RECRUITMENT AND SELECTION - City of Vincent

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CITY OF VINCENT POLICY MANUALCHIEF EXECUTIVE OFFICER - HUMAN RESOURCESRECRUITMENT AND SELECTIONPOLICY NO: 5.2.1PROFORMA - PRE-EMPLOYMENT MEDICAL REPORTThe aim of this Pre-Employment Medical Questionnaire is to ensure that applicantsphysical and other related abilities are matched to the medical and fitness standardsfor the particular duties of a job.Pre-Employment Medical Questionnaires are necessary to determine that:• The applicant is able to productively carry out the duties of the position safely.• There is no risk of aggravating a pre-existing medical condition.• The applicant should not, because of a medical condition, increase risk to otheremployees, equipment, products or the general public.ConfidentialityThe Pre-Employment Questionnaire is treated as a confidential document and accessis limited to a ‘need to know’ basis. In the event of you being employed, this formwill be retained on a confidential file. The Local Government reserves the right torefer to the information in the event of an accident, sickness, injury or claim forworker’s compensation. The information may also be used for other purposes, if sorequired by law.Important NoticeTo assist the Local Government in assessing your medical fitness for employment,you must answer the questions contained in this questionnaire truthfully and to thebest of your knowledge.Failure to disclose any relevant matter relating to your health may result in yournot being employed by the Local Government and, if already employed by theemployer, your employment may be affected and rights to workplacecompensation compromised.Name of applicant:Date of birth:Sex:Address:Telephone number:Position:Department/Location:Page 34 of 38
CITY OF VINCENT POLICY MANUALCHIEF EXECUTIVE OFFICER - HUMAN RESOURCESRECRUITMENT AND SELECTIONPOLICY NO: 5.2.1Position Requirements (to be completed by the Local Government)The position involves the following duties:Keyboard/mouse use.Lifting.Driving.Operating heavy machinery.Sitting for extended periods.Repetitive physical actions.Workshop activity.Working in remote locations.Working with animals.Working under pressure of constant deadlines and/or in the resolution of conflict.Activities where hearing protection is required.Other ___________________________________________________________Applicant’s Present Health StatusAre you currently attending a medical practitioner?Yes No Please give details whereappropriateAre you at present on any medication or treatment prescribedby a medical practitioner, which may affect your workperformance?Do you have any eyesight defects other than those correctedby glasses?Do you have any hearing problems?Do you have any defect of speech or communicationproblem?Do you have any physical disability necessitating specialaids, or requirements for access to premises?Do you have any other health problems, which may effectyour work performance?Page 35 of 38
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RECRUITMENT AND SELECTION - City of Vincent

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