Medical Questionnaire

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I would like to inform you that your application for employment with GR8 Security Limited has been successful and I would like offer you the position of Security Officer / Keyholder.

However before this offer can be confirmed you are required to complete the attached Medical Questionnaire and where applicable a Senses Test.

Please note that is a conditional offer and cannot be confirmed until this process has been satisfactorily concluded.

May I take this opportunity of welcoming you to our company and hope you enjoy working with GR8 Security Limited.

Yours sincerely

Managing Director
First Name*
Last Name*
Address*
Street Address City Postcode Country
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Health
Are you physically fit?*
Are you generally in good health?*
Is your hearing normal in both ears, including for telephone use?*
Is your speech defective?*
Have you ever had an operation?*
Have you been in hospital for more than two weeks in the last ten years?*
Are you taking a course of injections, tablets, pills or drugs?*
Have you ever had fainting attacks, blackouts or epilepsy?*
Have you ever suffered mental ill-health, nervous breakdown or debility?*
Have you ever had heart trouble, rheumatic fever, high blood pressure?*
Have you ever had varicose veins?*
Have you ever had any other illness, allergy or disease?*
Do you suffer from any medical condition which may affect your ability to do this type of work?*
Have you ever had any back or joint trouble, prolapsed disc, fractures, skeletal trouble?*
Is your eyesight satisfactory for all normal purposes (with glasses if necessary)?*
Have you ever had arthritis, rheumatism or gout?*
Have you ever had diabetes?*
Have you ever had any ear disease (including running from the ears)?*
Have you ever suffered a rupture?*
Give details of any declared illness or incapacity shown above, including any periods off work in the last three years of more than fourteen days*
Doctor's Information
The Name of my Doctor is:*
Doctor's Telephone No:*
Doctor's Address*
Street Address City Postcode Country
Signature
Signature*

I hereby authorise GR8 Security Limited to contact my doctor to verify the above information.
Date*
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Registered in England And Wales: GR8 Security Limited, Unit 18 Greenwich Centre Business Park, 53 Norman Road, London. SE10 9QF. Companies House registration number: 6497135. VAT Registration Number: 932 408633

GR8 Security Limited currently holds SIA Approved Contractor Scheme (ACS) status for the provision of Security Guarding.
GR8 are proud to be an Equal Opportunities Employer

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Medical Questionnaire

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Health

Doctor's Information

Signature

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