WC Approval Request

WORKER'S COMPENSATION APPROVAL REQUEST
Recruiting Firm Name *
Recruiter Name *
Recruiter E-mail *
Physical Work Location (i.e. office, hospital, warehouse, outpatient facility, nursing home) *
Job Title *
Pay Rate (must be an exact dollar amount) *
Estimated hours per week *
Estimated length of assignment *
State *
Client company name that the contractor will be working for *

Client company address that the contractor will be working *