ADA Application Form

Note: A license fee of $33.00 (incl. GST) applies and license is valid for the financial year or part thereof. The driving authority will expire on 30 th June of that financial year and will be renewed at AAC’s discretion.

APPLICANT DETAILS

NAME

EMPLOYER/BUSINESS NAME

SITE NUMBER

HANGAR LOCATION

HOME ADDRESS

Phone

ARE YOU REPLACING ANOTHER EMPLOYEE/ PERSON?

YES

NAME OF ANOTHER EMPLOYEE/PERSON(Required)

STATE/TERRITORY DRIVER LICENCE

(photocopy must be attached)

LICENCE NUMBER

CLASS

EXPIRY DATE

CATEGORY OF ADA PERMIT

CATEGORY NUMBER

CAT 1 – ALLOCATED GATE AND LEASED AREA
CAT 2 – ALLOCATED GATE, LEASED AREA, TAXIWAYS AND APRONS FOR OPS ACTIVITIES
CAT 3 - ALLOCATED GATE, LEASED AREA, TAXIWAYS, APRONS AND CROSSING RUNWAY FOR OPS ACTIVTIES

CAT 1

CAT 2

CAT 3

JUSTIFICATION

(please state the reason for ADA, relevant actions and duties involved)

CAT 3 APPLICANTS ONLY

Aeronautical Radio Operator Certificate (AROC) Licence No.:

EMPLOYER/COMPANY ENDORSEMENT

I certify that the above applicant is required to drive/operate Company vehicles/equipment on the Apron/Taxiways/Runways at Archerfield Airport.

NAME

POSITION

SIGNATURE

Date

APPLICATION ACKNOWLEDGEMENT AND CERTIFICATION

I acknowledge that, in making this application, I undertake that any vehicle/equipment I use will be operated in compliance with the rules and conditions as promulgated by Archerfield Airport Corporation (AAC), in the Airside Vehicle Control Handbook, which I have read and understood. I further confirm that I have read, understood and accepted the Airport Conditions of Use and Airport User Rules. I acknowledge that AAC may cancel or suspend the ADA, without refund, at any time.

Signature

Date

ATTACHED DOCUMENTS

Copy of Driver Licence (Must be Open Licence)

Copy of AROC (Category 3 Applicants only)

DOCUMENTS FILES

Drop files here or

Max. file size: 256 MB, Max. files: 5.

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