Labour Hire Service Request Form
Please complete all sections to request approval for a new or replacement labour hire position.
Client Details
Company Name
*
Contact Person
*
Position
*
Phone Number
*
Email Address
*
Service Request Details
Request Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Required Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expected Duration:
*
One day
One week
Ongoing
Other
Number of Workers Required
*
Number
Position or Role Type Needed:
*
Registered Nurse
Enrolled Nurse
PCA
Community Support Worker
Domestic Cleaner
Role Type Needed:
*
Permanent Staff
Temporary Staff
Contract Staff
Seasonal
Duties and Responsibilities
Please describe the work to be performed:
*
Number
Required Skills/Qualifications:
*
Number
Work Schedule Details
Days Required
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Start and Finish TIme
*
Number
HEALTH AND SAFETY REQUIREMENTS
Site Induction Required?
*
Yes
No
Known Site Hazards:
*
Emergency Contact on Site:
*
Approval
Requested By:
Name
Approve By:
Name
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Request
Submit Request
Should be Empty: