• A white-collar worker is a person who performs professional, managerial or administrative work.
  • Start Date*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Finish Date*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Is This An Extension Or A New Application?*
  • Original Start Date*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Does the contract company have a valid contract with GM³?*
  • Has the applicant had any claims to Coal Mines Insurance?*
  • Please list each claim with details of both the date and injury as a separate line item. You must click 'Save & Enter' to add the claim.*
  • Has the applicant worked in the coal industry before?*
  • Has the applicant been an employee of GM³ previously?*
  • Is the applicant currently working at another GM³ site?*
  • Is the applicant banned from any GM³ site?*
    • Internal Use Only 
    • Responsible Manager Approval*
    • Is Spend Budgeted?*
    • General Manager Approval*
    • Is Spend Budgeted?*
    • HR Approval*
    • Approved Date*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Should be Empty: