Transcript
Page 1: Application for a taxi driver licence in the ACT · PDF fileApplication for a Taxi Driver Licence in the ACT ... Republic of Ireland, ... Application for a taxi driver licence in the

Application for a Taxi Driver Licence in the ACT

Road Transport Regulation | Access Canberra PO Box 582 Dickson ACT 2602 | phone: 13 22 81 | www.act.gov.au/accessCBR

Eligibility requirements • You must be a permanent Australian resident or have a visa that allows you to

work in Australia. • You must hold a full Australian driver licence.

Forms you will need The following forms are included in your application package:

• Upgrade of Driver Licence Application. • Commercial Driver’s Health Assessment. • Police Character Check. • Authorisation to Release Public Passenger Driver Licence and Accreditation Status.

You must also provide evidence of your resident status. Evidence of resident status may be provided as:

• An Australian Birth Certificate issued by Births, Deaths and Marriages (not commemorative);

• An Australian Passport; • A Department of Immigration and Border Protection (DIBP) Certificate of Evidence

of Resident Status; or • A work or student visa that allows the holder to work in Australia.

Further information for applicants Interstate applicants should note a 5 year driver Licence History is required and if they do not hold an ACT driver licence but consider that they may be eligible to hold one, they should contact Access Canberra at www.act.gov.au/accessCBR or phone 13 22 81 to obtain information regarding the requirements for obtaining a driver licence. It should also be noted that a Public Vehicle licence endorsement may not be approved where an applicant has, within the last five (5) years:

• Been convicted of a disqualifying offence as defined in section 15 (1) of the Road Transport (Driver Licensing) Regulations 2000; or

• Been disqualified from holding or obtaining an Australian driver licence under the law of any jurisdiction; or

• Has had his or her driver licence suspended under the law of any jurisdiction other than for the non-payment of an infringement notice penalty (fine default).

Applicants who find themselves in any of the above circumstances should contact Road User Services for advice before proceeding with a taxi driver licence application.

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Application process You will need to read and comply with all the requirements on this page before you attend the Licence and Registration Unit at the Dickson Motor Vehicle Registry

Commercial Driver’s Health Assessment Applicants will need to undergo a comprehensive medical examination with their General Practitioner (GP). The medical report section of the Commercial Driver’s Health Assessment form will be completed by the GP and returned to the applicant.

If you are confirmed medically fit to drive a public vehicle, return this form along with your completed application package to the Licence Registration unit on Level 2 at Dickson Motor Vehicle Registry.

Police character check On completion of the relevant details in the Police Character Check form, applicants are required to lodge the form with the Licence Registration Unit at the Dickson Motor Registry and pay the prescribed fee or forward it with the appropriate fee to the postal address on the form (PO Box 582, Dickson ACT 2602). A response usually takes 4 to 6 weeks. Applicants will be informed of the results of the Police Character Check by letter.

Language skills assessment An International Second Language Proficiency Rating (ISLPR) to National Standards assessment may be conducted through CIT and they can be contacted on 6207 4800. A passed Certificate from an approved course provider may also be accepted meeting minimum scores for English Test Components. These are the International English Language Test (IELTS) www.ielts.org or Test of English as a Foreign Language (TOEFL iBT) www.ets.org/toefl. On completion of the Language skills assessment, applicants are required to lodge the completed assessment form with the Licence Registration Unit at the Dickson Motor Registry. Please note if you are a Citizen, or a passport holder from any of the following countries you are exempt from the English Language course, Australia, Canada, New Zealand, Republic of Ireland, United Kingdom and the USA.

Adding a ‘T’ Condition to the licence Applicants will need to have their application assessed through the Licence and Registration Unit at the Dickson Motor Vehicle Registry. To have your application assessed you will need to provide the following:

• Letter of confirmation of approved Police Character Check; • Completed and passed Commercial Driver’s Health Assessment form; • Completed Upgrade of Driver Licence form; • Completed Language skills Assessment certificate; • Authorisation to Release Public Passenger Driver Licence and Accreditation Status;

You must also provide evidence of your resident status. Evidence of resident status may be provided as:

• An Australian Birth Certificate issued by Births, Deaths and Marriages (not commemorative);

• An Australian Passport;

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• A Department of Immigration and Border Protection (DIBP) Certificate of Evidence of Resident Status; or

• A work or student visa that allows the holder to work in Australia.

Application submission options Email certified copies of the original documents to: [email protected] Post certified copies of original documents to: Manager Licence Registration Unit PO Box 582 Dickson ACT 2602 Once you have received written confirmation of approval of your application you can attend an Access Canberra Shopfront at Civic, Belconnen, Dickson, Gungahlin, Tuggeranong or Woden to have your licence upgraded. The counter officer will need to sight your approval letter and your ACT Driver Licence or full proof of identity.

Further information If you have any queries please contact the Licence Registration Unit on 6207 7063 or at [email protected].

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Privacy Statement: The information on this form is being collected for driver licensing purposes. The information may be used for the administration of driver licensing and vehicle registration legislation and enforcement. The information may be disclosed to Commonwealth, Territory or State law enforcement agencies; transport authorities; government agencies authorised by law; Compulsory Third Party Insurers; and individuals, their agents or insurers following a report provided to the police of a motor vehicle accident. The Road Transport Authority is authorised to retain a digital copy of your photograph and signature under Part 4 of the Road Transport (Driver Licensing) Act 1999. Retained images may be used to assist in addressing identity fraud and disclosed to law enforcement and court agencies, interstate road authorities, or when authorised by law. The Information Privacy Act 2014 prevents the ACT Government from using your information and retained images for any unauthorised purpose and require it to implement safeguards to protect the information and retained images from unauthorised access.

10,029 (07/2016)

Application for Upgrade of Driver Licence

Licence details

National Heavy Vehicle Drivers licence applicants only

Driver licence number Class Date first issued State/Territory/Country of issue Staff verification

Important Information • Applicants for a public vehicle licence are required to undergo a Commercial Drivers Health Assessment, and a Police Character Check.• Where a Public Vehicle Licence is issued, a Public Vehicle Driver Authority Card will also be issued to the licence expiry date.• Applicants for a ‘T’ or ‘H’ licence are required to undertake a driving assessment with their industry provider.• If the applicant for an ‘O’ licence is to remain within their current licence class (e.g. C, LR, MR, HR, HC, MC) the applicant will be exempt from

the practical driving assessment.

Eye colourPlace of birth Height

I wish to apply for a (please tick appropriate box)LR Light rigid vehicle licence MR Medium rigid vehicle licence HR Heavy rigid licenceHC Heavy combination vehicle licence MC Multi-combination vehicle licence H Hire CarM Hire Car Motorcycle W Restricted Hire Car O Public BusT Taxi D Rideshare

Personal details

Residential address

Other namesSurname Given name

Date of birth Business hours phone number E-mail address

Declaration

Signature of applicant Date

Consent: I provide consent for the Road Transport Authority (RTA) to confirm my visa status with the Department of Immigration and Border Protection. I understand that this consent, once signed, is effective for the entire period in which I hold an ACT Driver Licence and may be used periodically by the RTA.

I understand that in consideration of the Australian Capital Territory permitting me to undertake the Practical Driving Assessment (the test) the Australian Capital Territory accepts no liability for injury sustained including any injury sustained as a result of or arising out of negligence of the Australian Capital Territory, its officers, servants and agents in the course of undergoing the test.I declare that I am able to read, write and speak the English language. I declare that I am entitled to work in Australia as either a permanent resident or temporary resident with a visa that entitles me to work in Australia.

Office use onlyVisual Acuity

Both Right Left

Was eye test conducted with corrective lenses?

Yes No6/6/6/

Road Transport Authority | PO Box 582 Dickson ACT 2602 | Phone: 13 22 81

For full requirements on upgrading your licence please visit www.act.gov.au/accessCBR or phone 13 22 81.

Class/Condition Minimum age Minimum tenureLR or MR 18 years of age 12 months C class driving experience.

HR 19 years of age 24 months C class driving experience.HC 19 years of age 12 months MR or HR class driving experience.MC 20 years of age 12 months HR or HC class driving experience.‘O’ N/A Full Australian C or higher class licence for a for at least 1 year (or for periods totalling 1 year) in the last 3 years.‘M’ N/A Full Australian R or higher class licence.

‘H’, ‘W’, ‘D’ or ‘T’ N/A Full Australian C or higher class licence.

Upgrade of driver licence information

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CONFIDENTIAL

The doctor may extend the examination where considered clinically appropriate, but must advise the applicant of any extra costs involved.

Payment for the medical examination is the responsibility of the licence holder / applicant.

If this form is not returned by the due date, your Public Vehicle Licence will be suspended.

Commercial Driver’s Health Assessment10,004 (03/2016)

Applicants for an original ‘T’ (Taxi), ‘O’ (Public Bus), ‘H’ (Private Hire Car), ‘W’ (Restricted Hire Car), ‘M’ (Hire Car Motorcycle) or ‘D’ (Rideshare) public vehicle licence are required to undergo an initial medical examination by their General Practitioner (GP) and appropriate specialist prior to the grant of the public vehicle licence. Holders of a ‘T’, ‘O’, ‘H’, ‘W’, ‘M’ or ‘D’ public vehicle licence must thereafter undergo an annual examination by their GP until the age of 70, at which time a practical driving assessment must also be completed at the applicant’s cost. Accredited driving instructors must also undergo an annual examination by a GP.

If the completed Health Assessment is not returned by the due date, the public vehicle licence and public vehicle driver authority will be suspended until the assessment is received. Should you wish to apply for an internal review of this decision, applications for review should be addressed to:

• The Manager, Road User Services, PO Box 582, Dickson ACT 2602.

An application for internal review must be made within 28 days of receiving this form. If you are not satisfiedwiththeoutcomeoftheinternalreview,youhavetherighttoapplytotheACTCivilandAdministrativeTribunal (ACAT) to review the decision of the internal review. An application to the ACAT regarding the subject of this form can only be made following an internal review. Applications to the ACAT must be made within 28 days of the date of the decision of the internal review. Please note that an application fee may apply. Applications should be sent to:

• ACT Civil and Administrative Tribunal, Level 4, Moore St, Canberra ACT 2600. • Phone: (02) 6207 1740.

Forfurtherenquiries,inthefirstinstance,phoneAccessCanberraon132281.

This application concerns: (Please place an X in the corresponding box)

Public Bus Rideshare

Hire Car

Restricted Hire Car

Accredited Driving Instructor

Hire Car Motorcycle

Taxi

Heavy Vehicles over 8t GVM

Guidelines for completing this form

The Examining Doctor Must:

• Read Part A and sections of Part B of the booklet ‘Assessing Fitness to Drive’;

• Review Section 1 with the applicant, and comment on any abnormality;

• Complete Section 2 on page iv and the Medical Examiner’sCertificateon page i;

• Return completed and signed copy of this form to the applicant

The Applicant Must:

• Complete Section 1 on page ii and iii prior to the medical examination;

• Present the completed form to the examining doctor;

• If you wear spectacles, hearing aids etc. please bring them with you to the examination;

• Supply the examining doctor with any relevant documentation.

Forward the completed and signed copy of this form to:

Road User Services, PO Box 582 DICKSON ACT 2602

Mail: [email protected]: (02) 6207 7120Fax:

Road Transport Authority | PO Box 582 Dickson ACT 2602 | Phone: 13 22 81

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Page i

Medical Opinion Action Required

I certify that I have examined the above mentioned patient in accordance with the National Medical Standards as set out in ‘Assessing Fitness to Drive’. In my opinion the person subject of this report:

Meets the relevant medical criteria for an unconditional licence. No further information required.

Examining doctor to obtain required information from specialist and attach report.

Requires appropriate specialist assessment and I have requested and obtained a report as attached.

Examining doctor to clearly note in the box provided:

1) Criteria not met and other relevant medical details

Does not meet the medical criteria for an unconditional or a conditional licence.

Examining doctor to clearly note in the box provided:

1) Criteria not met and other relevant medical details.

2) Proposed restrictions to licence (if appropriate).3) Suggestions for management and periodic review interval (conditional licence).

Does not meet the medical criteria for an unconditional licence but may be suitable for a conditional licence based on opinion below and additional details attached as required.

Examining doctor to clearly note in the box provided,details regarding the medical condition as relevant to the driving task.

Requirespracticaldrivingtestandismedicallyandpsychologicallyfittoundertake a test.

Previously unlicensed or on a conditional licence but condition has now improved so as to meet criteria for a conditional or unconditional licence. No further information required.

Requires occupational therapist assessment and is medically and psychologicallyfittoundertakeanoccupationaltherapistassessment. Examining doctor to clearly note in the box provided,

details regarding the medical condition as relevant to the driving task.

Examining doctor to clearly note in the box provided, details regarding the medical condition as relevant to the driving task.

Requires an assessment by the Fitness to Drive Medical Clinic.

Licence holder / Application details

Medical opinion - medical practitioner to complete

SignatureName of examining doctor (please print or stamp) Date of examination

TelephoneAddress

Medical practitioner details

Residential address

Other names

Business hours contact number

Surname

Date of birth

Given name

Licence number

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Please answer the following questions by ticking the correct box. If you are not sure leave it empty, the Doctor will ask you additional questions during the examination.

1. Are you being treated by a doctor for any illness or injury?

2. Are you receiving any medical treatment or taking any medication?

3. Have you ever had, or been told by a Doctor that you had any of the following?

3.1 High blood pressure

3.2 Heart Disease

3.3 Chest pain / Angina

3.4 Any condition requiring heart surgery

3.5 Palpitations / Irregular heartbeat

3.6 Abnormal shortness of breath

3.7 Head injury, spinal injury

3.8 Seizures,fits,convulsionsorepilepsy

3.9 Blackouts or fainting

3.10 Stroke

3.11 Dizziness, vertigo, problems with balance

3.12 Doublevision,difficultyseeing

3.13 Colour blindness

3.14 Kidney disease

3.15 Diabetes

3.16 Neck, back or limb disorders

3.17 Hearing loss or deafness or had an ear operation or use a hearing aid

3.18 Doyouhavedifficultyhearingpeopleonthetelephone(includinguseofhearingaidifworn)?

3.19 Have you ever had, or been told by a doctor that you had a psychiatric illness, or nervous disorder?

3.20 Have you ever had any other serious injury, illness, operation, or been in hospital for any reason?

4.1 Have you ever had, or been told by a doctor that you had a sleep disorder, sleep apnoea, or narcolepsy?

4.2 Has anyone noticed that your breathing stops or is disrupted by episodes of choking during your sleep?

4.3 How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? (This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently try to work out how they would have affected you).

Page ii

No Yes

Use the following scale to choose the most appropriate number for each situation. It is important that you put a number (0 to 3) in each of the 8 boxes.

0 = would never doze off

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing

Sitting and reading

Watching TV

Section 1 - Applicant to complete

Sitting, inactive in a public place (e.g. a theatre or meeting)

As a passenger in a car for an hour without a break

Lying down to rest in the afternoon when circumstances permit

Sitting and talking to someone

Sitting quietly after a lunch without alcohol

Inacar,whilestoppedforafewminutesinthetraffic

SituationChance of dozing (0 - 3)

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Applicant’s declaration (in presence of health professional)

5.2 How many drinks containing alcohol do you have on a typical day when you are drinking?

5.3 How often do you have six or more drinks on one occasion?

5.4 How often during the last year have you found that you were not able to stop drinking once you had started?

5.5 How often during the last year have you failed to do what was normally expected from you because of drinking?

5.6 Howoftenduringthelastyearhaveyouneededafirstdrinkinthemorningtogetyourselfgoingafteraheavy drinking session?

5.7 How often during the last year have you had a feeling of guilt or remorse after drinking?

5.8 How often during the last year have you been unable to remember what happened the night before because you had been drinking?

5.9 Have you or someone else been injured as a result of your drinking?

5.10 Has a relative or friend or a doctor or other health worker been concerned about your drinking or suggested you cut down?

6. Do you use illicit drugs? No Yes

7. Do you use any drugs or medications not prescribed for you by a Doctor? No Yes 8. Have you been in a vehicle crash since your last licence examination? No Yes

If Yes, please give details:

1 or 2 3 to 5 5 to 6 7 to 9 10 or more

5.1 How often do you have a drink containing alcohol?

Never

Monthly

Two to four times a month

Two to three times a week

Four or more times a week

Never Less than monthly Monthly Weekly Daily or almost daily

Never Less than monthly Monthly Weekly Daily or almost daily

Never Less than monthly Monthly Weekly Daily or almost daily

Never Less than monthly Monthly Weekly Daily or almost daily

Never Less than monthly Monthly Weekly Daily or almost daily

Never Less than monthly Monthly Weekly Daily or almost daily

No Yes, but not in the last year Yes, during the last year

No Yes, but not in the last year Yes, during the last year

Page iii

Privacy Statement: The information sought on this form is to assess your compliance with the required medical standards. The lawful authority for collecting this information is the Road Transport (Driver Licensing) Regulation 2000. The information may be disclosed to Commonwealth, Territory or State law enforcement agencies; transport authorities in those jurisdictions; and government agencies authoried by law. The information may also be disclosed to medical professionals and driving assessors only as is needed to assess your ability to drive safely.

releasing medical information to the Road Transport Authority or a medical practitioner nominated by the Road Transport Authority, in order to assess my medical eligibility for a commercial vehicle driver licence.

I, (Print name in full) certify that to the best of my knowledge

the above information supplied by me is true and correct; and I consent to Doctor

Signature Date

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Page iv

10. Epilepsy Date of last attack / /

8. Neuropsychological Assessment (Where clinically indicated apply the Mini Mental State Questionnaire or General Health Questionnaire or equivalent).

Score

Relevant Clinical Findings

Note commentsonanyrelevantfindingsdetectedinthequestionnaire or examination, making reference to the requirements of the standards outlined in the ‘Assessing Fitness to Drive’ publication.

Is a driving assessment (A) or review (R) required by a medical specialist?

9. Diabetes

Insulin dependent

Tablets

Dietary

Does this affect his or her ability to drive? Yes No

Is a driving assessment or review required by a medical specialist? Yes No

Does this affect his or her ability to drive? Yes No

Note: Please refer to the table contained in ‘Assessing Fitness to Drive’ guidelines (Commercial Standards) on page 49 when assessing people with diabetes for a commercial licence.

Note: Please refer to the table contained in ‘Assessing Fitness to Drive’ guidelines (Commercial Standards) on page 57 whenassessing people with epilepsy for a commercial licence.

(A) Yes No

(R) Yes No

1. Cardiovascular System:

1.1 Blood pressure (repeat if necessary)

Systolic mm Hg mm Hg

Diastolic mm Hg mm Hg

1.2 Pulse Rate Regular Irregular

1.3 Heart Sounds Normal Abnormal

1.4 Peripheral pulses Normal Abnormal

2. Chest / Lungs: Normal Abnormal

3. Abdomen (liver): Normal Abnormal 4. Neurological / Locomotor:

4.1 Cervical Spine Rotation Normal Abnormal

4.2 Back Movement Normal Abnormal

4.3 Upper Limbs

(a) Appearance Normal Abnormal

(b) Joint movements Normal Abnormal

4.4 Lower Limbs

(a) Appearance Normal Abnormal

(b) Joint movements Normal Abnormal 4.5Reflexes Normal Abnormal

4.6 Romberg’s sign* Normal Abnormal *A pass requires the ability to maintain balance while standing with shoes off, feet together side by side, eyes closed and arms by sides, for thirty seconds.

5. Vision:

5.1 Visual Acuity

5.2 Visual Fields Normal Abnormal (Confrontation to each eye)

R L R L

6 / 6 / 6 / 6 /

Uncorrected Corrected

6. Hearing Normal Abnormal

7. Urinalysis

7.1 Protein Normal Abnormal

7.2 Glucose Normal Abnormal

Both

6 /

Both

6 /

Section 2 - Medical examiner to complete

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Medical Examination of Commercial Vehicle Driver Licence

Pleasefindenclosedyourmedicalformtobecompletedbyyouandthedoctorinordertomaintainavalidcommercial vehicle licence. Medical assessments are valid for six months from the date of issue.

The medical standards set out in ‘Assessing Fitness to Drive’ act as a guide for medical practitioners in providing expertadvicewhencarryingoutdriverfitnesschecksonbehalfofdriverlicensingauthorities.

The standards (and medical form) were developed in conjunction with a range of medical organisations on behalf of the National Transport Commission (NTC) and Austroads and have been endorsed as the national standards for commercial vehicle drivers.

In accordance with the ACT’s commitment to national road safety initiatives, these standards apply to all drivers of public buses, taxis, hire cars, restricted hire cars, riders of hire car vehicles, accredited driving instructors, rideshare vehicles and heavy vehicles over 8 tonne GVM.

All medical practitioners in the ACT have been issued the medical standards. The assumed and preferred role of the examining doctor is to advise whether the criteria for driving a commercial vehicle are met. The ultimate decision as to whether a person applying for or retaining a commercial vehicle licence, is a matter for the Road Transport Authority.

Please follow the instructions on the medical form and arrange an appointment with your own doctor as required. If you pass the medical examination, the examining doctor will return the completed Commercial Driver’s Health Assessment to you, and it should be forwarded to Road User Services immediately. Failure to do so may result in your commercial licence being cancelled. Road User Services does not acknowledge the return of medical assessment reports. If there is a problem with the report or the report is not received by the due date, you will be contacted.

The completed Commercial Driver’s Health Assessment can be submitted by mail to P.O Box 582 Dickson ACT 2602 or emailed to [email protected] or faxed to (02) 6207 7120.

Payment

The licence applicant is responsible for payment of the medical examination fee.

TheAustralianTaxationOfficehasadvisedthatataxdeductionmaybeallowableforamedicalexpensethatissufficientlylinkedtoaparticularvocation.Onthisbasisthecostoftheexaminationmaybeclaimedasaworkrelatedexpense.FormoreinformationpleasecontacttheAustralianTaxationOffice.

Should you require further information about medical examinations of commercial vehicle drivers in the ACT, please contact the Registration & Licence Section on (02) 6205 1577.

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10,020 (03/2016)

Application for Police CheckPolice Character Check / Criminal Records & Traffic Infringements

This form, payment and a photocopy of your driver licence must be posted immediately to the Road Transport Authority (see overleaf for details).This form can take up to six weeks for approval and must be filled out in black biro or typed.

Please provide details of your permanent home addresses or home address for the last ten (10) years.

ADDRESS PERIOD OF RESIDENCEIf full details are unavailable, town(s) and state(s) will suffice. If actual dates are unavailable, year(s) of residence will suffice.Current Address

(If more space is required, please supply a separate page)

/ / to / /

/ / to / /

/ / to / /

/ / to / /

Permanent home addresses

Questions 1 to 3 relate to applications for a public vehicle driver licence or accreditation as a driving instructor.

1. Are you the subject of any criminal charge(s) still pending before a court? Yes No

2. Do you have any conviction(s) or finding(s) of guilt which are less than ten (10) years old, or any juvenile Yes No conviction(s) or finding(s) of guilt which are less than five (5) years old?

3. Do you have any conviction(s) or finding(s) of guilt which are over ten (10) years old [or five (5) years Yes No for juvenile conviction(s) or finding(s) of guilt], where the sentence imposed was greater than six (6) months imprisonment?

Question 4 relates to application for appointment under the Authorised Examiner Scheme

4. In the case of an application by a natural person, has the applicant; or in the case of a body corporate, Yes No has a director of the corporation, during the period of five (5) years preceding the date of the application for appointment been convicted of an offence that involves fraud or dishonesty whether in the Territory or elsewhere?

If you answered YES to any of the above questions, please provide details overleaf.

Criminal charge, conviction or pecuniary penalties

Personal Details

Residential address

Other namesSurname Given name

Contact Phone NumberTown / City of Birth State / Country of Birth

Class(es) Currently Held Licence Number State / Territory / Country of Issue

Date of birthOther names used (including maiden name) Gender

Male Female

Application details

Authorised Examiner Scheme - Examiner Authorised Examiner Scheme - Proprietor

Hire car RideshareTaxi Restricted hire car Public bus Accredited driving instructor

I wish to apply for a Police character check in support of my application for a public vehicle driver licence, approval as an accredited driver instructor, or appointment under the Authorised Examiner Scheme. (Please tick appropriate box)

This application is for a (please tick): Original Renewal Restoration

Road Transport Authority | PO Box 582 Dickson ACT 2602 | Phone: 13 22 81

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Details of any cancellations / suspensions of your driver licence or disqualification from obtaining a licence.

Details of any court convictions and findings of guilt.

Date Place Nature of Offence Penalty

STAFF IN CONFIDENCE - NO EXCLUSION

1. Acknowledge that I have read the General Information provided with this form and understand that I do not have to disclose details of ‘spent convictions’; 2. Certify that the personal information I have provided on all pages of this form relates to me and is correct;

3. Consent to the AFP, other relevant Australian Police Force(s) an Australian Court of Law or a Road Transport Authority extracting from its records details of traffic violations and criminal records relating to me, pending before a Court, and/or details of convictions or findings of guilt which have been recorded against me and which are not ‘spent convictions’ for the purposes of the Spent Convictions Act 2000;

4. Acknowledge that any information provided by me on this form or by the Police, a Court of Law or Road Transport Authority as a result of the records, check may be taken into account by the Road Transport Authority in assessing my suitability to hold a public vehicle driver licence, be accredited as a driving instructor, or be an authorised examiner; and

5. Acknowledge that such information may be provided to an accredited public passenger service operator in circumstances where the RTA is satisfied on reasonable grounds that it is necessary for the protection of public safety or the security of public transport infrastructure.

A Police check is valid for six (6) months from the date of issue. The information sought on this form is required under the Road Transport (Driver Licensing) Act 1999 to assess your application for a driver licence and/or accreditation as a driving instructor; and/or under the Road Transport (Vehicle Registration) Act 1999 to assess your application for authorisation as an examiner.

Period State / Territory Type of cancellation / suspension / disqualification Reinstated

• This application must be filled out in black biro or typed.• If there has been a change of names, then previous and current names MUST be included with this form (e.g. Maiden name etc.), • Births, Deaths & Marriages change of name certificate is required• Your signature must be no more than three (3) months old.• Please check that all the necessary details have been completed and that the form is signed.

PROCEDURE

The fee for the Police Check is: $45.00 (fee is subject to change without notice).

Cheques and money orders are to be made payable to: The Commissioner, Australian Federal Police.

Send the completed form and a copy of your driver licence with a cheque or money order to: Road Transport Authority, PO Box 582, Dickson ACT 2602.

When the police check is completed it will be returned by the Australian Federal Police to the Road Transport Authority.

/ /

(attach a separate sheet if necessary)

Requirements For Sending This Form

(attach a separate sheet if necessary)

Consent To Obtain Personal Information(For categories where NO EXCLUSION has been granted from spent convictions legislation). Complete with BLOCK LETTERS:

I, (full name) hereby:

Signature Date

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General Information

Persons applying to hold a public vehicle driver licence or seeking to be accredited as a driving instructor or authorised examiner are required to provide to the Road Transport Authority (RTA) a statement of the applicant’s criminal history supplied by the police.

The ‘Application for Police Check’ form is used to authorise the Australian Federal Police or an Australian Court to supply to the RTA details of an applicant’s disclosable criminal and or traffic convictions. An applicant’s disclosable criminal and or traffic convictions are considered by the RTA in assessing whether the applicant is a suitable person to hold a public vehicle driver licence, be accredited as a driving instructor or be an authorised examiner. Unless statutory obligations require or provide otherwise, the information provided on this form will not be used without your prior consent for any purpose other than:

• Assessing your suitability for a public vehicle driver licence, accreditation as a driving instructor or an authorised examiner; and

• Providing advice to an accredited public passenger service operator for the protection of public safety or the security of public transport infrastructure.

Police Records Check

On this form you are asked to disclose whether you are the subject of any criminal charges including traffic violations still pending before a Court, or whether you have been the subject of criminal and or traffic convictions or findings of guilt before a Court. You are not required to reveal any convictions, which are ‘spent convictions’ under the Spent Convictions Act 2000.

This form must be forwarded to the Road Transport Authority together with a cheque for the required amount (made payable to: The Commissioner, Australian Federal Police), and you are asked to consent to:

(a) The AFP disclosing criminal history information from its own records to the Road Transport Authority for your entitlement;

(b) The AFP accessing the records of any State / Territory Police Forces and to obtain any criminal and or traffic history information which in turn would be disclosed to the Road Transport Authority;

(c) An Australian Capital Territory Law Court disclosing information from its own records in relation to criminal offences to the Road Transport Authority for assessing your entitlement; and

(d) A Road Transport Authority disclosing details of your traffic violations from its records.

Spent Convictions

Generally, persons are not required to disclose, and no account may be taken of a ‘spent conviction’. However, if you are to be employed or engaged in work which provides a service for children, older people or people with a disability, such as the provision of public passenger services, you are required to disclose all convictions.

Convictions for the following can never become spent:

• For which a prison sentence of longer than 6 months is imposed;

• For a sexual offence; and

• Of a corporation.

All other convictions become spent on completion of the relevant crime free period. If a person was convicted of an offence as an adult, upon the completion of a crime free period of 10 consecutive years; i.e. a period during which the person was not in prison because of conviction for an offence, convicted of an offence punishable by imprisonment, subject to a convict order or unlawfully at large, the conviction becomes spent.

The relevant crime free period for a person who was dealt with as a juvenile in relation to the offence is five years.

An individual who believes the standards dealing with disclosure and use of conviction information have been breached may apply to the Privacy Commissioner for an investigation of the matter. The address is GPO Box 5218, SYDNEY NSW 2001.

Provision of false or misleading information

You are asked to certify that the personal information you have provided on this form is correct. If it is subsequently discovered, for example as a result of a check of police records that you have provided false or misleading information, this may be taken into account in the assessment of your suitability to be licensed / accredited as the case may be.

Police records check for application for: • Accreditation for public vehicle driver licence; or • Accreditation as a driving instructor; or • Authorisation as an examiner.

Page 14: Application for a taxi driver licence in the ACT · PDF fileApplication for a Taxi Driver Licence in the ACT ... Republic of Ireland, ... Application for a taxi driver licence in the

Authorisation to Release Public Passenger Driver Licence and Accreditation Status

70,049 (07/2016)

Office use only

Accepted by Signature Date

Application type

Taxi Hire car (including restricted and motorcycle hire car) Public bus Rideshare

Taxi Hire car (including restricted and motorcycle hire car) Public bus Rideshare

AND/OR

I am applying for the following Public Vehicle Driver Licence Class:

I am applying for the following Public Passenger Service Accreditaton:

Personal details

Postal address

Residential address

Other namesSurname Given name

Date of birth Business hours contact number Mobile phone number

Driver licence number Driver Authority Number (if applicable)

E-mail address

Consent

Signature Date

I consent to the ACT Road Transport Authority:

1. Releasing information to Transport Booking Services regarding the status of my public passenger service accreditation and/or my licence to operate a public passenger service and /or my driver’s licence or public vehicle driver authority.

2. Releasing information to third party insurers or individuals or their agents following a motor vehicle accident involving a public passenger vehicle I operate.

3. Obtaining details on any matter from a Transport Booking Service and/or any other Government agency relating to the operation of my public passenger service and/or driver’s licence or public vehicle driver authority.

4. Obtaining details of any matter, including details relating to a conviction, which may be deemed relevant to ascertain if I am a suitable person to hold a public passenger service accreditation and/or a public passenger driver’s licence.

This form must be returned to the Road Transport Authority via:Email: [email protected] or Post - P.O Box 582 Dickson ACT 2602 or Fax - 02 6207 7120

Road Transport Authority | PO Box 582 Dickson ACT 2602 | Phone: 13 22 81


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