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Confidential Application Form: Crowd Controller

I heard about Sibley Lawyers via;
My preferred method of contact is:
I am the subject of any of the following outstanding matters;
I am aware of circumstances that could result in a criminal or disciplinary matter being initiated against me in the next 24 months
During the past 10 years I have been the subject of a criminal charge, disciplinary investigation or hearing
During the past 5 years I have had a complaint made against me by a member of the public, or been questioned in relation to my professional conduct
Have you suffered a work place injury or developed any symptoms within the last 3 years
During the last 5 years I have been issued a show cause letter, or any other form of management letter in relation to my work performance
I am interested in;
I am a member of a union and/or association
I am interested in paying my annual retainer and premium
Do you have any other employment outside of your role as a crowd controller/security guard?
If yes, are you interested in seeking employment related cover for your other employment as well?

Note: Your completed application form will be relied upon as a basis to consider entering into a client service agreement with you. If formalised, only the client is authorised to access the services covered by the retainer with Sibley Lawyers, and benefit from the retainer. All correspondence will be directed to the retained client unless indicated otherwise. You have an ongoing obligation to disclose all and any matters you know, or that a reasonable person could be expected to know, would be relevant to our decision to enter into a client agreement with you. The firm reserves the right not to offer you an agreement to enter into a client retainer with you for any reason, or to amend the agreement if circumstances become known that would have affected our decision to enter into an agreement with you.

*** Any information provided in answer to this or any future questionnaires/conferences will be treated as confidential client/lawyer privilege.