Medical Examination Agreement

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Name*

First

Last
Address*

Address line 1

Address line 2

Town/suburb

State

Postcode

Country
Date of Birth*

Day

Month

Year
I agree:
1. That a medical examination may be carried out,
  - Prior to my employment at the Midfield Meat Group to assess my suitability for the job
  - During the course of my employment at the Midfield Meat Group to assess my fitness for work and/or my ability to carry out the inherent requirements of the job
2. That such a medical examination may include any of the following supervised tests - breath, blood, urine, hair, oral fluid or other method depending on the technology available.
3. That I shall make myself available at a nominated testing facility for such medical examination no later than 24 hours from this form being signed by the Midfield Meat Group Human Resource Manager.
4. That the results of this examination and any test will be forwarded to the Midfield Meat Group Human Resources Manager, and shall be held in strict confidence.
5. That I shall accept the results of the authorised testing agency as being final.
6. Signature of Employee*
7. Date
  
  Day
  
  Month
  
  Year
8. Signed by parent/guardian if employee is under 18 years
9. Date
  
  Day
  
  Month
  
  Year
10. CAPTCHA

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