Illawarra Metallurgical Coal - Contractor Validation (Blue Collar)

Blue-Collar Contractor Application
Applicant Name *

First Name Last Name
Date of Birth *

Month Day Year
Role *
Company *
Company Contact Email *
example@example.com
Does the contract company have a valid contract with Illawarra Coal? *

Yes No
Has the applicant had any claims to Coal Mines Insurance? *

Yes No
Please list each claim with details of both the date and injury as a separate line item *
Has the applicant worked in the coal industry before? *

Yes No
What is the total number of years that the applicant has worked in the coal industry? *
Has the applicant been an employee of Illawarra Coal previously? *

Yes No
If so specify location, last position held and period of employment *
Is the applicant currently working at another Illawarra Coal site? *

Yes No
If yes, which site and who is the employer? *
Is the applicant banned from any Illawarra Coal site? *

Yes No
Number of years with current employer? *
If less than 2 years, state previous employer, time employed and role: *
Details of work experience (role, types of work/skills e.g. development, longwall): *
Site Selection *
Processing Contract Owner
Appin Contract Owner *
Dendrobium Contract Owner *
Illawarra Coal Office
ownerEmail
example@example.com

Blue-Collar Contractor Application