Post-Offer Medical Questionnaire

Post-Offer Medical Questionnaire

Joe, this is the Medical and Financial Release/Non-Disclosure Post-Hire Form Form Preview
  • Post-Offer Medical Questionnaire

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  • a partner of ProForce Staffing, Inc.

    By completing this form, I am verifying that the above named company has already presented a conditional job offer to me. The presence of one or more impairments does not automatically render you unfit as an employee. All decisions will be made on job-related criteria. Reasonable accommodation will be made if appropriate, provided it does not pose an undue hardship upon the company making the conditional job offer.

  • Please Complete the Following Medical Information:

    Have you ever had?

  • If you answer 'NO' to any question below, you are saying you have NOT experienced pain, discomfort or injury to that particular body part and have NOT sought treatment from a medical professional.

  • IMPORTANT: Our Workers Compensation Insurance carrier may check for previous claims by name and social security number. If you have had a previous claim or injury, and fail to make it aware to us, you may be legally denied benefits. For your own protection, please make us aware of any previous injuries.

  • SELECT DESIRED METHOD of PAYROLL PAYMENT

    (ProForce Staffing, Inc's weekly pay period begins on Wednesday and ends on Tuesday)
  • AUTHORIZATION and eSIGNATURE

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  • I hereby authorize Quality Business Solutions, Inc., a partner and payroll provider for ProForce Staffing, Inc., to initiate credit entries to my bank account indicated above, and I authorize the financial institution named above to process said credit entries.

    This authority is to remain in full force and effect until Quality Business Solutions, Inc., has received written notification from me of its termination in such manner as to afford Quality Business Solutions, Inc. and the financial institution a reasonable opportunity to act on it.

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