LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS) ACT 1976

TOWN POLICE CLAUSES ACT 1847

Hackney Carriage/Private Hire Vehicle Driver’s LicenceApplication

1.Filling in this form / 2.If you need help
Pleaseanswer EVERY question and ensure your answers are inside the boxes and written in black ink. Use additional sheets if necessary. You may wish to keep a copy of the completed form for your records. / Write to the Licensing Section atNorth East Derbyshire District Council, District Council Offices, 2013 Mill Lane, Wingerworth, Chesterfield, S42 6NG
Tel: 01246 217228/217548/217216
Email:
Which Council are you applying to for your driver licence? / Please Tick
Bolsover District Council
North East Derbyshire District Council

1 – Application Type

Please Tick
Is this application for a new licence or the renewal of your current licence? / New / Renewal
If this is a renewal application please provide the following information:
Driver’s Badge No: / Expiry Date:

2- Your Personal Details

Title (delete as appropriate) / Mr / Mrs / Miss / Ms / Other(Please state)
Surname: / Forename(s):
Date of Birth: / Age:
Address (including post code):
National Insurance Number:

CONTACT DETAILS

Home Tel: / Mobile:
E-mail Address:

3 -Driving Licence

Please tick as appropriate
Do you hold a current full UK/EU driving licence? / Yes / No
Driving Licence Number:
How long have you held your full UK/EU driving licence?
DVSA access code to enable your driving licence to be checked (this can be obtained from or we can assist you in generating the code when you make your application). This code is case sensitive please write it as you see it on the screen
Do you have any endorsements on your full UK/EU driving licence? / Yes / No
Have you ever had your full UK/EU driving licence revoked or received a driving ban? / Yes / No
Are you aware of any pending motoring incidents which may result in you receiving a fixed penalty notice or court proceedings against you? / Yes / No
If you answered yes to any of the three previous questions above, please give details:

4 – Private Hire/Hackney Carriage Driver’s Licence History

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Please Tick
If you are applying for a new licence (not renewing an existing licence) have you ever previously held a Hackney Carriage or Private Hire Driver’s Licence with this licensing authority? / Yes / No
Do you currently hold or have you ever previously held a Hackney Carriage or Private Hire Driver’s Licence with ANY OTHER licensing authority? / Yes / No
Do you currently have any outstanding applications for a Hackney Carriage or Private Hire Driver’s LicencewithANY OTHER licensing authority? / Yes / No
Have you ever had a Hackney Carriage or Private Hire Drivers Licence suspended, revoked or refused by this or any other licensing authority? / Yes / No
Have you ever had a Hackney Carriage or Private Hire Vehicle Licence revoked or refused by this or any other licensing authority? / Yes / No
If you have answered yes to any of the above, please give details:

5 -Convictions

The Rehabilitation of Offenders Act 1974

Private Hire Vehicle and Hackney Carriage drivers are classed as an excepted occupation under the Rehabilitation of Offenders Act 1974, therefore any previous convictions, irrespective of age, can never be ‘spent’. It is immaterial whether the convictions are for crime, motoring offences or any offence whereby a fine, imprisonment or other punishment has been received,

Please Tick
Have you ever been convicted of any offence? / Yes / No
Have you ever received a caution, fixed penalty, anti-social behaviour order, acceptable behaviour contract, anti-social behaviour warning, injunction or ASB injunction? / Yes / No
Have you recently been involved in any incident likely to result in police or any other enforcement agency investigations or court proceedings against you? / Yes / No
If you have answered yes to any of the above, please give details belowincluding the date of the incident(s)/conviction(s), details of the offence(s) and what penalty was imposed:

6 -Medical Condition (For Renewals only)

Please Tick
Has your medical condition changed since your last application? / Yes / No
If yes, please provide details:

7 -PRIVATE HIRE OPERATOR

Please Tick
Do you currently or will you be working for a private hire operator? / Yes / No
If yes, please provide the name and address of the Operator:

8 -Residency

Please tick as appropriate
Country of Birth:
Have you ever lived or worked outside the UK? / Yes / No
If yes, please provide the date/s when you lived outside the UK and the date you moved to the UK
9 – RIGHT TO WORK IN THE UNITED KINGDOM

We are now required to ensure that all applicants for hackney carriage and private hire driver licences have a right to work in the UK. Licences will not normally be issued beyond any date on which a person’s right to work in the UK ends.

Home Office Guidance relating to the Nationality Act 2006 provides information regarding the documents that are acceptable for proving someone has the right to work in the UK, these are split into two lists.

List A - documents show the holder is not subject to immigration control, or has no restrictions on their stay, so they have an ongoing right to work in the UK.

List B - documents show the holder has been granted leave to enter or remain in the UK for a limited period of time and, or, has restrictions on their right to work.

As part of the application process you will be required to provide 1 or more documents from List A and/or B to confirm that you have the right to work in the UK

List A / Please tick as appropriate
A passport showing you are a British citizen or a citizen of the UK and colonies having the right of abode in the UK
A passport or national identity card showing that you are a national of an EEA country or Switzerland
A residence permit, registration certificate or document certifying or indicating permanent residence issued by the Home Office to a national of an EEA country or Switzerland
A permanent residence card or document issued by the Home Office to the family member of a national of an EEA country or Switzerland
A Biometric Residence Permit issued by the Home Office to you indicating that you are allowed to stay indefinitely in the UK,or have no time limit on their stay in the UK
A passport or other travel document endorsed to show that you are exempt from immigration control, are allowed to stay indefinitely in the UK, have the right of abode in the UK, or have no time limit on your stay in the UK
An Immigration Status Document issued by the Home Office to you with an endorsement indicating that you are allowed to stay indefinitely in the UK or have no time limit on your stay in the UK together with an official document issued by a previous employer or Government agency with your name and National Insurance number
A full birth or adoption certificate issued in the UK including the name(s) of at least one of the holder’s parents together with an official document issued by a previous employer or Government agency with their name and National Insurance number
A birth or adoption certificate issued in the Channel Islands, the Isle of Man or Ireland together with an official document issued by a previous employer or Government agency with your name and National Insurance number
A certificate of registration or naturalization as a British citizen together with an official document issued by a previous employer or Government agency with your name and National Insurance number
A letter issued by the Home Office to you indicating that you are allowed to stay indefinitely in the UK together with an official document issued by a previous employer or Government agency with your name and National Insurance number
List B / Please tick as appropriate
A passport or travel document showing you are allowed to stay in the UK and are allowed to work in a driving role
Biometric Residence Permit issued by the Home Office to the holder indicating that you can stay in the UK and are allowed to work in a driving role
A residence card or document issued by the Home Office to a family member of a national of an EEA country or Switzerland
A work permit or other approval to work issued by the Home Office together with either a passport or travel document showing you are allowed to stay in the UK and to do the work or a letter issued by the Home Office confirming the same
A Certificate of Application less than 6 months old issued by the Home Office to or for the family member of a national of an EEA country or Switzerland stating you are allowed to work togetherwith a positive verification letter from the Home Office’s Employer Checking Service
10 - IMPORTANT INFORMATION – PLEASE READ

1You should be aware that under Section 57(3) of the Local Government (Miscellaneous Provisions) Act 1976,if you knowingly or recklessly make a false statement or omit any material particular in giving information under this section, you shall be guilty of an offence.

2You are required to declare ANY convictions or cautions you may have. The information you give will be treated in confidence and will only be taken into account in relation to your application.

3You should be aware that the licensing authority is empowered by 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 while the licensing process takes its course and will be retained for no longer than is necessary.

4The disclosure of a criminal record or other information will not prevent you from gaining a licence unless the authority considers that the conviction renders you unsuitable. In making this 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 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.

If you would like to discuss any part of your application in confidence then please contact the Licensing Section.

11 - Declaration by the Applicant

I certify that:

  1. I have read, understand and agree to my information being used in accordance with the Fair Obtaining Notice and Equality Policy Statement on page six.
  2. The information given on this form is correct to the best of my knowledge and belief and I have not omitted to include any information which may be relevant to the application. I understand that I may be liable to prosecution if I knowingly or recklessly make a false statement or omit any material particular to this application.
  3. I hereby undertake to observe and perform the conditions set out in the Local Government (Miscellaneous Provisions) Act 1976 and the Licence Conditions imposed by the Council.

Signature:Date:

Print name: .

Please ensure that you have:
Enclosed your DVLA driving Licence (photocardor old style paper licence). / All applicants
Enclosed a passport size colour photograph (full face). / All applicants
Enclosed the fees. / All applicants
Enclosed evidence to support your right to live and work in the UK (See Section 7) / All applicants
Enclosed a completed D4 Medical examination report & certificate of fitness signed by a doctor / All new applicants, once every 5 years for drivers aged 45 and over and yearly for drivers aged 65 and over
Enclosed evidence that you have passed the Driving Standards Agency Private Hire/Hackney Carriage Assessment / New applicants only
Enclosed a Certificate of Good Conduct (only for applicants who have lived or worked outside of the UK). / New applicants only

CONSENT OF APPLICANT

I consent to North East Derbyshire and/or Bolsover District Council (The Council/s) using and processing my personal, sensitive data for the purposes of determining this application and any subsequent review of my licence.

Should my application be refused or my licence subsequently revoked and if I appeal against either of those decisions, I understand that my personal, sensitive data may be disclosed by The Council/s in Court.

I agree to any information held regarding my application or licence being forwarded to other Licensing Authorities and/or enforcing agencies.

I consent to any other Licensing Authority disclosing relevant information to The Council/s regarding to any licence; application for a licence; revocation or suspension of a licence; refusal to renew a licence; or any other matter which may affect my fitness to hold a licence with The Council/s.

Applicant’s Signature:

Applicant’s Name:

Date:

IMPORTANT INFORMATION BELOW

PLEASE READ CAREFULLY

Data Protection Act 1998 – Fair Obtaining Notice

I understand that all information provided to The Council/s will be held and treated in confidence in accordance with the Data Protection Act 1998. It will only be used for the purpose for which it is given and may be shared with other council departments or third party organisations. The information provided may be held electronically and/or in paper form and will be kept secure at all times.

The Council/sare required by legislation to keep public registers. This means that information provided will be made available to the public.

This authority is under a duty to protect the public funds it administers, and to this end may use information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes.

For further information see

Equality Policy Statement

The Council/s are committed to equalities as an employer and in all the services provided to all sections of the community. The Council/s believes that no person should be treated unfairly and is committed to eliminate all forms of discrimination in compliance with its Equality Policy. The Council/s also have due regard to eliminate racial discrimination and to proactively promote equality of opportunity and good relations between persons of different racial groups when performing its functions.

If you need help in understanding any of our documents or require an alternative format or translator to help you, we can arrange this for you. Please contact us on the telephone numbers at the bottom of this page.

For further information contact John Chambers on 01246 217216 or alternatively via e-mail at

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