Fillable STRICTLY PRIVATE AND CONFIDENTIAL NEW PRIVATE HIRE DRIVER (Guildford Borough Council)

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STRICTLY PRIVATE AND CONFIDENTIAL NEW PRIVATE HIRE DRIVER (Guildford Borough Council)

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STRICTLY PRIVATE AND CONFIDENTIAL NEW PRIVATE HIRE DRIVER APPLICATION FORM
Guildford Borough Council – Application for a New Private Hire Driver JAN2020 Page 1 of 5
Before you apply you must have passed the Council’s Private Hire driver knowledge test within the past 3
months. If you have not passed this test, your application will be rejected. With your application, you must
provide the documents detailed in the checklist at the end of this form. If these documents are not
provided or have expired, then your application will be rejected.
Please complete all sections of the application form. Incomplete applications will be rejected. If you
have any questions relating to the application process or requirements, please refer to the Council’s
Licensing Policy (available at www.guildford.gov.uk/taxi) or contact the Licensing Office.
APPLICANT DETAILS
Title Full Name
Date of Birth Place of Birth
Previous Name(s) Date(s) Known
National Insurance
Number
Nationality
Email Address
Home Phone
Number
Mobile Number
Current Home
Address incl.
postcode
Date moved
to current
address
Have you lived and worked in the UK since birth, without
interruption?
YES NO
If NO, please
provide details:
APPLICATION FOR THE GRANT OF A PRIVATE HIRE
DRIVER LICENCE
Local Government (Miscellaneous Provisions) Act 1976
STRICTLY PRIVATE AND CONFIDENTIAL NEW PRIVATE HIRE DRIVER APPLICATION FORM
Guildford Borough Council – Application for a New Private Hire Driver JAN2020 Page 2 of 5
ADDRESS HISTORY
Please provide previous addresses covering the past 5 years. Do not leave any gaps. Continue on a separate sheet if
necessary.
DRIVING LICENCE DETAILS
Driving Licence number
How many years have
you held the licence?
Is your Driving Licence
registered in your
current address?
Yes No Valid until
Issuing Authority DVLA Other
(Specify)
Category / Group
Entitlement
EMPLOYMENT
I
f you are currently not driving as a Hackney Carriage/Private Hire driver, you must notify the Council should you start
working for an operator or proprietor.
Previous Address
incl. postcode
Dates
From
to
Previous Address
incl. postcode
Dates
From
to
Do you currently or have you previously held a Hackney Carriage / private
hire driver’s licence with Guildford Borough Council or another local
authority, including Transport for London?
YES NO
Have you ever been refused a Hackney Carriage / Private Hire driver’s
licence with another local authority / TfL, or had a licence suspended or
revoked?
YES NO
If YES, please provide
Will you be carrying out any other employment while working as a licensed
driver?
YES
NO
details of employment and
hours worked:
Name and Address of
Employer
Name of all Private Hire
Operators you will be
driving for:
Wheelchair Accessible
YES NO
Have you completed the
DVSA Wheelchair
Assessment?
YES NO
STRICTLY PRIVATE AND CONFIDENTIAL NEW PRIVATE HIRE DRIVER APPLICATION FORM
Guildford Borough Council – Application for a New Private Hire Driver JAN2020 Page 3 of 5
MEDICAL HISTORY
Have you ever suffered from any physical or mental medical condition or
illness, or other disability which could impair your ability to drive?
YES
NO
Have you ever been advised by a doctor that you should not drive?
YES
NO
If YES, please
provide details:
OFFENCE HISTORY
Please declare details of any Convictions, Spent Convictions, Motoring offences (including endorsements, periods of
disqualification and driver awareness courses), Cautions, Discharges, Fixed Penalty Notices, Anti-Social Behaviour
Orders, County Court Judgements, Warning, Reprimands, Restraining Orders, Criminal Behaviour Order or if are you
subject to current enquiries which could lead to any of the above in the box below.
A previous conviction may not prevent you from obtaining a licence. Please refer to the Councils policy on convictions
for further guidance. Continue on a separate sheet if necessary.
If you omit any information your application is likely to be refused and you could be prosecuted.
Details of conviction,
caution, charge or notice
Date of conviction,
caution, charge or notice
Issuing Authority
(Court / Police)
Sentence
Have you been convicted of an offence in another country?
YES
NO
Have you ever been arrested but not charged?
YES
NO
If YES, please provide
details:
STRICTLY PRIVATE AND CONFIDENTIAL NEW PRIVATE HIRE DRIVER APPLICATION FORM
Guildford Borough Council – Application for a New Private Hire Driver JAN2020 Page 4 of 5
CERTIFICATES
DECLARATION
I HEREBY make an application to Guildford Borough Council for the grant of a Private Hire Driver’s licence subject to
the Statutes, Regulations, Policies and Conditions relating to the same for the time being in force.
I declare that I am over the age of 18, and I have held a full DVLA licence (or equivalent) for at least one year, and I
have the right to live and work in the United Kingdom.
I declare that I have checked the information on this application and to the best of my knowledge and belief it is
correct. I understand that it is an offence for any person to knowingly or recklessly make a false statement or to omit
material information for which I could be prosecuted, and any licence issued suspended or revoked.
I understand that should I engage in other employment, I also agree to partake of sufficient rest and refreshment after
finishing work before commencing driving for hire.
I declare that I have supplied all the appropriate supporting documentation listed in the checklist below, and I am
aware that if any of the information supplied on this application should change, I need to inform the Council in writing
and pay the fee for amending the licence, if applicable.
I understand that I must undertake to comply with the legislation, byelaws, policy, code of conduct and conditions of
licence as are now, or may hereafter be in force, for regulating hackney carriage or private hire business and drivers
within the said Borough.
The information you provide on this form will be used by Guildford Borough Council for licensing purposes. We may
share your information and make any other necessary enquiries regarding your application with other departments
and statutory organisations in relation to the application. Your personal information will be processed in line with Data
Protection legislation and we will not disclose information about you to anyone outside the Council unless the law
permits or requires us to.
The Council is under a duty to protect the public funds it administers and to assist other agencies in the prevention
and detection of crime. We may use the information provided on this form for this purpose, and share this information
with other bodies responsible for auditing or administering public funds.
Under Section 51(3) Local Government (Miscellaneous Provisions) Act 1976, the local authority is required to maintain
a register of private hire vehicle licences, including the following details which are available for inspection by members
of the public: The name of the person to whom it is granted; the date on which and the period for which it is granted; if
the licence has a serial number, that number. As Guildford Borough Council issues dual Hackney Carriage and
Private Hire Licences, the above applies to both.
We will retain your data for as long as it is required for our administrative use, after which it will be securely disposed
of.
Date you completed the BTEC Qualification Certificate in the role of the
professional taxi and private hire driver completed within the last 3
years?
Date
Date you completed the Safeguarding Adults and Child Sexual
Exploitation Course?
Date
Signature of applicant:
Date:
click to sign
signature
click to edit
STRICTLY PRIVATE AND CONFIDENTIAL NEW PRIVATE HIRE DRIVER APPLICATION FORM
Guildford Borough Council – Application for a New Private Hire Driver JAN2020 Page 5 of 5
If you believe the data we process on you is incorrect you may request to see this information and, if necessary have it
corrected or deleted. If you wish to raise a complaint you can contact our Data Protection Officer at the address
below. If you believe we are not processing your data lawfully you can complain to the Information Commissioner’s
Office (https://ico.org.uk/). Further details are available on our website - https://www.guildford.gov.uk/dataprotection
, or
from the Information Rights Officer, Guildford Borough Council, Millmead House, Millmead, Guildford, GU2 4BB
(email:
foi@guildford.gov.uk).
APPLICANTS CHECKLIST
Your application will not be accepted without all appropriate documentation:
Type of
application
Required Document Check
Box
DVLA / Equivalent Driving Licence
Must be in the name of the applicant
Right to work document
Passport or Birth Certificate
Passport Photos X2
Must be recent photos
Proof of address issued within the last 3 months
Bank statement or utility bill (we do not accept credit card statements or mobile phone bills)
Enhanced DBS Certificate
Must have been issued within the past 3 months
BTEC Level 2 Certificate in the Introduction to the Role of the Professional Taxi and Private Hire
Driver
Required by 1
st
January 2019 for ALL drivers
Payment of the fee, by debit or credit card.
Please note, we do not accept cash
Group 2 Medical Form
Must be completed by a registered doctor and completed within the last 3 months
DVSA Private Hire/Hackney Carriage driving assessment pass certificate
Safeguarding Adults and Child Sexual Exploitation Pass Certificate
Knowledge Test Pass Certificate
Must have been passed within the past 3 months
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Completed 26 December 2020

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