TEMPORARY WORKER INFORMATION & SAFETY AGREEMENT.

temporary worker information
& safety agreement.

Please fill out all required fields.

* Indicates required field

Select Salutation *

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

emergency contact name *

Relationship *

phone number *

Project Location: 2711 bridgeville lane, Charlotte, NC, 28262

Agreed Pay Rate: $17.50 per hour

Estimated project duration: 2-3 hours

I agree to:

Worker Certification *

I certify that the information provided above is accurate.

By typing my name below, I agree that this electronic signature is the legal equivalent of my handwritten signature.

Worker Signature *

Date (MM/DD/YYYY) *

Releaf Services
Charlotte, NC
[email protected]