Fillable Driver Authorisation Application (Department of the Environment and Energy)

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Driver Authorisation Application (Department of the Environment and Energy)

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Driver Authorisation Application
Instructions
Page 1 of 6 LTSR Forms Area F2978 CFD V01 Aug 2021
continued over page...
Drivers of motor vehicles used to provide particular public passenger services are required to hold DA.
The purpose of DA is to maximise public condence in public passenger services in relation to the drivers of public
passenger vehicles.
Information bulletins about DA and application forms may be obtained from the Department of Transport and Main
Roads (the department) website www.tmr.qld.gov.au.
If you hold a current DA elsewhere you may be eligible to apply under mutual recognition. Please refer to the
information bulletin Mutual Recognition of Public Passenger Driver Authorities issued in other States, Territories or New
Zealand PT01.
Driver Authorisation (DA)
DA applicants must have a legal entitlement to work in Australia. Applicants must provide evidence specied in section
6 of the application form that they are:
• an Australian citizen
• a permanent resident of Australia
• a New Zealand citizen who is the holder of a special category visa as dened by the Migration Act 1958
(Commonwealth), section 32
• entitled, under a visa granted under the Migration Act (Commonwealth) to work in Australia.
If you are not an Australian citizen or permanent resident, you must present your foreign passport, Visa Evidence Card
or Document for Travel to Australia at the time of application. You must also complete an Authority to Check a Visa
Holder’s Work Entitlement (form F4595) so the department can verify you have an entitlement to work in Australia.
Criminal history checks are undertaken by the department on all DA applicants before an application can be approved.
Applicants cannot provide their own criminal history check, because the criminal history check information provided to
the department for DA purposes contains more information than is normally released.
All criminal history is considered, regardless of time elapsed. Driver disqualifying oences are categorised into category
A, B and C oences. Persons convicted of category A driver disqualifying oences are ineligible for DA. Persons
convicted of a category B driver disqualifying oence cannot hold DA unless they can demonstrate an exceptional case
exists. DA can also be refused if a person is convicted of a category C driver disqualifying oence or charged with a
driver disqualifying oence (any category) and the charge has not been nally disposed of.
Information bulletin Driver Authorisation - Eect of a Driver Disqualifying Oence PT17 provides more information
about category A, B and C disqualifying oences.
Driving history checks are part of the DA application process for assessing the suitability of a person to hold DA.
Information bulletin Driver Authorisation - Eect of a Driving History PT16 provides more information.
A DA application will not be accepted where an applicant has an alcohol interlock condition on their driver licence.
Applicants must obtain and submit a Medical Certicate for Motor Vehicle Driver (form F3712) assessed in accordance
with the commercial medical standards set out in Austroads Assessing Fitness to Drive – For Commercial and Private
Vehicle Drivers publication. This publication is available from the Austroads website www.austroads.com.au.
The certicate must be no more than six months old. The applicant is responsible for payment of all fees associated
with the issue of the certicate. Medical certicates not using form F3712 may be not be accepted. Once an authorised
passenger transport driver turns 75 years of age, the driver is required to submit a medical certicate issued for a
commercial vehicle driver to the department on an annual basis.
There are two categories of DA:
• Booked hire/taxi - authorises a driver to provide any public passenger service that requires DA including those
services provided under General DA. Required by drivers of taxi and booked hire services (including services
provided under a limousine licence).
• General - authorises a person to provide any public passenger service other than a taxi service or booked hire
service.
From 1 September 2018 the scheduled and motorcycle tourist services DA categories have been replaced by general
DA.
Applicants for DA must have an entitlement to work in Australia
Holders of DA must have an acceptable criminal history
Holders of DA must have an acceptable driving history
Medical tness
Categories of DA
Instructions
Page 2 of 6 LTSR Forms Area F2978 CFD V01 Aug 2021
• A DA applicant must hold a current Australian open or restricted driver licence for the type of vehicle to be used
• Applicants for booked hire/taxi and general DA are required to have held an open, restricted, provisional or
probationary driver licence (Australian or overseas) for at least three years in total
• In addition, applicants for booked hire/taxi DA must have held for a continuous period of at least one year any of the
following licences or a series of the following licences:
• an Australian open, restricted, provisional or probationary driver licence
• or a corresponding foreign licence issued by an experienced driver recognition country or a recognised country
listed on the Austroads website. (These are countries recognised as having similar driver licensing standards to
Australia.)
Full payment of fees is required when the application is lodged. Information about DA fees may be found on the
department’s website www.tmr.qld.gov.au.
You will be required to allow the taking of a digital photo and the recording of a digitised signature to help verify your
identity and to reproduce the photo and signature on your industry authority card.
The application form must be lodged in person at a transport and motoring service centre (locations may be found on
the Queensland Government website www.qld.gov.au). The form must be accompanied by evidence of identity (EOI),
your driver licence, evidence of Australian work entitlement and full payment. If you are not the holder of a Queensland
driver licence, you may have to complete the New Customer Application (form F3503), and provide EOI. Refer to EOI
Requirements for Individuals/Organisations (form F4362).
The majority of applications are nalised within two weeks. Some applications can take longer while national criminal
and trac history checks are being obtained from other agencies. Upon approval of your application, you can use an
interim industry authority as evidence that you are authorised until your industry authority card arrives in the mail. To
obtain your interim industry authority by email ask to sign up for the department’s e-reminders when submitting your
application. For more information on e-reminders please refer to www.qld.gov.au/transport/enotice.
DA fees
Digital photo and signature
How to submit your DA application
Driver licence requirements
Page 3 of 6 LTSR Forms Area F2978 CFD V01 Aug 2021
continued over page...
Driver Authorisation Application
Transport Operations (Passenger Transport) Act 1994
This form is to be used if you are applying for Queensland driver
authorisation (DA) to drive a public passenger vehicle.
1. Personal details
Family name
Given name/s
Residential address
Postal address (if dierent to residential address)
Postcode
Postcode
Mobile/Telephone number Telephone (other)
Email address
Date of birth Town/City of birth
/ /
State of birth Country of birth
Town/City and state of birth details must be supplied if born
in Australia
2.
3.
4.
Customer reference number
Driver licence details
Have you ever been known by any other name?
Do you have a departmental customer reference number
(CRN)? (A CRN is a Queensland driver licence number,
Adult Proof of Age card number, Photo Identication card or
Industry Authority number).
(a)
No
Yes
Complete a New Customer Application (form
F3503)
Provide CRN and then go to Q3
Was your driver licence issued in Queensland?
No
Yes Go to Q4
Please provide interstate driver licence number
State issued Expiry date
Note: you will need to present your interstate driver
licence with your application.
Do you have either:
• a current Australian open driver licence
• a restricted driver licence issued by a court order for
driving a public passenger service.
No
Yes
You cannot hold DA.
(b)
/ /
No
Yes Give full details of all names
Go to Q5
5.
(a)
(b)
Have you lived in New Zealand or in another
Australian state or territory?
Have you lived in any other country for more
than 12 months in the last 10 years and been
aged at least 18 years of age or more for any
period during this time?
No
No
Yes
Yes
Give details, then go to (b)
Give details
Go to (b)
Go to Q6
Where?
Where?
When? (Year/s)
When? (Year/s)
6. Entitlement to work in Australia
(a) Are you an Australian citizen, Australian permanent
resident or a New Zealand citizen holding a special
category visa?
Your application will be accepted on presentation of
one of the following documents. Please tick (ü) which
documents you will be providing and provide details
below—
No
Yes
Go to (b)
Green Medicare Card
Full Australian Birth Certicate
Queensland Birth Extract
Australian Citizenship Certicate/Extract
Australian Naturalisation Certicate
Australian Passport
(which is not expired more than two years)
New Zealand Passport
Evidence of your permanent residency
Document number
Note: If your name is dierent from the name on the documents
you are providing this question, you need to submit a change
of name document. For a list of acceptable documents please
refer to Evidence of Identity Requirements for Individuals/
Organisations (form F4362).
Place of issue (if stated) Date of issue (if stated)
/ /
Print Form
Reset Form
Page 4 of 6 LTSR Forms Area F2978 CFD V01 Aug 2021
continued over page...
Driver Authorisation Application continued... Page 4 of 6
9.
10.
11.
Medical Fitness
Have you ever been convicted of a criminal, drug
or weapons oence or been charged with any of
these oences and the charge has not been nally
disposed of?
Have you ever had a DA or equivalent authority
suspended, cancelled or refused in Queensland or
elsewhere?
Applicants must submit a Medical Certicate for Motor
Vehicle Driver (form F3712) issued in accordance with the
commercial standards stated in the Assessing Fitness to
Drive - Commercial and Private Vehicle Drivers medical
standards. The certicate must be no more than six months
old. Certicates not using form F3712 may not be accepted.
Note: All criminal history must be declared regardless of time
elapsed. The department conducts a criminal history check on each
applicant.
(b)
(b)
Do you hold a current visa with a work entitlement?
Do you meet the driver licence requirements (refer
to page 2) for the category you are applying for?
No
No
Yes
Yes
One year
Four years
Two years
Five years
Three years
Your application cannot be processed. Please
contact the Department of Home Aairs about
your entitlement to work in Australia.
The application may be refused if you do not
meet these requirements.
Your passport, Visa Evidence Card or
Document for Travel to Australia will be
required by the department along with a
completed Authority to Check a Visa Holder’s
Work Entitlement (form F4595).
Go to Q8
7.
8.
DA categories and licence requirements
How long do you want your DA for?
(a) What category of DA are you applying for?
Booked hire/taxi [authorises the holder to
drive a vehicle being used to provide any kind
of public passenger service. Required for
drivers of taxi or booked hire services]
General [authorises the holder to drive a vehicle
being used to provide any public passenger
service other than a taxi service or booked hire
service]
/ /
Other
• The fee will be determined by the issue period chosen.
• If you hold a current work visa with a work entitlement, DA
will not be issued past your work entitlement end date.
• DA will not be issued past your medical certicate expiry
date.
Are you submitting your medical certicate with this
application?
No
Yes
Yes
Yes
No
No
This application will not be fully assessed
until the medical certicate is lodged.
Please provide date, place, oence and
outcome if known.
If known give the authority number and
details of the suspension or cancellation.
If insucient space, attach separate sheet
If insucient space, attach separate sheet
Page 5 of 6 LTSR Forms Area F2978 CFD V01 Aug 2021
Oce Use Only over page...
Driver Authorisation Application continued... Page 5 of 6
12. Driving history Statement
I declare that:
I understand my responsibilities as the holder of a driver
authorisation under the Transport Operations (Passenger
Transport) Act and I understand that failure to comply with
relevant legislation may result in the refusal, suspension or
cancellation of driver authorisation.
Please note: An applicant in this application shall not:
• wilfully make or authorise the making of a statement that
is misleading
• wilfully make or authorise the omission of any matter
or thing without which the application is misleading in a
material respect.
If you do not tell the truth in your application you may be
prosecuted under the relevant Acts or Regulations.
I state that I have read the above statement and the
information provided in this application is complete, true and
correct in every detail.
(a) In the last ve years have you had your driver
licence amended, suspended, cancelled or have you
been disqualied from holding or obtaining a driver
licence, or have you committed a trac oence
other than parking (for example, speeding)?
The department will be verifying your driving history.
Yes
No
Please provide date, place, oence
and outcome if known.
If insucient space, attach separate sheet
13. Applicant declaration
I give my consent for the department to conduct enquiries
it deems necessary to assess my application and ongoing
suitability to hold driver authorisation, including, but not
necessarily limited to:
• a national criminal history check through the Queensland
Police Service and a New Zealand criminal history check
through New Zealand Police if required. I authorise the
release of that information by Queensland Police Service,
the Australian Police Services and New Zealand Police to
the department
• a driving history check in all states and territories of
Australia
• enquiries with the courts, police, prosecuting authorities
or other relevant bodies or entities to enable the
department to make a full and informed assessment of
my suitability for DA
• verifying that I hold a current visa with an entitlement to
work in Australia if required
• verifying evidence of identity information provided in this
application.
I authorise the department to use this information to maintain
a database which is used to prepare correspondence,
monitor transactions and to provide accredited operators
and other relevant government agencies with information
relating to my DA.
I give my consent to the department taking, keeping, and
using my personal information, digital photo and digitised
signature for the issue of DA under the Transport Operations
(Passenger Transport) Act, or as otherwise authorised by
law.
Applicant’s signature
Date
/ /
Privacy statement: The department is collecting the information on this form to
assess your suitability for a DA. The department is authorised by the Transport
Operations (Passenger Transport) Act to collect this information and to obtain
information from other government agencies relating to your criminal and driving
history and by the Migration Act (Commonwealth) to verify your entitlement to
work in Australia. The documents collected for the purpose of this application will
be accessible by authorised departmental persons and some of this information
may be disclosed to the Queensland Police Service and interstate licensing
authorites as allowed under the Acts.
If this application is approved, and an industry authority card is produced, the
department’s card contractor will have controlled access to your information,
digital photo and digitised signature to make a card. Your information and digital
photo may be accessed by authorised departmental persons or police exercising
a power in relation to this Act, section 328A of the Criminal Code Act 1899 or
otherwise authorised under the Police Powers and Responsibilities Act 2000. The
department will not disclose your personal details, documents or digital photo to
any other third parties without your consent unless required by law.
click to sign
signature
click to edit
Driver Authorisation Application continued... Page 6 of 6
Page 6 of 6 LTSR Forms Area F2978 CFD V01 Aug 2021
continued over page...
Lodging Customer Service Centre (CSC) to complete
Oce Use Only - Checklist
/ /
Lodgement date CSC lodged at
Operator user ID
Booked hire/taxi
1:1 match performed
General
Further action
DA hub to complete
Approval of DA
Please indicate with a þ when completed/submitted, or a ý
when not required.
Criminal history check results
Is the application approved?
Driver licence requirements
EOI proof of
identication
Fee paid
Work entitlement
checked
Application
forwarded to DA hub
(If not sighted, specify reason)
(Amount paid) (Receipt number)
$
(Work entitlement end date)
(Expiry date)
(Issue date) (Expiry date)
_____/ _____/ _____
_____/ _____/ _____
_____/ _____/ _____ _____/ _____/ _____
Nil
History referred to PT
Approving ocer
Queensland driving
history
Interstate driving
history
Check for previous
DA history
Medical certicate
Yes
Approval entered on TICA
Refusal of DA - PT oce to complete
Decision maker
Application refused Issue refusal notice
Comments
Refusal request sent to DA hub
Page 1 of 2 LTSR Forms Area F3195 CFD V01 Feb 2017
continued page 2...
Private and Commercial Vehicle Driver’s
Health Assessment
Transport Operations (Passenger Transport) Act 1994
Transport Operations (Road Use Management) Act 1995
This form is provided to guide your treating doctor’s assessment of your medical tness to drive. This assessment should be
conducted in accordance with the national medical standards as set out in the Austroads Assessing Fitness to Drive - Commercial
and Private Vehicle Drivers publication (AFTD).
• When making your appointment to see your treating doctor, we recommend that you advise the reason for your visit so that an
appropriate length appointment can be made for you.
• It is recommended that you complete the health questionnaire below prior to attending your appointment.
• If you need to wear glasses/contact lenses/hearing aids when driving, take them with you to the assessment.
• At the beginning of your appointment, give this form to your treating doctor who will complete the rest of the form and retain it
for their records.
• After the assessment, your health professional will complete the Medical Certicate for Motor Vehicle Driver (form F3712) for
you to present to the Department of Transport and Main Roads (the department).
Your treating doctor’s fees are set at their discretion and you are responsible for the payment of these fees.
Important information
Part 1 - Health Questionnaire - to be completed by
the patient (this form will be kept by the health professional)
1.
1.
2.
3.
4.
Personal details (please print)
Family name
Given name/s
State/territory/country of issue
Date of birth
/ /
Driver licence number (if known)
Please answer the following questions by ticking the
applicable box. If you are unsure of a question, ask your
health professional what it means before answering. Your
health professional may ask you additional questions during
the assessment.
No
No
Yes
Yes
Are you currently being treated by a health
professional for any illness or injury?
Do you use any drugs or medications
prescribed by a health professional?
Do you use any drugs or medications not
prescribed by a health professional?
Have you ever had, or been told by a health
professional that you had any of the following?
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
4.12
4.13
4.14
4.15
4.16
4.17
4.18
4.19
High blood pressure
Heart disease
Chest pain, angina
Any condition requiring heart surgery
Palpitations/Irregular heartbeat
Abnormal shortness of breath
Head injury/Spinal injury
Seizures, ts, convulsions, epilepsy
Blackouts, fainting
Stroke
Dizziness, vertigo, problems with balance
Double vision, diculty seeing
Colour blindness
Kidney disease
Diabetes
Neck, back or limb disorders
Hearing loss or deafness
Psychiatric illness or nervous disorder
Sleep disorder, sleep apnoea or narcolepsy
5.
8.
6.
7.
Have you ever had an ear operation, or do you
use a hearing aid?
How frequently do you drink alcohol?
Have you ever had any serious injury, illness,
operation, or been in hospital for any reason?
Has anyone noticed that your breathing stops
or is disrupted by episodes of choking during
your sleep?
Daily Occasionally
Two-three times per week Never
2. Patient declaration
I declare that the information I have provided on this form for
my treating doctor is true and complete.
No Yes
Patient’s signature
Date
/ /
Important: Please do not send this completed assessment
to the department as it should be retained by the treating
doctor and form part of your medical le. Your treating
doctor’s recommendation regarding your medical tness
to drive should be recorded on the Medical Certicate for
Motor Vehicle Driver (form F3712).
click to sign
signature
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Part 2 - Clinical Examination - to be completed by the treating doctor
Patient’s details
Family name (please print)
Given name/s
Residential address
Postcode
Please be guided by the information your patient has provided
in Part 1 - Health Questionnaire. You may apply appropriate
tests other than those outlined here i.e. mine mental state, or
equivalent for cognitive conditions.
1.
2.
3.
4.
5.
Cardiovascular system
Chest/Lungs
Abdomen (Liver)
Neurological/Locomotor
Vision
1.1
2.1
3.1
4.1
5.1
4.2
4.5
4.6
4.3
4.4
1.2
1.3
1.4
Blood pressure - (repeat if necessary)
Chest/Lungs
Abdomen (liver)
Cervical spine rotation
What is your assessment of the person’s visual
acuity?
Back movement
Reexes
Romberg’s sign
Upper limbs
Lower limbs
(a) Appearance
(a) Appearance
(b) Joint movements
(b) Joint movements
Pulse rate
Heart sounds
Peripheral pulses
Systolic
Diastolic
mmHg
mmHg
mmHg
mmHg
Regular
Normal
Normal
Irregular
Abnormal
Abnormal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Abnormal
Abnormal
Abnormal
Abnormal
Abnormal
Abnormal
Abnormal
Abnormal
Abnormal
Abnormal
A pass requires the ability to maintain balance while
standing with shoes o, feet together side by side,
eyes closed and arms by sides, for 30 seconds.
R 6/ L 6/ Binocular 6/
5.2 Does this person need to
wear glasses or contact
lenses for driving?
Yes
No
5.3
Visual elds
(confrontation to each eye)
Normal Abnormal
6.
8.
9.
10.
7.
Hearing (Commercial vehicle drivers only)
Neuropsychological assessment
Relevant clinical ndings
Assessment
Urinalysis
6.1
8.1
7.1
7.2
Hearing
Score
Protein
Glucose
Normal
Normal
Normal
Abnormal
Abnormal
Abnormal
Where clinically indicated, apply the Mini Mental State
Questionnaire or General Health Questionnaire or
equivalent.
Note comments on any relevant ndings detected in
the questionnaire or examination, making reference to
the requirements of the standards outlined in the AFTD
guidelines.
Which standard did you assess your patient against in the
AFTD?
Private Commercial
Treating doctor’s full name (please print)
Signature
Date of examination
/ /
Your recommendation regarding your patient’s medical
tness to drive should be provided on the Medical Certicate
for Motor Vehicle Driver (form F3712)
Important: Please do not send this completed
assessment to the department as it should be retained
by you and form part of your patient’s medical le. Your
recommendation regarding your patient’s medical tness
to drive should be recorded on the Medical Certicate for
Motor Vehicle Driver (form F3712).
Page 2 of 2 LTSR Forms Area F3195 CFD V01 Feb 2017
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Driver Authorisation Application (Department of the Environment and Energy)

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