Answer the following questions to the best of your ability, please be truthful.

Do you have a valid OSHA 30 hours Cert?

YesNo

Have you operated the required equipment in the past 12 months?

YesNo

Are you covered with workers compensation insurance?

YesNo

Does you or your company have general liability insurance?

YesNo

First Name:*

Last Name:*

Company:*

Phone:*

Email:*

Job Name:*

Job Address:*

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