Application for a Licence to Drive a Private Hire Vehicle in the District of Medway

Form App-1

Licensing Unit Medway Council Gun Wharf Dock Road Chatham Kent ME4 4TR

APPLICATION FOR A PRIVATE HIRE DRIVER LICENCE FOR HOME TO SCHOOL TRANSPORT CONTRACT WORK ONLY

Applicants must complete ALL sections and SIGN before submitting to the Licensing Unit

Please write in BLOCK LETTERS. Note: Full names MUST be declared.

1. Last Name 2. First Name(s) 3. Previous Names or Aliases/also know as 4. Home Address

5. Postcode 6. Date of Birth 7. National Insurance No. 8. Home Telephone Number 9. Mobile Telephone Number 10 Email Address . 11 Receipt No. .

11.Current trade or occupation

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12. Have you ever previously held a private hire driver’s licence, private hire vehicle licence, private hire operator’s licence, hackney carriage driver’s licence or hackney carriage vehicle (proprietor’s) licence issued by this or any other council? If so, please state which council and the date?

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13. Have you ever been refused a private hire driver’s licence, private hire vehicle licence, private hire operator’s licence, hackney carriage driver’s licence or hackney carriage vehicle (proprietor’s) licence or had such a licence suspended or revoked, by this council or any other council. If so, please state which council and the date?

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14.Do you have a statutory right to live and work in the UK? YES  NO 

Form App-2 Applicant Declaration of Convictions, Cautions and Pending Prosecutions The Rehabilitation of Offenders Act 1974 Local Government (Miscellaneous Provisions) Act 1976 Full Name Date of Birth Address Postcode

Failure to disclose convictions, cautions and pending prosecutions can be taken into account when assessing applications / review of licences.

Section A – please answer all question in this section.

Please note: Proceedings relating to taxi driver (hackney carriage and private hire) licensing fall outside of the Rehabilitation of Offenders Act 1974. This means that any convictions or cautions must be declared irrespective of if they could normally be regarded as spent. Medway Council will consider any convictions when determining your application. The council, in appropriate cases, may take any cautions into account when determining your application.

Do you have any criminal convictions? If you have ticked yes you must give full details of all your convictions whether spent or YES  NO  not, as listed in Section B. Have you ever been cautioned by the police for any reason? YES  NO  If you have ticked yes you must give full details. Do you have any traffic convictions? YES  NO  If you have ticked yes you must give full details of all your convictions whether spent or not, as listed in Section B. Do you have any pending matters for which you are currently being investigated, for example, by the police or other enforcement agency? YES  NO  If you have ticked yes you must give full details. Do you have any pending criminal or traffic convictions? YES  NO  If you have ticked yes you must give full details. Do you have any convictions or pending matters in any other country? YES  NO  If you have ticked yes you must give full details.

If you have answered yes to any questions please give details in the table in Section B or on a separate piece of paper).

Section B – please complete all this section. I do solemnly and sincerely declare that (tick either declaration 1 or 2 as appropriate):

EITHER 1 I do not have any convictions or cautions to declare and I am not subject to any pending prosecutions or being investigated for any other matter.  OR 2 I list here full details of all convictions and cautions I have ever received. I also list full details of any offences for which I am currently being prosecuted or  other matter for which I am being investigated.

IMPORTANT: It is an offence under Section 57(3) of the Local Government (Miscellaneous Provisions) Act 1976 for any person to knowingly or recklessly make a false statement or omit any material particulars in giving the required information. It is an offence for any person to act as a driver of a private hire or hackney carriage vehicle licensed by Medway Council without having first obtained the appropriate driver licence from Medway Council.

Convictions, Cautions and Pending Prosecutions Details (INCLUDING Motoring and Criminal)

Date Type of Conviction Court or Offence or Pending Matter Penalty Convicted (Criminal, Police Motoring, Caution or Pending Matter) Example Example Example Example Example 28.07.09 Motoring Conviction 1733 or IN10 Driving without insurance £500 fine M/C and 6pts If necessary, please continue on a blank sheet of paper

I declare that to the best of my knowledge and belief that the information provided is true and correct.

Date: ……………………….. Signed: ………………………………………………………….…….. (signature of applicant)

Form App-3

Data Protection Mandate, Declaration and Statement of Truth

Release of Information in Accordance with the Provisions of the Data Protection Act 1998

Medway Council is a Data Controller under the Data Protection Act 1998. We hold information for the purposes specified in our Data Protection Notification made to the Information Commissioner and may use this information for any of them. We may get information about you from others, or we may give information to them. If we do it will be only as the law permits, to check accuracy of information, prevent or detect crime, or to protect public funds. We may check information we receive about you with what is already in our records. This can include information provided by you as well as by others such as government departments and statutory agencies. We will not give information about you to anyone outside Medway Council unless the law permits us to do so.

By completing this document you give Medway Council the authority to collect and retain information about you for the purpose of licensing yourself as a private hire and/or hackney carriage driver. In order to grant a licence, we may need to check this information with other enforcement agencies, local authorities or government departments.

We must protect the public funds we handle and so we may use the information you have provided on this form to prevent and detect fraud. We may also share this information with other enforcement agencies, including those organisations’ which handle public funds. Medway Council will not disclose information about you unless the law permits.

Declaration & Consent

I consent to the contents of the DBS disclosure being divulged to members of the Licensing Authority and council officers serving that authority.

I understand that Medway Council may liaise with the UK Border Agency to verify that I am permitted to live and work in the UK.

I declare that I have a statutory right to work in the UK.

I declare that to the best of my knowledge and belief the answers given in my application are true. I am aware that making a false declaration or statement of truth is an offence and may be subject to legal proceedings. If a licence is granted I undertake to comply with the conditions attached on the grant of the licence. Should I engage in other employment, I also agree to partake of sufficient rest and refreshment after finishing work before commencing driving for hire.

Should I be granted a licence, I understand I am required to immediately notify the Licensing Unit of any convictions, cautions and/or penalty points that I receive from the date of this application.

Date: ……………………….. Signed: ………………………………………………………….…….. (signature of applicant)

Form App-4

FORM OF ENDORSEMENT OF PHOTOGRAPH

Please staple the photographs in the spaces below after one of them has been endorsed with a Statement verifying the likeness of the photograph to the applicant. Please then ask the person endorsing the photograph to complete the details below.

Attach Attach Attach photograph photograph photograph here here here

Name of applicant in the above photograph

Address of applicant in the above photograph

Name of person who has endorsed the back of the photograph

Address of the person who has endorsed the back of the photograph Telephone Number of the person who has endorsed the back of the photograph The formal role/function of the person who has endorsed the back of the photograph (e.g. Company Secretary, Hospital Manager, Head Teacher, Head of Recruitment, Finance Director, Senior Partner.)

Form App-5

Equality Monitoring Form

You are asked to complete this monitoring form to assist us in monitoring equality in relation to race/ethnicity, including colour, nationality and national/ethnic origins

Ethnic Origin - Please tick the box which most closely describes your cultural background:

White British White Irish

Any other White background (please specify) ……………………………………..

MULTI ETHNIC

Black Caribbean and White Black African and White Asian or Asian British

Any other multi ethnic background (please specify) ………………………………

ASIAN OR ASIAN BRITISH

Indian Pakistani Bangladeshi

Any other Asian background (please specify) …………………………………….

BLACK OR BLACK BRITISH Caribbean British African

Any other Black background (please specify) …………………………………….

CHINESE OR OTHER ETHNIC GROUP

Chinese

Any other ethnic group (please specify) ……………………………………………