Académique Documents
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Culture Documents
Part A - Personal Details 16. Have you ever held a driver licence issued by another state
or territory?
Please note: if your details change you must notify Note: If you have held a driver licence from another state or
Enrolment Services Roads and Maritime Services within territory in the last 5 years you will be required to provide a
7 days. copy of your driving history from that state.
1. Surname (family name)
Yes if yes give details State/territory of issue
No
2. Given names
Date issued Date cancelled / expired
day
/ month
/ year day
/ month
/ year
3. Sex Male Female
4. Date of birth 17. Are you now or have you ever been known by another name
or date of birth?
/ /
day month year Yes if yes give details
5. Place and country of birth No
Details
8. Email address
12. Driver licence number 13. State issued and class Polaroid, black backed and
passport photographs
are not acceptable
14. Expiry date
AFFIX PHOTO HERE
day
/ month
/ year
15. How long have you held your NSW Driver licence for?
years
i Date v Date
/ / day
/ month
/ year
day month year
Court
Court
Outcome
Outcome
day
/ month
/ year
/ /
day month year
Court Court
Outcome Outcome
continued
UNCLASSIFIED
Catalogue No. 45071754 Form No. 1692 (05/2018) Page 3 of 6
SENSITIVE: PERSONAL
Application for an Authority to Drive a Bus
ii Date 24. Do you have any criminal convictions in NSW or
elsewhere which occurred more than ten (10) years ago
day
/ month
/ year (more than three (3) years ago if committed as a
juvenile) where you were imprisoned for more than 6
Details of offence months or the conviction/s related to a sexual offence?
This question requires you to provide details of any convictions
which occurred more than ten (10) years ago in which you were
imprisoned for more than 6 months or where the conviction related
to a sexual offence. You must provide details of any sexual offence
you have been convicted of even if the sentence was less than 6
Court months or where no sentence was served.
day
/ month
/ year
Details of offence
iii Date
day
/ month
/ year
Details of offence
Court
Outcome
Court
Outcome
ii Date
day
/ month
/ year
Details of offence
iv Date
day
/ month
/ year
Details of offence
Court
Outcome
Court
Outcome
iii Date
day
/ month
/ year
Please attach a separate sheet if you require more space Details of offence
Court
Outcome
26. Are you an New Zealand Citizen? I have listed all details of charges pending against me,
convictions recorded against me or proven offences against
Yes refer below me for any offence(s).
No
I am in possession of a valid Australian/New Zealand passport,
If yes please provide your New Zealand passport number or birth certificate or visa.
a certified copy of your New Zealand Citizenship Certificate.
I am aware that a person who attempts to obtain a driver
New Zealand passport number authority by false statement, misrepresentation or omission of
details likely to affect the application, shall be guilty of an
offence and liable to a penalty of up to $2,200 and any
authority issued may be cancelled.
27. If you are not an Australian or New Zealand Citizen, do
you hold the appropriate visa to lawfully seek I will comply with the Passenger Transport Act 1990 and 2014,
employment in Australia? associated regulations and conditions relevant to a driver
authority and understand that failure to do so may result in my
Yes refer below driver authority being suspended, cancelled or varied.
No
To be ticked if applying for a driver authority through an
If yes, please provide your passport number and the name accredited bus operator – e.g. State Transit Authority
of the country that issued your passport I consent to the disclosure of my personal information
Passport number (including traffic and criminal records, driver licensing records,
health records, any information provided by me in support of
this application and any other records obtained by Roads and
Maritime to enable the assessment of my application for a
driver authority) to the accredited bus operator (or an
Country of issue
agent/contractor of the accredited operator e.g. an employment
agency) facilitating my application.
A copy of your NSW driver licence. If you hold a driver Criminal History Results:
licence in another state or territory (ie not NSW you First results:
must supply a certified copy of your driver licence) NSW VIC QLD TAS
An original or certified certificate stating that you have SA WA FED NT
successfully completed the required training course
Revised results:
Evidence of Citizenship and Visa Status NSW VIC QLD TAS
Applicant Declaration signed SA WA FED NT
Bank: Westpac
BSB: 032-001 Eligibility check:
Account No: 170497 Min. 20 years of age OK Not OK
Current NSW driver licence OK Not OK
*please provide your driver licence number in the Birth certificate, Passport or Visa OK Not OK
reference field of your financial institution when Immigration check OK Not OK
processing your payment. You will need to provide your
Training completed OK Not OK
receipt number in the box below.
Passed Commercial standard Yes No
medical on Drives?
Receipt number Date
Mutual Recognition:
/ /
day month year Application received Yes No
Documentation provided Yes No
MASTERCARD VISA
Card number Valid until
/
CCV number
What is a CCV number? - Several numbers are printed in the signature area on the back of your card. The last three digits
make up the CCV Number.
Note: A surcharge of 0.4% applies to payments made by Visa/ Master Card. Amex and Diners Cards are not accepted.
$
Card holder's address