NEW APPLICANT
B O R O U G H O F T A M W O R T H
Licensing, Public Protection, Growth, Assets & Environment
Application for Hackney Carriage and Private Hire Drivers Licence
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 licence 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 AND BY APPOINTMENT ONLY
PLEASE TELEPHONE 01827 709709 (MONDAY TO FRIDAY) TO MAKE YOUR APPOINTMENT
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 licence 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 licence 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 licence has a right to appeal to a Magistrates Court.
If you would like to discuss your application you may telephone 01827 709674 for advice.
December 2017
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
OFFENCE / DATE OF
OFFENCE / COURT PUNISHMENT / PENALTY 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 LICENCE.
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 LICENCE OR HAS A LICENCE 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 LICENCE NUMBER:
NOTE: The Driving Licence 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 ______
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 LICENCE (NOT BEING A PROVISIONAL LICENCE) 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 LICENCE I MAY HAVE BEEN GRANTED MAY BE REVOKED AND I MAY BE SUBJECT TO LEGAL PROCEEDINGS FOR OBTAINING OR ATTEMPTING TO OBTAIN A LICENCE 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 LICENCE RECORD AND I GIVE CONSENT FOR THESE ENQUIRIES TO BE MADE.
Signed
Dated
Tamworth Borough Council is the Data Controller in respect of all personal data contained within this application. The information collected on this form will be used primarily to assess and process your application in connection with the issue of a Hackney Carriage / Private Hire Drivers Licence. Tamworth Borough Council has a duty to protect public funds and detect fraud; therefore we may share the data within the authority, with other bodies administering public funds, Inland Revenue and the police. The Data Protection Act 1998 gives you the right to access your personal information, for a set fee upon written application.
For further information contact the Information Officer on 01827 709587
Each licensing authority is required to maintain a public register giving certain details of the current hackney carriage and private hire driver licences it has issued.
Section 42 of the Town Police Clauses Act 1847 sets out requirements of the public register concerning hackney carriage drivers.
Section 51(3) of the Local Government (Miscellaneous Provisions) Act 1976 specifies the requirements of the public register requirements for private hire drivers.
Also available to view registers of Hackney Carriage Vehicles, Private Hire Vehicles and Private Hire Operators licensed by the Council.
PART C
COUNTERSIGNATURE OF FORM AND PHOTOGRAPH
When you have completed the form and signed the declaration, this section and the reverse of one copy of your photographs should be signed by someone of standing who has known you for at least one year, for example, a Doctor, Local Councillor, Justice of Peace, Minister of Religion, Police Officer, School Teacher, Social Worker, Solicitor or someone of similar standing. You should note that some of these people may make a charge for this. The Council may contact the person who countersigns this form.
I confirm that I have known the applicant named above for (insert number) ______years and that to the best of my knowledge and belief the facts given by the applicant on this form relating to his identity, and present address are correct.
Signed by dated
Full name
Home Address
Telephone Number
Occupation
Business Address
Telephone Number ______
FOR OFFICIAL USE ONLY
APPLICATION
DATE OF RECEIPT OF APPLICATIONAMOUNT OF FEE PAID
RECEIPT NUMBER
DRIVING LICENCE
ISSUE NUMBERLICENCE NUMBER
REFERENCE NUMBER
IF ANY CONVICTIONS – COPY LICENCE
OR CHECKED AND COPIEDMEDICAL
DATE: / TIME: / DOCTOR:DATE POLICE MEDICAL DVLA K/LEDGE / POLICE / MEDICAL / DVLA / KNOWLEDGE
FORM SENT
FORM RET'D
CHECKED
LICENCE
LICENCE 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 LICENCES
Before an application is submitted you must ensure that the driving licence is up to date and that in particular:
a. Your current address is recorded on the driving licence.
b. Any current motoring convictions/endorsements have been recorded on the licence by the DVLC, Swansea.
DVLA checks are conducted annually. It is the responsibility of the licence holder to ensure these are conducted by either booking an appointment with customer services on 01827 709709 or obtaining a password code from the DVLA website https://www.gov.uk/view-driving-licence . The code must be supplied to the licensing officer exactly as it appears (upper and lower case). This code is a use once code so ensure you do not use it before providing it to the licensing officer.
NOTE 3 - MEDICALS
It is a condition of the licence 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. Further medical examinations may be determined by the medical examiner.
Medical appointment intervals will be outlined within your renewals. It is the responsibility of the licence holder to ensure these appointments are booked with the medical examiner at Aldergate Medical Practice in Salters Lane, Tamworth. Medical fees must be paid directly to the medical practice at the time of booking
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.
TAMWORTH BOROUGH COUNCIL
HACKNEY CARRIAGE AND PRIVATE HIRE DRIVER
ESSENTIAL KNOWLEDGE REQUIREMENTS
ROADSAbbey Road
Albert Road
Aldergate
Amington Road
Apollo
Argyle Street
Ashby Road
Birds Bush Road
Blackwood Road
Bolebridge Street
Bonehill Road
Brindley Drive
Browns Lane
Buckingham Road
Campion Drive
Chiltern Road
Church Street
Claremont Road
Colehill
Comberford Road
Coton Lane
Cottage Farm Road
County Drive
Crowden Road
Dosthill Road
Fazeley Road
Field Farm Road
Fontenaye Road
Fossdale Road
George Street
Gillway Lane
Glascote Road
Hedging Lane
High Street (Dosthill)
Hockley Road
Holloway
Kerria Road
Kettlebrook Road
Leyland Road
Lichfield Road
Lichfield Street
Lower Gungate
Malham Road
Mariner
Market Street
Marlborough Way
Masefield Drive
Mercian Way
Moor Street
Moor Street, The Leys
Ninian Way
Offa Drive
Overwoods Road
Park Farm Road / Peelers Way
Pennine Way
Pennymoor Road
Perrycrofts Crescent
Riverdrive
Salters Lane
Sandy Way
Saxon Drive
Sheepcote Lane
Shuttington Road
Silver Link Road
Spinning School Lane
Tamar Road
Tame Drive
Tamworth Rd (Amington)
Tamworth Rd (Dosthill)
Tamworth Rd (K'brook)
Thackeray Drive
Thomas Guy Way
Tinkers Green Road
Tom Williams Way
Torside
Upper Gungate
Vangard
Ventura Park Road
Victoria Road
Watling Street
Wigginton Road
Wilnecote Lane
Wilnecote Road
Woodland Road
LANDMARKS
Amington Industrial Estate
Beauchamp Park Industrial Estate
Lichfield Rd Industrial Estate
Tame Valley Industrial Estate
Two Gates Trading Estate
Sir Robert Peel Hospital
Rawlett School
Tamworth Bus Station
Tamworth College
Tamworth Police Station
Tamworth Railway Station
Town Hall
Wilnecote Rail Station
Assembly Rooms
Coreys
Kube
Kuda
Snowdome
Peaks Leisure Centre
Tamworth Town FC
YOU MAY BE ASKED TO DESCRIBE HOW TO GET TO 25 OR MORE OF THESE ROADS OR LOCATIONS BY THE SHORTEST AVAILABLE ROUTE, AND WILL BE ASKED TO DESCRIBE THE LOCATION OF APPROXIMATELY 3 LANDMARKS.
THOSE WHO ARE ABLE TO SHOW THE CORRECT KNOWLEDGE OF 20 OR MORE OF THE ABOVE, WILL BE CONSIDERED TO HAVE SUFFICIENT KNOWLEDGE OF THE DISTRICT.
FAILURE TO PASS WILL RESULT IN A CHARGEABLE RETEST.
June 2016