Driving School Instructor License Application Form (Page 2 of 2) in pdf

VEHICLE INFORMATION

TO BE COMPLETED BY INSTRUCTOR WITH VEHICLE ONLY:

Make: ______________________________

Model: _______________________ Year: ____________________

V.I.N.: _________________________________________________ Provincial Plate No.: _____________________

*** READ CAREFULLY BEFORE SIGNING THIS APPLICATION ***

This application may contain personal information as defined under the Municipal Freedom of Information and Protection

of Privacy Act. The information collected is required pursuant to the terms of the Municipal Act and will be used by the City

of Vaughan to process the application, and to determine whether to issue a license. Information will also be used for

administration of such license, and for law enforcement purposes to ensure compliance wilth all applicable statutes,

regulations and by-laws.

Questions relating to the collection of this information should be directed to the Licensing Officer, 2141 Major Mackenzie

Drive, Vaughan, Ontario, L6A 1T1, (905) 832-8504.

By signing this application the Applicant agrees that all information provided is true. The Applicant further agrees that any

false information may result in a revocation of any license that may be issued.

Signature of New Applicant: ___________________________________ Date:_____________________________

By signing the renewal portion this application below the Applicant agrees that all information provided is true. The

Applicant further agrees that any false information may result in a revocation of any license that may be issued

Renewal Signature of Applicant: ________________________________ Date: ____________________________

OFFICE USE ONLY

License Number:_____________ Accepted By:__________________

Date of Issue:__________________________

Comments:________________________________________________________________________________________

_________________________________________________________________________________________________

________________________________________________________________________________________________

Renewal Number:____________ Accepted By:__________________

Date of Issue:__________________________

Comments:________________________________________________________________________________________

_________________________________________________________________________________________________

Renewal Number:____________ Accepted By:__________________

Date of Issue:__________________________

Comments:________________________________________________________________________________________

_________________________________________________________________________________________________

Renewal Number:____________ Accepted By:__________________

Date of Issue:__________________________

Comments:________________________________________________________________________________________

Form Feb 1/09

Driving School Instructor License Application Form Page 2