Fillable APPLICATION FOR A HACKNEY CARRIAGE & PRIVATE HIRE (Ashfield District Council)

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APPLICATION FOR A HACKNEY CARRIAGE & PRIVATE HIRE (Ashfield District Council)

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APPLICATION FOR A HACKNEY CARRIAGE
& PRIVATE HIRE (DUAL) DRIVER LICENCE
This application form must be completed in full and legibly.
The default position under Section 53 of the Local Government (Miscellaneous Provisions)
Act 1976 (as amended by the Section 10 of the Deregulation Act 2015) is for the Council
to issue a licence for a maximum period of three years.
The Council does have the discretion to grant a licence for a lesser period than 3 years if it
is appropriate in the circumstances of the case. Should you feel that this is appropriate,
you will need to provide the necessary mitigation / evidence to support your case.
TYPE OF APPLICATION: NEW RENEWAL (tick appropriate box)
FULL NAME:
ADDRESS:
POSTCODE:
HOME TEL. NO.:
MOBILE TEL. NO.:
EMAIL ADDRESS:
DATE OF BIRTH:
NATIONAL INSURANCE NO.:
HC & PH (DUAL) DRIVER LICENCE NO. (BADGE):
EXPIRY DATE OF HC & PH (DUAL) DRIVER LICENCE:
NAME OF YOUR TAXI / PRIVATE HIRE OPERATOR:
FULL DVLA DRIVER LICENCE NO.:
START DATE OF DVLA DRIVER LICENCE:
EXPIRY DATE OF DVLA DRIVER LICENCE:
DO YOU HAVE ENTITLEMENT TO
WORK IN THE U.K.?
YES NO (tick appropriate box)
You will be required to provide proof of your entitlement to work in the U.K. at your appointment
with the Licensing Officer (see page 30 of the HC & PH (Dual) Driver Licence Application Pack)
HAVE YOU HELD /
DO YOU HOLD A
DRIVER
LICENCE WITH ANY OTHER COUNCIL?
YES NO (tick appropriate box)
IF YES, WHICH COUNCIL?
HAVE YOU EVER BEEN REFUSED OR HAD A
LICENCE REVOKED BY ANY COUNCIL?
YES NO (tick appropriate box)
IF YES, WHICH COUNCIL?
APPENDIX ONE:
1
CRIMINAL CONVICTIONS: ALL APPLICANTS
Applicants must disclose ALL CRIMINAL CONVICTIONS, PENDING PROSECUTIONS,
OFFENCES AND CAUTIONS. It is an offence to fail to disclose such matters, and any
application made that is later found to be misleading, inaccurate or false, may result in the
application being rejected and / or enforcement action being taken against the applicant.
You must disclose all spent and unspent convictions as well as any overseas
convictions, irrespective of how long ago it happened.
If you have NO previous criminal convictions, cautions, or offences to declare, nor
are you currently the subject of any pending prosecution, then please tick this box.
Otherwise please provide details below.
Please give details of all criminal convictions, pending prosecutions, offences and
cautions, irrespective of date of offences (please provide as much detail as
possible, failure to do so may result in your application being rejected).
DATE OF OFFENCE:
NATURE OF OFFENCE:
NAME AND PLACE OF COURT:
SENTENCE OR ORDER:
REASON FOR OFFENCE:
DATE OF OFFENCE:
NATURE OF OFFENCE:
NAME AND PLACE OF COURT:
SENTENCE OR ORDER:
REASON FOR OFFENCE:
Please continue on a separate sheet if you have further declarations to make.
2
MOTORING CONVICTIONS: ALL APPLICANTS
Applicants must disclose ALL MOTORING CONVICTIONS, PENDING PROSECUTIONS,
OFFENCES AND CAUTIONS. It is an offence to fail to disclose such matters, and any
application made that is later found to be misleading, inaccurate or false, may result in the
application being rejected and / or enforcement action being taken against the applicant.
You must disclose all spent and unspent motoring convictions as well as any
overseas motoring convictions, irrespective of how long ago it happened.
If you have NO previous motoring convictions, cautions, or offences to declare, nor
are you currently the subject of any pending prosecution, then please tick this box.
Otherwise please provide details below.
motoring
convictions, pending prosecutions, offences and
cautions, irrespective of date of offences (please provide as much detail as possible,
failure to do so may result in your application being rejected).
DATE OF OFFENCE:
NATURE OF OFFENCE:
NAME AND PLACE OF COURT:
SENTENCE OR ORDER:
REASON FOR OFFENCE:
DATE OF OFFENCE:
NATURE OF OFFENCE:
NAME AND PLACE OF COURT:
SENTENCE OR ORDER:
REASON FOR OFFENCE:
Please continue on a separate sheet if you have further declarations to make.
3
SUPPORTING STATEMENT: ALL APPLICANTS
If you have declared any criminal / motoring convictions, pending prosecutions,
offences and cautions, please provide any supporting information that you think
may assist you in your application to hold a Hackney Carriage & Private Hire (Dual)
Driver Licence (please continue on a separate sheet should you need to).
General Data Protection Regulation 2016 (GDPR) / Data Protection Act 2018
(DPA) - Privacy Notice.
Under the GDPR and DPA, Ashfield District Council, Urban Road, Kirkby in
Ashfield, Nottingham.
NG17 8DA is a Data Controller for the information it holds about you. The Council will hold the
information above provided by you for assessing your application. The lawful basis under which the
Council uses personal data for this purpose is Public Task.
The information provided by you includes the following special categories of personal data:
Physical or Mental Health
Genetic / Biometric data
Criminal History (including motoring offences)
Special Category Data is used by the Council on the basis that such use is necessary for reasons
of substantial public interest, in this instance Schedule 1, Part 2, 6(1), Statutory etc and government
purposes in accordance with the provisions of the Data Protection Act 2018. When processing the
information provided by you, it may also be necessary for the Council to ‘process personal data
relating to criminal convictions and offences’, in accordance with Schedule 1, Part 3 (protecting
individuals vital interests) within the provisions of the Data Protection Act 2018.
Your data will be held for a period of 6 years. Subject to some legal exceptions, you have the right
to request a copy of the personal information the Council holds about you; to have any inaccuracies
corrected; to have your personal data erased; to place a restriction on our processing of your data;
to object to processing; and to request your data to be ported (data portability). The information
provided by you may also be used for other functions carried out by the Council in accordance with
GDPR and DPA. For more information about how the Council may use your data and to learn more
about your rights please see the Council’s Privacy Statement: www.ashfield.gov.uk/privacy
If you have any concerns or questions about how your personal data is processed, please contact
the Council’s Data Protection Officer at the address at the bottom of this form or by email to
dpo@ashfield.gov.uk . If you are dissatisfied with the Council’s response you can complain to the
Information Commissioner's Office in writing to: Information Commissioner's Office, Wycliffe House,
Water Lane, Wilmslow, Cheshire SK9 5AF or by telephone 0303 123 1113 (local rate) or 01625 545
745.
4
Disclosure & Barring Services (DBS): Privacy Notice
As part of the application process, Ashfield District Council (as a Registered Body) will
apply for either a Standard or Enhanced DBS Check to assess the applicants’ suitability to
hold / continue to hold a licence.
Privacy Policy Declaration:
I, the undersigned, hereby declare that I have read the Standard / Enhanced Check
Privacy Policy for applicants:
https://www.gov.uk/government/publications/dbs-privacy-policies and I understand
how DBS will process my personal data and the options available to me for submitting an
application.
Please tick here:
Consent to obtain electronic Standard / Enhanced Check result (if using the DBS
Update Service):
I consent to the DBS providing an electronic result directly to the Registered Body that
has submitted my application. I understand that an electronic result contains a message
that indicates either the certificate is blank or to await certificate which will indicate that
my certificate contains information. In some cases the Registered Body may provide this
information directly to my employer prior to me receiving my certificate.
Please tick here:
Signature of Applicant: ________________________________Date:______________
Declaration
I, the undersigned, hereby declare that the information contained in this application is
true and accurate to the best of my knowledge. I understand that if I knowingly or
recklessly make a false statement or omit any material particularly in giving information
as part of this application I shall be committing an offence and will be liable for
prosecution.
I give my consent to the Licensing Authority to undertake checks of my records by way of
the DVLA, the DBS, my G.P. / Doctor, and any other relevant body in order to promote
the objective of upholding public safety both prior to the consideration of this application,
and if granted, at any time during the duration of the licence.
I confirm I have read the General Data Protection Regulation 2016 (GDPR) / Data
Protection Act 2018 (DPA) - Privacy Notice above and Disclosure & Barring Services
Privacy Notice below.
Signature of Applicant: ________________________________Date:______________
5
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FOR OFFICIAL USE ONLY
Application: Approved / Refused
Signed: Date:
Officer Name:
Designation:
REASON FOR DECISION:
HC & PH (DUAL) DRIVER LICENCE NO.:
DATE OF ISSUE:
EXPIRY DATE:
Licensing Team
Ashfield District Council
Council Offices
Urban Road
Kirkby in Ashfield
Nottinghamshire
NG17 8DA
Tel: 01623 457589
Email: licensing@ashfield.gov.uk
Web: www.ashfield.gov.uk/taxilicensing
6
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APPLICATION FOR A HACKNEY CARRIAGE & PRIVATE HIRE (Ashfield District Council)

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Completed 5 February 2021

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