Application For Mutual Recognition Of Public Passenger Or Driving Instructor Registration Form - Western Australia Department Of Transport
ADVERTISEMENT
1
2Government of Western Australia
E 33
Department of Transport
Application for Mutual Recognition
of Public Passenger or Driving Instructor Registration
Section 1 -
Taxi Driver
commercial bus Driver
Driving instructor
Applicant’s Personal Details
Family Name
Given Names
Date of birth
Place of birth (include city/ Town and country)
Home Address
Suburb
Post code
Postal Address
Suburb
Post code
Home PHoNe
WorK PHoNe
mobile PHoNe
FAx
oTHer NAmeS (HAve you ever beeN KNoWN by ANy oTHer NAme? iF yeS, WHAT NAmeS Are THey?)
emAil
Section 2 -
Details of interstate Drivers licence or any previous WA driver licence held
• Copies of the current licence must accompany this form
STATe/ TerriTory
liceNce Number
clASSeS HelD
iNiTiAl iSSue DATe
exPiry DATe
Section 3 -
Details of Taxi/ bus Driver or Driving instructor registration
(‘Registration’ includes any Driver Authority, Licence, admission, approval, certificate, etc.) Specify all the States and/or Territories in
which you currently hold, or have previously held registration
• Copies of the current registration must accompany this form
TAxi/ buS Driver
iSSue DATe
exPiry DATe
SPeciAl coNDiTioNS
STATe/ TerriTory
TyPe oF quAliFicATioN
STATe/ TerriTory
TyPe oF quAliFicATioN
iSSue DATe
exPiry DATe
SPeciAl coNDiTioNS
DriviNG iNSTrucTor
iSSue DATe
exPiry DATe
quAliFieD To iNSTrucT iN AuTHoriSATioN/clASS:
STATe/ TerriTory
liceNce Number
Section 4 - Details of previous Taxi/bus Driver employment
(Not Applicable for Driving instructors)
Please provide details of all previous Companies, Networks or Dispatch Services that you have worked for
NAme oF orGANiSATioN/S
coNTAcT NAme/S
coNTAcT PHoNe Number
NAme oF orGANiSATioN/S
coNTAcT NAme/S
coNTAcT PHoNe Number
Is your registration in any State or Territory cancelled, suspended or disqualified as a result of disciplinary action, or are you prohibited
from carrying on the occupation of taxi/ bus driver or driving instructor?
No
Yes, please give details
Are you subject to any disciplinary proceedings (including preliminary investigations or actions that may lead to
disciplinary proceedings) in relation to taxi/ bus driving or driving instruction in any State or Territory?
No
Yes, please give details
Do you have any unresolved complaints made about you?
No
Yes, please give details
Note: your application may be refused if any statements or information in this notice are false or misleading.
if the State/Territory’s governing body fails to respond, it is the client’s responsibility to
supply the information required to support your application for mutual recognition.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For Permit To Mix, Blend And/or Distributealcohol-gasoline Blends Form - Mississippi Department Of Agriculture And Commerce
Legal
Application For Class I, Ii & Iii Owts Designer's License Exam Form - Rhode Island Department Of Environmental Management
Legal
Application For A Winding Engine Driver's Certificate Of Competency - Western Australia Department Of Mines And Petroleum
Legal
Form 20 Notice To Tenant Of Breach Of Agreement - Government Of Western Australia, Department Of Commerce 2013
Legal
Related Categories
Parent category: Legal