Pre Employment General Form

Pre Employment General Form

(Request your sick certificate. Only a 2 minute form fill)

Role Details

Please provide details about the role

Applicant Details

Please provide your contact details

GP Details

Please provide contact details for your doctor


Payment Method


I declare that the information I have given is true and complete to the best of my knowledge and that I have not withheld any material facts. I understand that I am responsible for the accuracy of my statements and that if I wilfully suppress any information I risk the loss of appointment.

I understand that by submitting this medical assessment questionnaire I consent to Medmark Occupational Health furnishing the report and notification concerning my fitness to work to my employer / the company from which I'm seeking employment.

I consent to Medmark contacting my General Practitioner or any health professional who attended me concerning anything which affects my physical or mental health.

I understand that relevant details of my personal or medical history will not be disclosed to the personnel department without my consent.

I understand that the report will offer an opinion on my fitness for work and may contain suggested restrictions / alterations/ accommodations to ensure the health and safety of myself and others at work.

By submitting this document to Medmark I understand, accept and consent to all of the above.