By completing the following form, you will begin the process to apply for a role within Clough. The first stage of this application is the completion of an online medical questionnaire, and then depending on the role applied for, a face-to-face medical / physical assessment which you will be notified of the details separately via phone call or email.
Please complete the following fields about yourself, then select the role you are applying for, and once you click submit you will immediately be directed to the online questionnaire component to be answered online.
Please note, all medical information collected shall be held in strict confidence and in accordance with Privacy legislation.
We note that: · Where it is proved that a worker has, at the time of seeking or entering employment in respect of which he claims compensation for an injury, wilfully and falsely represented himself as not having previously suffered from an injury, an arbitrator may in the arbitrator’s discretion refuse to award compensation which otherwise would be payable. [WORKERS' COMPENSATION AND INJURY MANAGEMENT ACT 1981 - Section 79 amended by No. 48 of 1993 s. 28(1); No. 42 of 2004 s. 63, 146 and 147.] · Failure to answer all questions fully may invalidate the pre selection process and result in your application for employment being disregarded.
By proceeding, you hereby certify that to the best of your knowledge and belief, the answers given by you are true and correct.
By proceeding, you hereby agree to take part in this voluntary assessment. You consent to your Pre Employment results being shared with authorised Company representatives and its engaged Health and Medical Practitioners (“Health Practitioners”).
I have read and understood the information above. Authority is given by me for the Health Practitioners and /or Company’s Injury Management Representatives to make any enquiries considered necessary to accurately establish my medical history and fitness for work in the position I have applied for, and to report such assessment to the Company.