post employment medical questionnaire template

post employment medical questionnaire template is a post employment medical questionnaire template sample that gives infomration on post employment medical questionnaire template doc. When designing post employment medical questionnaire template, it is important to consider different post employment medical questionnaire template format such as post employment medical questionnaire template word, post employment medical questionnaire template excel. You may add related information such as post offer medical questionnaire template, post offer medical questionnaire eeoc, post offer of employment medical inquiry, post offer medical questionnaire georgia.

post employment medical questionnaire template

notice to offerees: in compliance with the americans with disabilities act of 2008 (ada), you have received a conditional offer of employment. the job offer, which you have received, is conditioned upon satisfactory completion and review of this medical questionnaire and any required medical examination or follow up. to comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. “genetic information” includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

the purpose of this inquiry is as follows: (1) to determine whether i currently have the physical qualifications necessary to perform the essential functions of the job that has been offered; (2) to determine what accommodations, if any, may be necessary for me to perform the essential functions of the job; and (3) to determine whether i can perform the essential functions of the job without posing a significant direct threat to the health and safety of myself and others. i hereby affirm that the questions in the medical questionnaire have not been asked of me by anyone with the employer until after i have signed this statement and been offered a conditional job. if you answer ‘no’ to any question below, you are saying you have not experienced pain, discomfort or injury to that particular body part and have not sought treatment from a medical professional. if you have had a previous claim or injury, and fail to make it aware to us, you may be legally denied benefits.

this information will be kept strictly confidential in a separate medical file, apart from my personnel file. i hereby affirm that the questions in the medical questionnaire have not been asked of me by anyone with the employer until after i have signed this statement and been offered a conditional job. (to be completed by prospective employee after offer of employment conditioned by completing this form, i am verifying that the above named company has benefits of a post-offer medical questionnaire​​ the benefits of a pomq program can be significant. 1. a pomq can help the prospective employer determine whether an employee is qualified to perform the essential functions of the job., post offer medical questionnaire template, post offer medical questionnaire template, post offer medical questionnaire eeoc, post offer of employment medical inquiry, post offer medical questionnaire georgia

post employment medical questionnaire template format

employee affirmation: i herewith affirm that the employer has made me an i hereby affirm that the questions in the medical questionnaire have not been post-offer medical questionnaire. post-offer medical questionnaire. employee name * today’s date * date. date of birth * date. social security # * (example: 999-99-9999) height * (example: 5′ – 11″ / five feet and eleven inches tall) weight * (example: 180 lbs. a partner of rock staffing. received a conditional offer of employment. this medical affirm that the questions in the medical questionnaire have not been asked of me by anyone with the., conditional job offer and medical review form, post offer physical exam form, post offer physical exam form, post offer medical examination, pre existing medical condition employment, post offer medical questionnaire template, post offer medical questionnaire eeoc, post offer of employment medical inquiry, post offer medical questionnaire georgia, conditional job offer and medical review form, post offer physical exam form, post offer medical examination, pre existing medical condition employment