New Zealand Gazette – 1926 – No. 28

Page 1254

✨ Motor-omnibus Regulations Forms



1254
THE NEW ZEALAND GAZETTE.
[No. 28

INFORMATION TO ACCOMPANY DRIVER’S APPLICATION FOR A LICENSE.
THE following questions must be answered by applicant:—

  1. What is your name in full ?
  2. (a.) What is your age next birthday ?
    (b.) What is the date of your birth ?
  3. Have you ever spat blood or had rheumatic fever, rheumatism, habitual cough, asthma, disease of the heart, or any serious disease or accident involving absence from work for more than a week at a time ; or have you been invalided from, or declined after examination for, any public service or life insurance company ?
  4. (a.) Has any motor-omnibus driver’s license ever been issued to you ?
    (b.) If so, by what licensing authority or authorities ?
  5. (a.) Have you ever been refused a motor-omnibus driver’s license ?
    (b.) If so, by what licensing authority or authorities, and on what date or dates ?
    [NOTE.—The applicant will be held responsible for the accuracy of the above statement. By wilfully suppressing any information he will be guilty of an offence.]

[Applicant’s signature.]

Date :

[Form D.

The Motor-omnibus Regulations, 1926.

MEDICAL CERTIFICATE.

  1. Height : ft. in. Weight : st. lb. Chest-measurement : in. (minimum, 34 in.).
  2. Has the applicant rupture, piles, or other swelling ?
  3. Has the applicant varicose veins ?
  4. Eyesight : Right eye, ; left eye, .
  5. Colour-vision :
  6. Hearing :
  7. Is the respiration natural, and are the respiratory sounds and the resonance of the chest normal ?
  8. Are the pulsations of the heart natural in rhythm and force, and are its sounds those of health ?
  9. Urine : Reaction, ; albumen, ; specific, ; sugar,
  10. Is the applicant free from all physical defect and disease ?
  11. Are there any circumstances connected with the health of the applicant which in your opinion tend to disqualify him from performing his duties efficiently ?
  12. Do you consider him well suited for employment as a motor-omnibus driver ?
  13. Has the applicant to your knowledge ever fainted or been subject to fits of any kind ?

Date :

, Medical Examiner.

[Form E.

The Motor-omnibus Regulations, 1926.

MOTOR-OMNIBUS DRIVER’S LICENSE.

[Full name and address], is hereby licensed by [State name of the licensing authority] as a motor-omnibus driver from the date hereof.
This license shall remain in force until the 31st day of March, 19 , and no longer.
The number of this license is :
The license is issued subject to the provisions of the Motor-omnibus Regulations, 1926.

Dated at , this day of , 19 .

[Signature of Town or County Clerk, &c., as case may be.]
[Name of Licensing Authority]

F. D. THOMSON,
Clerk of the Executive Council.

(P.W. 26/5/2.)

Authority : W. A. G. SKINNER, Government Printer, Wellington.
Price, 6d.


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🏭 Motor-omnibus Regulations (continued from previous page)

🏭 Trade, Customs & Industry
Regulations, Motor-omnibuses, Licensing, Transport, Forms
  • F. D. THOMSON, Clerk of the Executive Council
  • W. A. G. SKINNER, Government Printer