Please enable JavaScript in your browser to complete this form. – Step 1 of 2Name *FirstLastEmail *PhoneDo you have any current physical or mental health conditions or disabilities that would affect your ability to perform this role? *YesNoDo you require an adjustment or adaptation to the work, work equipment or workplace to enable you to do your job? *YesNoDo you have, or have you ever had, any health problems that may have been caused, or might be made worse, by your work? *YesNoAre you undergoing or waiting for any medical treatment or investigation, or taking any medication? *YesNoDo you have any hearing problems not corrected with a hearing aid? *YesNoDo you have any Allergies / Anaphylactic shock risk? *YesNoHave you ever had Asthma / bronchitis or chest problems that require routine inhaler use / inhalers to be carried on your person? *YesNoDo you have any difficulty in standing, bending, lifting or other movements? *YesNoDo you or have you ever had Epilepsy / history of seizures / Heart conditions / Diabetes? *YesNoDo you or have you ever had a Stoke / history of TIA / Vasavagal episodes? *YesNoDo you require to use/ have any other medications (insulin/ epi pens/ other inhalers/ GTN spray and such) during working hours? *YesNoIf you have Selected Yes to any of the above questions, please provide more informationNextMedical DisclosureMultiple Major Recruitment process your personal data lawfully, fairly and in a transparent manner. As part of our service, we need to ensure your safety at work in accordance with the Health and Safety regulations. During your registration, you have completed a medical questionnaire (overleaf). Our HR department will review your responses to the questionnaire and will decide whether any adjustments need to be made to your role or working environment, to ensure your safety. In order for us to facilitate these adjustments to your working environment or role, we need to share your medical questionnaire/condition with our client. Please choose one option below;I give my consent for to share my medical information with the client in which I have been placed to work for the purpose aboveI DO NOT want to provide consent for Major Recruitment to share my medical information with the client for the purpose aboveSubmit
