Please read through and answer each question in the Pre Placement Fit Slip form below.
"*" indicates required fields
Step 1 of 6
I acknowledge all of the information provided is correct and that I will notify Engage immediately of any changes to this information. I agree to immediately notify Engage and the host employer of any workplace injuries, including near misses suffered at work. I accept and acknowledge that non- disclosure of any relevant medical information will result in an immediate termination of my Engage employment contract.
By signing this form I hereby give consent for the Engage Rehabilitation Co-ordinator to contact my treating doctor and obtain any medical information relevant to any workplace incident that occurs while working for Engage.
© Copyright Engage 2023 | Website By GREENhouse Media