How many sickness absence days have you had over the last 2 years?
If any, please specify the reasons
Do you, or have you, ever suffered from any of the following
Any other medical illnesses or investigations not mentioned above?
Declaration to be signed by prospective employee
I declare that I have fully considered the above questions and the answers are true and correct.
I declare that no relevant information has been withheld or any misleading statements made.
I consent to a statement of my fitness for duties, together with a summary of any recommended adaptations, being produced by the assessing doctor and sent to a representative of Human Resources.
I understand that the doctor may require further information from my doctor (a separate consent will be sought should this be requested).