Page 5 of 6 LTSR Forms Area F2978 CFD V01 Aug 2021
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Driver Authorisation Application continued... Page 5 of 6
12. Driving history Statement
I declare that:
I understand my responsibilities as the holder of a driver
authorisation under the Transport Operations (Passenger
Transport) Act and I understand that failure to comply with
relevant legislation may result in the refusal, suspension or
cancellation of driver authorisation.
Please note: An applicant in this application shall not:
• wilfully make or authorise the making of a statement that
• wilfully make or authorise the omission of any matter
or thing without which the application is misleading in a
If you do not tell the truth in your application you may be
prosecuted under the relevant Acts or Regulations.
I state that I have read the above statement and the
information provided in this application is complete, true and
correct in every detail.
(a) In the last ve years have you had your driver
licence amended, suspended, cancelled or have you
been disqualied from holding or obtaining a driver
licence, or have you committed a trac oence
other than parking (for example, speeding)?
The department will be verifying your driving history.
Please provide date, place, oence
and outcome if known.
If insucient space, attach separate sheet
13. Applicant declaration
I give my consent for the department to conduct enquiries
it deems necessary to assess my application and ongoing
suitability to hold driver authorisation, including, but not
necessarily limited to:
• a national criminal history check through the Queensland
Police Service and a New Zealand criminal history check
through New Zealand Police if required. I authorise the
release of that information by Queensland Police Service,
the Australian Police Services and New Zealand Police to
• a driving history check in all states and territories of
• enquiries with the courts, police, prosecuting authorities
or other relevant bodies or entities to enable the
department to make a full and informed assessment of
my suitability for DA
• verifying that I hold a current visa with an entitlement to
work in Australia if required
• verifying evidence of identity information provided in this
I authorise the department to use this information to maintain
a database which is used to prepare correspondence,
monitor transactions and to provide accredited operators
and other relevant government agencies with information
relating to my DA.
I give my consent to the department taking, keeping, and
using my personal information, digital photo and digitised
signature for the issue of DA under the Transport Operations
(Passenger Transport) Act, or as otherwise authorised by
Privacy statement: The department is collecting the information on this form to
assess your suitability for a DA. The department is authorised by the Transport
Operations (Passenger Transport) Act to collect this information and to obtain
information from other government agencies relating to your criminal and driving
history and by the Migration Act (Commonwealth) to verify your entitlement to
work in Australia. The documents collected for the purpose of this application will
be accessible by authorised departmental persons and some of this information
may be disclosed to the Queensland Police Service and interstate licensing
authorites as allowed under the Acts.
If this application is approved, and an industry authority card is produced, the
department’s card contractor will have controlled access to your information,
digital photo and digitised signature to make a card. Your information and digital
photo may be accessed by authorised departmental persons or police exercising
a power in relation to this Act, section 328A of the Criminal Code Act 1899 or
otherwise authorised under the Police Powers and Responsibilities Act 2000. The
department will not disclose your personal details, documents or digital photo to
any other third parties without your consent unless required by law.
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