Application to be Licensed as a NEW DRIVER PLEASE COMPLETE IN CLEAR BLOCK CAPITALS. Surname (MR.MRS.MISS.MS). Maiden Name...

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1 Application to be Licensed as a NEW DRIVER Receipt No:... Date:.. Income Code C05027 I This form should be completed and together with the appropriate fee and supporting documentation SUBMITTED AT ONE OF THE HEREFORDSHIRE COUNCIL CUSTOMER SERVICE CENTRES PLEASE COMPLETE IN CLEAR BLOCK CAPITALS Surname (MR.MRS.MISS.MS). Maiden Name... All Forenames Previous Surnames / Aliases. Date of Birth. Place of Birth. Sex M/F Present address..post Code Telephone Number: Business.. Home. Mobile National Insurance No address.. How long have you been licensed to drive a motor vehicle?. DVLA Driving Licence No (Note: New applicants should be at least 21 years of age and have held a driver s licence for a minimum period of one year) PREVIOUS ADDRESSES IN LAST 5 YEARS DATE FROM DATE TO Give names and addresses of present employer, if any, and particulars of employment during the past 5 YEARS: FROM TO EMPLOYER ADDRESS NATURE OF EMPLOYMENT 1

2 CONVICTIONS/CAUTIONS You must declare any convictions or cautions you may have, under the Rehabilitation of Offenders Act The information you give will be treated in confidence and will only be taken into account in relation to your application. A definition of convictions is set out below. You should be aware that the Council is empowered in law to check with the CRB for the existence and content of any criminal record held in the name of an applicant. Information received from them 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 bar you from gaining a licence unless the Council considers that the conviction renders you unsuitable. In making this decision the Council 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 driver s licence on the ground that he/she is not a fit and proper person to hold such a licence has a right of appeal to a Magistrates Court. CONVICTION Please include all past convictions spent and unspent. Have you ever been convicted at a court for any offence under the terms of the Rehabilitation of Offenders Act 1974? If YES, please complete the following: - OFFENCE DATE OF COURT DATE OF PENALTY OFFENCE CONVICTION CAUTION Have you ever been cautioned for an offence? If YES, please complete the following: - OFFENCE DATE OF POLICE FORCE CAUTION INCIDENTS WHICH MAY LEAD TO CAUTION OR CONVICTION These include pending investigations. Have you been involved in any incident, which may lead to Court proceedings being taken against you? If YES, please supply full details on a separate sheet. Have you undergone a previous CRB check by any other Licensing Authority or body during the last 12 months? (you are not obliged to answer this question) 2

3 THEFT ACT 1968 SECTION 16 It is an offence under the Act to obtain a pecuniary advantage. If the application form is not filled in correctly i.e. failure to indicate any convictions subject to the Rehabilitation of Offenders Act 1974, you will have been deemed to have committed an offence and the matter may be referred to the Police. DEFINITIONS OF CONVICTIONS: - Rehabilitation Periods SENTENCE AGE 18 OR OVER UNDER 18 WHEN CONVICTED WHEN CONVICTED Prison and Young Offender Institution 7 years 3 years Sentence if 6 months or less Prison and Young Offender Institution - 10 years 5 years Sentence of more than 6 months 2½ years Fines, compensation order, probation (for People convicted on or after 3 rd February 1995), community service, combination 5 years 2 years order, action plan, curfew order, drug treatment, reparation order SENTENCE AGE 18 OR OVER UNDER 18 WHEN CONVICTED WHEN CONVICTED Borstal (abolished 1083) 7 years 7 years Detention centre 3 years 3 years Absolute discharge 6 months 6 months SENTENCES FOR WHICH THE REHABILITATION PERIOD VARIES: Probation order (for people convicted prior To 3 February 1995), conditional discharge, Bind over, supervision order, care order Attendance centre orders Hospital order Until the order expires (minimum period of 1 year) length of the order plus 1 year 2 years after the order expires (with a minimum of 5 years from the date of conviction) SUSPENDED SENTENCES A suspended prison sentence is treated as one that has taken effect and the rehabilitation period is the same as for the full sentence. Have you been convicted of any motoring offences If YES, please complete the following:-? CONVICTING DATE OF OFFENCE DATE OF FINE DISQUAL PEN COURT CODE CONVICTION OFFENCE PERIOD PTS D/M/Y D/M/Y 3

4 Have you previously been licensed to drive a private hire/hackney carriage vehicle? If YES, give details: - Name of Council Type of licence.. Period when licence held Have any licences in respect of Private Hire or Hackney Carriage held by you ever been revoked, suspended or refused? If YES, give details (including name of Authority).. TO BE COMPLETED BY THE VEHICLE PROPRIETOR Have you satisfied yourself that the applicant is a fit and proper person to be Employed in this capacity? Have you satisfied yourself that the applicant has a good knowledge of the area? Have you informed the applicant of the basics of the law relating to the service? Does your vehicle Insurance Cover include the applicant (copy to be forwarded With application) Signature of Vehicle Proprietor.. Date Print Name of Vehicle Proprietor.. Name of Company / Group for which vehicle operates Address from which Company / Group operates... NB Drivers on Social Services/Education Contract journeys must hold a County Transport Badge in addition to their Dual Driver Badge. Contact - Children and Young People's Directorate, School Admissions and Transport Department Blackfriars PO Box 185 Blackfriars Street Hereford HR4 9ZR Office Tel No:

5 TO BE COMPLETED BY THE APPLICANT I certify that the above answers are true and understand that if there are any omissions or false statements, my application will be refused or if a licence has been issued, it will be liable to immediate suspension or revocation. I am aware that the grant of such a licence is subject to a criminal record check. This has been explained to me and I understand that the licensing authority does consider spent convictions. I hereby declare that the information given above is true. I enclose the following: 1. Valid driving licence (if photo card format we require both paper and card parts) 2. My birth certificate / passport 3. Copy of the insurance certificate for the vehicle I will be driving I agree that information in relation to my application may be shared with other directorates within Herefordshire Council. Signature Date Data Protection Act 1998 This policy covers the treatment of personal data that Herefordshire Council may collect when you e- mail us, complete an application form, or when you complete and submit an online form on our web site. When completing forms you may be asked for personal information such as name, address, postcode etc. It is only when you supply this type of information that you can be personally identified. Herefordshire Council is registered with the Data Protection Act 1998 for the purpose of processing personal data in the performance of its legitimate business. Any information held by the Council will be processed in compliance with the principles set out in the Act. Where necessary we may share this personal data with partner organisations e.g. for the protection of public funds administered which may include the prevention or detection of fraud and auditing purposes. Further information relating to the Data Protection Act 1998 can be sent to you on request. If you have concerns about the processing of your personal data by the Council you may contact the Council s Data Protection Officer: Data Protection Officer, County Secretary and Solicitor, Herefordshire Council Brockington 35 Hafod Road Hereford HR1 1SH 5

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