all supporting documentation
regarding the issue of an ID pass must be retained and is subject to Stansted Airport or Department for Transport audit. I
understand that Stansted Airport have 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. 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.
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.
Authorised signature:
Authorised signatories name:
Company name:
Contact telephone number:
Date

Form 3 – Stored ID Pass Form