Company Contact Name *

First Name

Last Name

Company Contact Phone Number *

Country

(###)

###

####

Site Contact *

Is the Site Contact that workers will be reporting to the same person as the Company Contact?

Yes

No

Shift Type *

Day Shift

Afternoon Shift

Night Shift

Flexible Shift (Please specify hours in text field below)

Weekend Shift (Saturday/Sunday)

Split Shift (Please specify hours in text field below)

Overtime Requirements *

Is overtime occasionally required?

Yes

No

First Day *

The date of the first day you would like workers to start.

MM

DD

YYYY

Start time *

Time you'd like them to start on the first day.

Hour

Minute

Second

AM PM

Final Day *

Estimated date of final day workers will be needed for your project.

MM

DD

YYYY

Is this an ICI worksite? *

Most industrial, commercial, and institutional construction projects excluding home building.

Yes

No

PPE Requirements

What personal protective equipment (PPE) is required for this job? Please select all that apply.

Steel-Toed Boots

Eye Protection

Hard Hat

Hi-Vis Vest

Work Gloves

Other (Please specify in text field below)

Physical Requirements

Are there any specific physical requirements for this job? Please select all that apply.

Heavy Lifting (50 lbs)

Standing for prolonged periods of time

Outdoor Work

Other (Please specify in text field below)

Required Certifications

Are there any certifications workers are required to have for this job? Please select all that apply.

Class 5 Driver's License

WHMIS

First Aid/CPR

Confined Spaces/Confined Entry

Fall Protection

Lockout/Tagout (LOTO)

Other (Please specify in text field below)