Drivers Licence DisclosureThis form is for all Ingham staff as a form of identification, and must be completed by all staff who may drive a company and/or customer vehicles as a part of their role with Ingham. Please enable JavaScript in your browser to complete this form.Personal Details – Step 1 of 2Ingham Drivers Licence Disclosure. Name *FirstLastIngham Location *Select your locationAuckland | North Shore – NissanAuckland | West Auckland – NissanAuckland | North Harbour – Hyundai, Isuzu & RenaultAuckland | Auto Super Shoppe SilverdaleAuckland | Mercedes-Benz AucklandHamilton | Hamilton – Hyundai & IsuzuHamilton | Ingham AutomotiveHamilton | Hamilton – MitsubishiHamilton | Hamilton – Mercedes-BenzCambridge | Ingham Cambridge – Nissan & MitsubishiTe Awamutu | Ingham Te AwamutuMount Maunganui | Ingham-SearsTaupo | Great Lake – Hyundai, Isuzu, Omoda & JaecooTaupo | Mitsubishi, Kia, Suzuki & HondaNapier | Mercedes-Benz Hawkes BayNationwide | Ingham Group ServicesThe locations above are all associated businesses of Ingham Group Services Limited.Confirmation of Drivers Licence DisclosureI confirm that I have a valid Drivers LicenceI do not have a valid Driver LicenceI have an internationally NZ accepted Drivers LicenceI do not wish to submit my Drivers LicenceAcceptance of UseI understand Ingham will use my Drivers Licence for identification purposes and store it according to the Privacy Act 2020I will abide by the details outlined within Ingham motor vehicle policy.I will inform my direct manager immediately if my licence is lost, cancelled, impounded or restricted in anyway.I acknowledge if driving is required as part of my role with Ingham, that a change in my licence status or certain traffic infringements could impact my employment.I accept responsibility for any traffic infringements incurred while driving a vehicle under Ingham responsibility.Acknowledgement and acceptance of Drivers Licence Disclosure. PhoneDate Disclosure Submitted *Signature * Clear Signature NextDriver Check NZTA website including Driver Check information. Giving consent to access your information in Driver Check About Driver Check Driver Check is a safe and secure website set up by NZTA. It lets companies make sure they only have appropriately-licensed drivers driving their company vehicles. Information that can be released through Driver Check Driver Check lets the company or service provider you work for (usually a nominated staff member) see the: • licence classes you hold (eg a class 4 licence to drive heavy trucks) • licence endorsements you hold (eg a D endorsement to carry dangerous goods) • conditions on your licence (eg if you have to wear glasses or contact lenses while driving) • status of your licence (eg current, expired, limited, suspended, disqualifi ed, revoked or reinstated). If you’re added to the driver list for this company, NZTA will automatically let them know if any of the above information about your driver licence changes. The company can only access Driver Check if they’ve agreed to NZTA’s terms and conditions. Those terms and conditions include meeting the requirements in the Privacy Act 2020. If the company doesn’t meet the terms and conditions, they could have their Driver Check access removed. Getting your consent To get your information from Driver Check the company must: • have your consent before they access your licence record • keep a copy of that consent • give you a copy of that consent if you ask for it • give a copy of that consent to NZTA if we ask for it for auditing purposes • have your permission before releasing any information gathered through Driver Check to any third party. Withdrawing your consent By signing this form, you’ll be agreeing to the information listed above being released to the company or person you name. You may, at any time, withdraw your consent for a company to access your driver licence information through Driver Check. To withdraw your consent: • you must tell the company you want to be removed from their Driver Check list (In writing). • you can also contact driver.check@nzta.govt.nz and tell NZTA that you’d like to be removed from the company’s Driver Check access. Please be aware that NZTA will contact the company and let them know that you’ve asked to withdraw your consent. Your privacy The company using the Driver Check service must meet the requirements in the Privacy Act 2020. In particular, they must follow the information privacy principles set out under section 22. If you have any questions or concerns about your privacy, contact the company using the Driver Check service or fi nd more information on the Privacy Commissioner’s website at www.privacy.org.nz NZTA is also required by law to keep certain personal information from the Driver Licence Register available on inquiry to members of the public under section 199 of the Land Transport Act 1998. If you have any questions about the information NZTA holds about you, please email info@nzta.govt.nz Consent to access my information in Driver Check Please carefully read the information above about giving your consent before you sign this form. Drivers Licence holder's nameFirstMiddleLastDrivers Licence Name as it appears on your licence.Driver licence numberCar Class TypeFULLRestrictedLearnersVersionDate of birthAttach a photo of your Drivers Licence Click or drag files to this area to upload. You can upload up to 2 files. Ensure you provide the front AND back.CheckboxesI authorise Ingham Group Services Limited and all its associated businesses, to access my drivers licence status using the NZ Transport Agency Waka Kotahi Driver Check service.Access is given for the duration of my employment or contract with this company.Drivers Licence holder's Signature Clear Signature Driver Check Approval DateSubmit
