I declare that to the best of my knowledge the answers in this application are correct. I understand that if any false or deliberately misleading information is given, or any material fact suppressed, I may not be appointed, or if I am employed, my employment may be terminated.
I authorise permission for Counties Manukau Health Occupational Health and Safety Service to gain access to my personal immunity status and immunisation information held at my Educational Institute, other DHB Occupational Health and Safety Service, General Practitioner and CMH Medical Information Portal (CONCERTO).
I understand that the information related to health screening required by Occupational Health and Safety Service will be placed on my personal file. I also have a right to access this information and to obtain copies of my test results.
I consent to CMH Occupational Health and Safety Service disclosing this information to other DHB Occupational Health and Safety Services in relation to their Pre-Employment Health Screening, Contact Tracing or Health Monitoring requirements and my nominated General Practitioner subject to the Privacy Act 1993. The requirements of the Privacy Act 1993 will be applied to the sharing of any information provided through the pre-employment health screening process to other parties either within the organisation or externally.
I understand and accept that I may be required to attend a health assessment with Counties Manukau Health Occupational Health and Safety health practitioners.
I consent to information on my personal immunity status and immunisation to be made available to my manager for the purposes of assisting with managing staff and patient safety, and for emergency planning and response purposes.
I consent to information being made available to my hiring manager regarding work place accommodation requirements, based on my pre- employment health screening information.
A disciplinary process and/or investigation relating to the provision of information during the pre-employment medical assessment(s) and/or questionnaires: and/or Medical examination and/or medical disengagement process