LD Total is collecting personal information from you as part of the recruitment and selection process. LD Total recognises the importance of privacy and is committed to ensuring the privacy of your personal information collected and/or received by us.

1. Yes I agree to the privacy statement*

1. Title* Mr Mrs Ms Miss Dr Other
2. First name*
3. Last name*

1. E-mail*
2. Phone*

   Digits only or add + for international numbers

1. Street*
2. Street Cont.
3. City, Town or Suburb*
4. Postcode or Zipcode*
5. Country*Please choose... AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HONG KONG SAR, CHINA HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACAU SAR, CHINA MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY UZBEKISTAN VANUATU VENEZUELA VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE INTERNATIONAL OTHER Unknown
6. State, Region or Province*Please choose...

1. Do you have the legal right to work in Australia? *

   1. Yes, Australian Citizen or Resident
   2. Yes, current and valid working Visa
   3. Yes, other
   4. No, I require Sponsorship
2. If you've answered 'Yes, current and valid working Visa', please list the Visa Type and Expiry Date:
3. Do you hold a current Drivers Licence? *

   1. Yes - Manual
   2. Yes - Automatic
   3. No
4. Do you hold a blue/white construction induction card? It is a condition of employment to hold a current blue/white card. You will be required to produce a copy of your card prior to employment. *

   1. Yes
   2. No
5. Have you been convicted of an offence either within or outside Australia? (You are not required to disclose spent convictions and only convictions relevant to the position will be considered)*

   1. Yes
   2. No
6. Do you hold a current Police Clearance?

   1. Yes
   2. No
7. Please select the Qualifications, Certificates and Licences you currently have

   1. Horticulture Certificate II or III
   2. Landscape Certificate
   3. Australian recognised Trade Certificate
   4. Apprenticeship
   5. Diploma
   6. Degree
   7. Pesticide Licence
   8. Skid Steer (Bobcat)
   9. Current First Aid Certificate
   10. Mini Excavator
   11. Forklift
   12. Traffic Management (please list)
   13. High Risk Licence (please list)
   14. Other (please list)
8. If you have selected 'Other', 'Traffic Management' or 'High Risk Licence', please list here
9. Diversity Data
   We have asked the questions below so that we can use the information for statistical purposes. Responding to the questions is optional. By responding to and supplying the information below, you consent to LD Total collecting this information for statistical purposes.
   Please confirm that you agree to this by ticking the checkbox ‘I agree’*

   1. I agree
   2. I disagree
10. Country of Birth
11. Were one or both of your parents born overseas?

    1. Yes, both
    2. Yes, one
    3. No
12. LD Total is committed to increasing workforce participation of Australian Aboriginal and Torres Strait Islander people. To assist with our commitment, we would like to ask you some further questions. This information is collected for statistical purposes. Responding to this question is not compulsory.
    Do you identify as being an Australian Aboriginal or Torres Strait Islander person?

    1. Yes
    2. No
    3. Prefer not to say
13. Declaration by Application:
    1. I understand that any misrepresentation of facts in this application could be cause for termination if employed.
    2. I understand that part of the application process may involve a medical and/or drug and alcohol test, nominated by the company and I authorise disclosure of the results of this examination to LD Total.
    3. I consent to any reference checks which may be necessary to support this application.
    I hereby declare that the information contained in this application is to the best of my knowledge true and correct.*

    1. I understand and consent
    2. I do not give consent