Pre-Employment Medical Questionnaire

Add Your Resume (required) — 5MB: .pdf, .doc, .docx file types are accepted.

Were you referred by anyone?
YesNo

For employment purposes, your Work Site Employer or its agents may obtain consumer reports on you as an applicant or from time to time during employment. “Consumer Reports” are reports from consumer reporting agencies and may include driving records, criminal records, credit reports, etc.

For such employment purposes, your Work Site Employer may also obtain investigative consumer reports. An “Investigative Consumer Report” is a consumer report in which information as to character, general reputation, personal characteristics is obtained through personal interviews with neighbors, friends, associates, acquaintances, or others. You have a right to request disclosure of the nature and scope of an investigation and to request a written summary of consumer rights.

I authorize my Work Site Employer to obtain consumer reports and/or investigative consumer reports regarding me from time to time for employment purposes.

Yes

Add Your Resume (required) — 5MB: .pdf, .doc, .docx file types are accepted.

Were you referred by anyone?
YesNo

For employment purposes, your Work Site Employer or its agents may obtain consumer reports on you as an applicant or from time to time during employment. “Consumer Reports” are reports from consumer reporting agencies and may include driving records, criminal records, credit reports, etc.

For such employment purposes, your Work Site Employer may also obtain investigative consumer reports. An “Investigative Consumer Report” is a consumer report in which information as to character, general reputation, personal characteristics is obtained through personal interviews with neighbors, friends, associates, acquaintances, or others. You have a right to request disclosure of the nature and scope of an investigation and to request a written summary of consumer rights.

I authorize my Work Site Employer to obtain consumer reports and/or investigative consumer reports regarding me from time to time for employment purposes.

Yes

Add Your Resume (required) — 5MB: .pdf, .doc, .docx file types are accepted.

Were you referred by anyone?
YesNo

For employment purposes, your Work Site Employer or its agents may obtain consumer reports on you as an applicant or from time to time during employment. “Consumer Reports” are reports from consumer reporting agencies and may include driving records, criminal records, credit reports, etc.

For such employment purposes, your Work Site Employer may also obtain investigative consumer reports. An “Investigative Consumer Report” is a consumer report in which information as to character, general reputation, personal characteristics is obtained through personal interviews with neighbors, friends, associates, acquaintances, or others. You have a right to request disclosure of the nature and scope of an investigation and to request a written summary of consumer rights.

I authorize my Work Site Employer to obtain consumer reports and/or investigative consumer reports regarding me from time to time for employment purposes.

Yes