Get documents about "Application form drivers licence renewal
Document Sample
RENEWAL
BOROUGH OF TAMWORTH
Licensing, Public Protection, Assets & Environment
Application for Hackney Carriage and Private Hire Drivers License
PLEASE COMPLETE ALL OF THIS FORM IN BLOCK CAPITALS WITH
THE EXCEPTION OF THE SIGNATURES
In accordance with the provisions of the Local Government (Miscellaneous Provisions) Act 1976 and the Town
Police Clauses Act 1847
I (Full Name) ---------------------------------------------------------------------------------------------------------------
of (address) ---------------------------------------------------------------------------------------------------------------
Telephone Number --------------------------------------------------------------------------------------------------------------
hereby make application for a license to drive a Hackney Carriage Vehicle or Private Hire Vehicle operating
within the area of the Tamworth Borough Council.
THIS APPLICATION MUST BE PRESENTED IN PERSON BETWEEN THE HOURS
OF 09.00 AM AND 12.00 PM (NOON) MONDAY TO FRIDAY
(PLEASE NOTE POSTAL APPLICATIONS WILL NOT BE ACCEPTED)
YOUR APPLICATION CANNOT BE ACCEPTED UNLESS IT IS
ACCOMPANIED BY THE APPROPRIATE FEE AND SUPPORTING
DOCUMENTATION AS DETAILED IN THE APPLICANTS
GUIDANCE
When submitting an application for a license to drive a hackney carriage or private hire
vehicle all criminal convictions must be disclosed whether spent or otherwise in accordance
with Rehabilitation of Offenders Act 1974 (exemption) Order.
The information you give will be treated in confidence and will only be taken into account in
relation to your application.
You should be aware that the licensing authority is empowered in law to check with the
police for the existence and content of any criminal record held in the name of an applicant.
Information received from the Police will be kept in strict confidence and will be retained for
no longer than is necessary.
The disclosure of a criminal record or other information will not debar you from gaining a
license unless the authority considers that the conviction renders you unsuitable. In making
the decision the authority will consider the nature of the offence, how long ago and what
age you were when it was committed and any other factors which may be relevant. Any
applicant refused a drivers license has a right to appeal to a Magistrates Court.
If you would like to discuss your application you may telephone 01827 709445 or 01827
709674 for advice.
1
PART A - TO BE COMPLETED BY APPLICANT
1. NAME AND ADDRESS OF VEHICLE PROPRIETOR FOR WHOM YOU WILL DRIVE:
-------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------TEL NO:---------------------------
2. NAME OF RADIO CIRCUIT COMPANY OPERATING VEHICLE (if any): --------------------
-------------------------------------------------------------------------------------------------------------------------
3. HAVE YOU EVER BEEN CONVICTED OF ANY MOTORING OFFENCE(S): YES/NO
IF YES GIVE DETAILS
NATURE OF DATE OF COURT PENALTY
OFFENCE OFFENCE PUNISHMENT POINTS
NOTE: A COMPLETE AND FULL DECLARATION OF ALL PAST MOTORING OFFENCES MUST BE MADE
BUT SUCH INFORMATION WILL BE TREATED IN STRICT CONFIDENCE AND WILL NOT
NECESSARILY PREJUDICE THE GRANTING OF A LICENSE.
4. ARE THERE ANY CRIMINAL OR MOTORING PROSECUTIONS PENDING AGAINST YOU:
If YES please state: YES/NO
a) Alleged Offence: --------------------------------------------------------------------------------
b) Date and Place of Hearing: ------------------------------------------------------------------
(note - Applicant to declare all convictions under the Rehabilitation of
Offenders Act 1974 (exemption) Order, whether spent or otherwise)
5. HAVE YOU EVER BEEN REFUSED A LICENSE OR HAS A LICENSE BEEN
REVOKED BY THIS OR ANY OTHER AUTHORITY: YES/NO
If YES Supply details of such refusal or revocation:
Local Authority Name: --------------------------------------------------------------------------------------
Date of Refusal/Revocation: ------------------------------------------------------------------------------
Reason for Refusal/Revocation: -------------------------------------------------------------------------
6. NATIONAL INSURANCE NUMBER: -------------------------------------------------------------------
7. DRIVING LICENSE NUMBER: ---------------------------------------------------------------------------
NOTE: The Driving License must be produced for inspection when submitting the
application. SEE NOTE 2
8. IS DRIVING A HACKNEY CARRIAGE OR PRIVATE HIRE VEHICLE TO BE YOUR ONLY
EMPLOYMENT:
IF NO STATE YES/NO
a) Name of other employer ----------------------------------------------------------------------------
2
b) Address --------------------------------------------------------------------------------------------------
c) Nature of other employment ------------------------------------------------------------------------
PART B
AUTHENTICATION OF APPLICATION BY PROPRIETOR/OPERATOR
I HEREBY CERTIFY THAT I HAVE EXAMINED THE ABOVE APPLICATION AND THAT TO THE BEST OF
MY KNOWLEDGE AND BELIEF THE DETAILS OF THE APPLICATION ARE CORRECT.
Signed ---------------------------------------------------------- VEHICLE PROPRIETOR
DECLARATION OF APPLICANT
I THE UNDERSIGNED CERTIFY THAT I AM AT THIS DATE, AND HAVE BEEN FOR THE PREVIOUS
TWELVE MONTHS, THE HOLDER OF A LICENSE (NOT BEING A PROVISIONAL LICENSE) GRANTED
UNDER PART III OF THE ROAD TRAFFIC ACT 1972 AUTHORISING ME TO DRIVE A MOTOR CAR AND
THAT THE DETAILS I HAVE RECORDED ON THIS APPLICATION ARE CORRECT TO THE BEST OF MY
KNOWLEDGE AND BELIEF AND I UNDERSTAND THAT, IF I HAVE OMITTED ANY MATERIAL
PARTICULAR OR KNOWINGLY STATED ANYTHING THAT IS UNTRUE THE LICENSE I MAY HAVE BEEN
GRANTED MAY BE REVOKED AND I MAY BE SUBJECT TO LEGAL PROCEEDINGS FOR OBTAINING OR
ATTEMPTING TO OBTAIN A LICENSE BY DECEPTION:
I AFFIRM THAT I AM AWARE THAT THE COUNCIL WILL MAKE ENQUIRIES WITH THE DRIVER AND
VEHICLE LICENSING AGENCY (DVLA) REGARDING THE STATUS OF MY DRIVING LICENSE RECORD
AND I GIVE CONSENT FOR THESE ENQUIRIES TO BE MADE.
Signed ---------------------------------------------------------------------------------------------------------------------------
Dated ---------------------------------------------------------------------------------------------------------------------------
Tamworth Borough Council is the data controller of this information. The
information is collected on this form will only be used to assess this application and
for no other purposes. The information collected on this form may be disclosed to
Inland Revenue, in order to verify the information provided so to ensure the
protection of public funds. Under the Data Protection Act you have the right to see
your information for a set fee. For further information contact the Information
Officer on 01827 709570.
3
PART D
BOROUGH OF TAMWORTH
Licensing, Public Protection, Assets & Environment
Application for Hackney Carriage and Private Hire Drivers Licence
Medical Questionnaire
4
PLEASE COMPLETE ALL OF THIS FORM IN BLOCK CAPITALS
1. NAME OF APPLICANT: -------------------------------------------------------------------------------
2. DATE OF BIRTH: --------------------------------------------------------------------------------------
3. NAME AND ADDRESS OF YOUR DOCTOR: ---------------------------------------------------
4. HAVE YOU EVER HAD:
a. Any Heart Condition YES/NO
b. Any Epileptic Attack, Stroke, or Loss of Consciousness YES/NO
c. A Problem with Alcoholism or Drug Addiction YES/NO
d. Any Mental Health Issues YES/NO
5. EYESIGHT - DO YOU HAVE:
a. A good standard of sight in both eyes YES/NO
b. Loss of sight in One Eye, Tunnel Vision, or any other impairment of vision
YES/NO
6. HAVE YOU OR ARE YOU BEING TREATED FOR:
a. Angina YES/NO
b. Diabetes YES/NO
c. Mental or Nervous Disorder YES/NO
7. IF YOU ANSWERED YES TO QUESTION 4, 5 OR 6 OR IF YOU HAVE ANY OTHER
MEDICAL CONDITION AFFECTING YOUR DRIVING, PLEASE GIVE PARTICULARS
HERE:
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
8. ARE YOU CURRENTLY TAKING MEDICATION PRESCRIBED BY A DOCTOR: YES/NO
If YES write name of medication --------------------------------------------------------------------
9. DO YOU CONFIRM THAT YOU WILL NOTIFY THE COUNCIL OF ANY DISABILITIES
THAT MAY ARISE IN FUTURE AFFECTING YOUR ABILITY TO PERFORM YOUR
DUTIES AS A HACKNEY CARRIAGE AND PRIVATE HIRE DRIVER: YES/NO
10. DO YOU GIVE YOUR CONSENT FOR THE COUNCIL’S MEDICAL ADVISER TO
CONSULT YOUR DOCTOR, IF NECESSARY, ON THIS APPLICATION OR ANY
SUBSEQUENT RENEWAL APPLICATION: YES/NO
BOROUGH OF TAMWORTH
5
Licensing, Public Protection, Assets & Environment
Application for Hackney Carriage and Private Hire Drivers License
Medical Questionnaire
FOR OFFICIAL USE ONLY
I CERTIFY THAT ON _________________________________________ I CARRIED OUT
AN EXAMINATION OF THE APPLICANT AND I AM/AM NOT SATISFIED THAT HE/SHE
IS MEDICALLY FIT TO CARRY OUT THE DUTIES OF A HACKNEY CARRIAGE AND
PRIVATE HIRE VEHICLE DRIVER
Signed ------------------------------------------------------------------------
Official Stamp
Medical Practitioner
FOR OFFICIAL USE ONLY
APPLICATION
6
DATE OF RECEIPT OF APPLICATION
AMOUNT OF FEE PAID
RECEIPT NUMBER
DRIVING LICENSE
ISSUE NUMBER
LICENSE NUMBER
REFERENCE NUMBER
IF ANY CONVICTIONS – COPY LICENSE
OR CHECKED AND COPIED
MEDICAL
DATE: TIME: DOCTOR:
DATE POLICEPOLICE MEDICAL
MEDICAL DVLA KNOWLEDGE
K/LEDGE
FORM SENT
FORM RET'D
CHECKED
LICENSE
LICENSE NUMBER DATE OF ISSUE
PLEASE DETACH & KEEP FOR FUTURE REFERENCE
NOTE 1 - CRIMINAL CONVICTIONS
- Rehabilitation of Offenders Act 1974
All criminal convictions must be disclosed whether spent or otherwise in accordance with Rehabilitation of
Offenders Act 1974 (exemption) Order.
NOTE 2 - DRIVING LICENSES
7
Before an application is submitted you must ensure that the driving license is up to date and that in particular:
a. Your current address is recorded on the driving license.
b. Any current motoring convictions/endorsements have been recorded on the license by the
DVLC, Swansea.
NOTE 3 - MEDICALS
It is a condition of the license that licensees under 45 years of age will be required to undergo a medical
examination at five year intervals. Licensees from 45 years to 65 years of age will require medicals at 3 year
intervals and licensees over 65 years will be medically examined annually.
NOTE 4 - COMPETENCE TEST (Initial Application or Renewal after lapse of 3 years or more)
You will be required at a date and time to be arranged, to attend for assessment of your competence and
knowledge of the district. Details of which are overleaf.
8
TAMWORTH BOROUGH COUNCIL
HACKNEY CARRIAGE AND PRIVATE HIRE DRIVER
ESSENTIAL KNOWLEDGE REQUIREMENTS
Abbey Road Moor Street,The Leys
Albert Road Ninian Way
Aldergate Offadrive
Amington Road Overwoods Road
Apollo Park Farm Road
Argyle Street Peelers Way
Ashby Road Pennine Way
Birds Bush Road Pennymoor Road
Blackwood Road Perrycrofts Crescent
Bolebridge Street Riverdrive
Bonehill Road Salters Lane
Brindley Drive Sandy Way
Browns Lane Saxondrive
Buckingham Road Sheepcote Lane
Campion Drive Shuttington Road
Chiltern Road Silver Link Road
Church Street Spinning School Lane
Claremont Road Tamar Road
Colehill Tamedrive
Comberford Road Tamworth Rd (Amington)
Coton Lane Tamworth Rd (Dosthill)
Cottage Farm Road Tamworth Rd (K'brook)
County Drive Thackeray Drive
Crowden Road Thomas Guy Way
Dosthill Road Tinkers Green Road
Fazeley Road Tom Williams Way
Field Farm Road Torside
Fontenaye Road Upper Gungate
Fossdale Road Vangard
George Street Ventura Park Road
Gillway Lane Victoria Road
Glascote Road Watling Street
Hedging Lane Wigginton Road
High Street (Dosthill) Wilnecote Lane
Hockley Road Woodland Road
Holloway
Kerria Road Amington Industrial Estate
Kettlebrook Road Beauchamp Park Industrial Estate
Leyland Road
Lichfield Road Lichfield Rd Industrial Estate
Lichfield Street Tame Valley Industrial Estate
Lower Gungate Two Gates Trading Estate
Malham Road
Mariner Sir Robert Peel Hospital
Market Street Rawlett School
Marlborough Way Tamworth College
Tamworth Police Station
Masefield Drive Tamworth Railway Station
Mercian Way Magistrates Court
Wilnecote Rail Station
Assembly Rooms
Casa
Kube
Trinity
Snowdome
Peaks Leisure Centre
Tamworth Town FC
YOU MAY BE ASKED TO DESCRIBE HOW TO GET TO 3 OR MORE OF THESE ROADS OR LOCATIONS
BY THE SHORTEST AVAILABLE ROUTE, AND WILL BE ASKED TO DESCRIBE THE LOCATION OF
APPROXIMATELY 20 OF THE ABOVE LISTED ROADS AND LOCATIONS.
9
THOSE WHO ARE ABLE TO SHOW THE CORRECT KNOWLEDGE OF 80% OR MORE OF THE ABOVE,
WILL BE CONSIDERED TO HAVE SUFFICIENT KNOWLEDGE OF THE DISTRICT.
10
Related docs
Other docs by HC12110614845
A police helicopter and several police officers were dispatched to the scene
Views: 0 | Downloads: 0
