-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
- Start Date*
- Finish Date*
- Is This An Extension Or A New Application?*
- Original Start Date*
-
-
-
-
- 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?*
-
-
-
-
-
-