Free Pre-Employment Medical Form

Please complete this form to help us assess your medical fitness for employment.
Name
Date of Birth
Age
Gender
Male
Female
Position Applied For
Do you have or have you ever had any of the following medical conditions?
Check all that apply and provide details where necessary.
Mental Health Conditions
Respiratory Conditions
High Blood Pressure
Chronic Pain
Do you have any physical limitations or disabilities that may affect job performance?
If yes, please specify:
Applicant Declaration
I certify that the information provided is true and correct to the best of my knowledge. I understand that any false or misleading information may result in disqualification from employment.
Name:
Date:
Thank you for your submission!
We appreciate you taking the time to submit.
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Streamline hiring processes with this Pre-Employment Medical Form Template from Template.net. Designed for companies, recruitment agencies, and medical offices, this form assesses a candidate’s physical health before employment. Fully editable in our AI Editor Tool, personalize sections for medical exams, past health conditions, and physician assessments.