DECLARATIONI hereby declare that: - I have read and understood the conditions of this form. - I understand that the information I provide will be retained on my employee file and that the employer reserves the right to access and use the information in the event of any accident, injury, sickness or claim for workers compensation or for any other reasonable purposes, if so required by law. - I consent to HBG and its medical representatives obtaining or exchanging further medical information from my treating doctors or other health practitioners, if required for the purposes of this assessment. - My answers relating to my medical and employment history are true and complete to the best of my knowledge. Furthermore there is nothing else regarding my health, well being ,or ability to carry out my potential role which HBG or its medical advisers may need to know to assess me for the position(s) for which I have applied. - I am fully aware that if I fail to disclose any relevant matter relating to my health, which renders me incapable of properly fulfilling the duties of the position, the employer may not employ me or if already employed by the employer, my employment may be summarily terminated. - I understand and agree that this report and any related health information provided may be supplied to HBG and its medical advisors.
Section A: To be completed by the PAYEE
Section B: To be completed by the PAYER (if you are not lodging online)
Wrong Answer - PLEASE TRY AGAIN