Applications
Job Application Form
Physical Health Declaration Form
Reference Request Form
Physical Health Declaration Form
Full Name
General Health
Please answer the following questions about your general health.
Do you have any current medical conditions that may affect your ability to perform the duties of the role?
*
Yes
No
If yes, please provide details.
Are you currently taking any medication that may affect your work performance or safety?
*
Yes
No
If yes, please provide details.
Do you have any allergies (medications, food, substances)?
*
Yes
No
If yes, please provide details.
Any back, neck, joint, or muscle problems that could affect work duties?
*
Yes
No
If yes, please provide details.
Work-related injuries in the past 5 years?
*
Yes
No
If yes, please provide details.
Vision impairments affecting work duties?
*
Yes
No
If yes, please provide details.
Hearing impairments affecting communication?
*
Yes
No
If yes, please provide details.
Any mental health conditions (anxiety, depression, stress-related) affecting work?
*
Yes
No
If yes, please provide details.
Do you smoke?
*
Yes
No
Do you engage in regular physical activity?
*
Yes
No
Any dietary restrictions affecting workplace provision?
*
Yes
No
If yes, please provide details.
Do you believe you can perform all the duties of the role applied for, with or without reasonable adjustments?
*
Yes
No
If no, please provide details.
Declaration by Applicant:
*
I declare that the information provided is true and complete to the best of my knowledge. I understand that providing false information may affect my employment.
Submit