Government Exam Safety Declaration Form
Please complete the Government Exam Safety Declaration Form before attending your scheduled government examination.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Exam Name
*
Exam Date
*
-
Month
-
Day
Year
Date
Exam Location
*
In the past 14 days, have you experienced any of the following symptoms: fever, cough, shortness of breath, or loss of taste/smell?
*
No
Yes
In the past 14 days, have you been in close contact with anyone who has tested positive for an infectious illness?
*
No
Yes
I declare that all information provided in this Government Exam Safety Declaration Form is accurate and complete. I agree to follow all safety protocols as required by the exam authorities.
*
I agree and declare
Signature (Please sign below to complete the Government Exam Safety Declaration Form)
*
Submit
Submit
Should be Empty: