L2P Supervising Driver Application Form

The personal information in this form is for the purpose of registration as a Learner Driver with the L2P program. The information will be used for this purpose only and will not be disclosed to other organisations unless required by law.


Personal Details

Maximum characters 255
Maximum characters 255
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Emergency Contact

Maximum characters 255
Maximum characters 255

Drivers License Details

Do you hold a full Victorian drivers licence? required
Maximum characters 255

Referees

Please provide details of two professional (work, study, or community-based) referees who you authorise for us to contact who can provide a character reference. Referees must have been known by the applicant for 12 months and must not be family members

Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255

Availability

Options are limited to
Maximum characters 255
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Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255
Maximum characters 255

Permission to undertake further activities

Note: The personal information requested on this form is being collected by the Glenelg Shire Council for municipal purposes as specified in the Local Government Act 1989. The Council will use this information only for the specific purpose of collection or for directly related purposes. The information will not be disclosed except as required or specifically authorised by law. You may request access to any personal information that Council may have collected about you. Also, you may request correction of your personal information if you can establish that it is not accurate or complete. Such requests should be directed to Council’s Privacy Officer on telephone 03 5522 2305.

I agree to undertake all training relevant to the L2P program required
I agree to undertake a Working With Children Check OR I hold a current Working With Children Check required
I agree to undertake a VicRoads Driver History Report on my behalf OR I hold a current Driver History Report required
I give permission for my information to be shared with VicRoads for reporting purposes required
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