In compliance with the Americans with Disabilities Act of 1990 (ADA) you have received a conditional offer of employment. The answers to this medical questionnaire will be kept confidential as required by the ADA and HIPAA. The job offer, which you have received, is conditioned upon the satisfactory completion and review of this post-offer medical questionnaire, any required medical examination or follow up and job assignment availability. The purpose of this questionnaire is to determine whether you currently have the physical qualifications necessary to perform the essential job functions for security services; to determine whether and what accommodations may be necessary; and to determine whether you can perform the essential job tasks without posing a significant/direct threat to the health and safety of yourself and/or others.
Answer each of the following questions. If answered "yes", please explain in the box provided.
By having completed the post-offer medical questionnaire and clicking submit, you hereby affirm that Raven Security has made an offer of employment and you have reviewed the essential job functions detailed in the position you have applied for. You hereby affirm that the questions in this post-offer medical questionnaire have not been asked of you by our company until after you accepted a conditional offer of employment. The information provided in this questionnaire will be kept confidential.
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Document Blockchain ID: cCI3Amjt2K3OgZc3WGQLIgkvvimegDIFKsEOLO0rNNs1wfElMQp8aJbRkmS0n13y, Signed on: , Signor 1 given identity: [email protected], email verified by user, Login with Google Secure OAuth, IP Address: , Via browser: , Running on: , Language: , Timezone: , Resolution: , Destruction Date: , Document last modified prior to signature:
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Electronic Signature Disclosure & Consent