Do you suffer from any pre-existing medical condition or take any prescription medication/s which might impact upon your ability to safely perform the relevant services?
Do you take any prescription medication/s which might impact upon your ability to safely perform the relevant services?
Do you suffer or have you in the past suffered from any injuries which may impact upon your ability to safely perform the relevant services?
Has any Operator/Driver previously made a claim with Work Cover? If so, please detail the injury (include year, period unfit for work, type of injury(ies) and any modifications or assistance you may require from your employer to perform the relevant services:
I declare that the information I have provided PatAsh & Civil is true, complete and correct. I understand that in the event of providing any misleading or false information, the termination of any ensuing contract for services may result and further, that PatAsh & Civil will not be accountable in any form.
As Director, I declare I have assessed the above employee/s as experienced, licensed and suitable to employ.
Thank you! We’ll be in touch.
