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Work Cover Declaration Form - Haileybury 2026

The Haileybury WorkCover Declaration Form is a document that requires job applicants to disclose any previous workers' compensation or disability claims, as well as any pre-existing injuries or diseases that may be affected by the proposed employment role. It includes questions about understanding the job role and inherent requirements, and emphasizes the legal obligations under the Workplace Injury Rehabilitation and Compensation Act 2013 regarding disclosure. The form must be signed and submitted during the interview process.

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Click ‘Get Form’ to open the Work Cover Declaration Form - Haileybury in the editor.
Begin by answering the first question regarding any previous Workers’ Compensation or Disability Claims. Select 'Yes' or 'No', and if applicable, provide details about your injury and role.
Indicate the role you are applying for in the designated field. Ensure that this matches the position description provided.
Confirm whether you have received a position description that includes the inherent requirements of your role by selecting 'Yes' or 'No'.
Acknowledge your understanding of Role A and its requirements by selecting 'Yes' or 'No'.
List any pre-existing injuries or diseases that may be affected by your proposed employment. Be thorough and honest, as this is crucial for compliance.
Review all entered information for accuracy before signing the declaration at the end of the form. Ensure your full name, signature, and date are included.
Once completed, present the signed form to the Chair of the Interview Panel during your first interview.

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