Bar Lane, Boroughbridge York, YO51 9NN Tel: 01423 321322 Fax: 01423 321314
Equal Opportunities: We provide equal opportunities and are committed to the principle of equality regardless of race, creed, colour, nationality, sex, disability, religion, gender re-assignment or sexual orientation. We will apply employment policies which are fair, equitable and consistent with the skills and abilities of our employees and the needs of the business. We ensure that all employees are accorded equal opportunity for recruitment, training and promotion and, in all jobs of like work, on equal terms and conditions of employment.
As we wish to ensure that you do not risk your health in an unsuitable environment, please complete the following medical questionnaire below to confirm that you do not have any health problems nor a medical condition that would adversely affect your ability to do the job for which you have applied.
Asylum & Immigration Act 1996. Any offer of employment is subject to the confirmation of your National Insurance number in accordance with the Asylum and Immigration Act 1996.
Information contained within this document is governed by the Data Protection Act 1998. The information you give will be kept entirely confidential and is needed to ensure the safety of you and others. Any points of uncertainty can be discussed further during your initial interview.
Reed Boardall will honour its obligations under the Disability Discrimination Act 1995, Health & Safety at Work Legislation, the Working Time Regulations 1998 and the Data Protection Act.
This information is for the use of the Store Manager(s) and the interviewing officer (Training). This information will be retained as part of the Company's confidential records. Should your employment not be confirmed this information will be destroyed.
In accordance with legal requirements the contents will NOT be disclosed without your permission to any unauthorised personnel. Please fill in this form as accurately as possible. Before starting to answer, read it carefully through to the end.
Please indicate if any of the following apply or have applied to you in the past. Please give details below where appropriate.
Prolonged or severe neck or back pain or injury
[ Yes ] [ No ]
Rheumatism, rheumatic fever, arthritis or other joint problems or pain
Head injury, migraine or frequent headache
Dermatitis, eczema or other skin complaint
Chest pain, angina
Raised Blood Pressure
Breathlessness, palpitations
Asthma, bronchitis, pneumonia or frequent chest infections
Fits, epilepsy, fainting attacks, blackouts, giddiness
Allergies, hay fever or wheezing
Claustrophobia or vertigo
Kidney or bladder problems
Diabetes, thyroid or other gland problems
Nervous breakdown, anxiety or depression or stress related illness
Chilblains, Raynauds or other circulation problems
Persistent / recurrent indigestion, stomach disorder or ulcers
Hernia, rupture varicose veins or piles
Jaundice or Hepatitis
Recurrent ear infections, tinnitus or deafness
Eye disease such as glaucoma or cataract or any history of blurred vision
Have you restricted movements of hands, arms, legs, feet and neck
Are you receiving medical treatment, or awaiting treatment now
Have you ever had an operation
Are you currently taking any prescribed drugs, or other medication?
Have you any hearing defect or do you wear a hearing aid
Do you wear spectacles or contact lenses
Are you colour blind
Are there any other health conditions or medical concerns we should be aware of?
I confirm that in submitting this application I have completed it honestly and to the best of my ability
