Form F3948 Cfd Driver Trainer And Rider Trainer Accreditation Application (Page 3 of 4) in pdf

Driver Trainer and Rider Trainer Accreditation Application continued... page 3 of 4

14 - Applicant’s declaration

Other Driver Trainer qualifications (please detail below)

I consent to the department verifying my EOI information

and using my personal information, digital photo and

digitised signature for the purposes associated with my

application for a Driver/Rider Trainer Accreditation.

Please attach a copy of your qualification(s) and statements

I declare that I have read the above statement and that the

of attainments for the specific competency units.

answers given by me are complete, true and correct in every

11 -

Have you read, and do you understand the

detail.

Code of Conduct for Queensland Accredited

I understand that any false misleading or incorrect

Driver Trainers?

information provided by me may result in the immediate

cancellation of the Driver/Rider Trainer Accreditation.

Yes

You cannot proceed with this application

unless you answer yes to this question.

Consent to conduct enquiries

Note: If you are teaching/training a person under the age of 18

In making this application, I agree to the department

years you should be aware that the Queensland Public Safety

carrying out those enquiries it deems necessary to

Business Agency requires the possession of a suitability card (blue

determine if I meet the suitability requirements for a Driver/

card).

Rider Trainer Accreditation and to conduct such enquiries

12 - Fitness to perform industry authority role

during the period of my accreditation to assess my ongoing

suitability to hold the licence. Such enquiries include, but are

Do you have a medical condition that may prevent you from

not limited to:

satisfactorily performing the activities authorised under a

• a driving history check in all states and territories of

licence or certificate?

Australia

Yes

You are required to have your treating

• a national criminal history check (charges including

doctor complete Section 13 Medical

those yet to be determined, convictions and certain

Practitioner Certification.

investigative and disciplinary information) through the

13 - Medical Practitioner Certification

Queensland Police Service or a New Zealand criminal

check (if applicable)

Driver/Rider Trainer

• enquiries with the courts, police, prosecuting authorities

A driver/rider trainer provides verbal advice, practical

or such as other relevant bodies or entities necessary

demonstration and instruction to a learner driver/rider. This

to enable the department to make a full and informed

can be either by being seated next to the learner driver (in

assessment of my suitability for a Driver Rider Trainer.

a car or truck) or by riding another motorcycle. Therefore,

medical certification is required to ensure that the applicant

Consent for the release of information

has the physical and mental capacity to perform the role.

I consent to the release of that information by the

I have examined the applicant having regard for the health

Queensland Police Service and the Australian Police

and safety of the public generally, and state that the

Service to the department. I understand that the release of

applicant:

my criminal history by those authorities is subject to relevant

is mentally and physically an appropriate person to

legislation.

hold an approval

Responsibilities as a Driver/Rider Trainer

is not mentally and physically an appropriate person

I understand my responsibilities as a Driver/Rider Trainer

to hold an approval

under the Transport Operations (Road Use Management)

Doctor’s name (please print)

Act.

I understand that failure to comply with the statutory

Address or stamp

accreditation conditions and the Code of Conduct for

Queensland Accredited Driver Trainers may result in the

amendment, suspension or cancellation of my accreditation

as a trainer.

Sign only in the presence of a departmental officer.

Applicant’s signature

Date

Telephone number

Doctor’s signature

Privacy Statement: The department collects the information on this

form under the Transport Operations (Road Use Management) Act and

Transport Planning and Coordination Act for managing the Driver and

Rider Trainer Accreditation scheme. Where required, the department

Date

usually discloses some or all of this information, to its agents and

contractors, the Queensland Police Service and other Queensland,

interstate and federal government agencies. In the event that you apply for

a product of another government agency, your digital photo and digitised

signature may be used by this department to issue you with the prescribed

authority. The department will not disclose your personal information to any

other third party without your consent unless authorised or required to by

law.

continued next page...

Page 3 of 4 TRB Forms Area Form F3948 CFD V01 Jul 2016

Form F3948 Cfd Driver Trainer And Rider Trainer Accreditation Application Page 3

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