GENERAL STAFF PRE- EMPLOYMENT MEDICAL (P.E.M.

) REQUIREMENTS
Please read and complete as fully as possible the attached P. E. M. Questionnaire to enable us to complete your employment selection process. The notes below give a brief overview for guidance, but they are by no means comprehensive. If you have any questions, please contact your ! representative. Please note that candidates will undergo full medical screenings by the "overnment Medical #ommission in $oha. Employment will be terminated if the candidate is medically unfit or if the infectious disease profile and%or chest &'ray are abnormal. "ood general health with no disability, which could compromise or impede continuous effective fulfilment of duties, is a pre'requisite to employment with Inter#ontinental $oha. Pre'e(isting medical conditions requiring medical care, specialist follow'up, surgery or regular medication must be declared. )ailure to declare such, will adversely affect your employment. *ll active, chronic or potentially relapsing conditions must be specifically highlighted and full details +including a specialists report, are to be forwarded to the Medical #linic for assessment through your !ecruitment #oordinator. -e advise that any dental wor. that needs attention should be completed before your arrival, since dental treatment is e(pensive in $oha.

Please sign and fa(%email bac. the Pre Employmen Me!"#$l %&e' "onn$"re with your signed offer letter along with your contract within three days. Mar. it for the attention of/ (M$ryl"e (on)ol$n * +R, T$len Re'o&r#"n) Coor!"n$ or) 0 -./0 001002/3 or (em$"l) M$ryl"e.4on)ol$n5"6).#om and bring the original document on your first day at wor.. In#omple e 7orm' m$y #$&'e !el$y $n! &nne#e''$ry "n#on8en"en#e. Ple$'e en'&re yo& #on $# yo&r +R repre'en $ "8e "7 yo& 6$8e $ny %&er"e'. Please be advised that the following medical conditions +including past history thereof, MAY pre#l&!e re#r&" men . *ny conditions predisposing to sudden incapacitation Epilepsy, progressive neurological diseases, severe migraine and #1 * !espiratory diseases 2 #ardiac diseases Psychiatric illness +including depression and personality disorders, 3ong'term illness. epatitis 4 I1 % *I$5 *ny contagious diseases

Pre Employmen Me!"#$l Q&e' "onn$"re

Position applied for/ )ull 6ame/ *ge/ 5e(/ ome *ddress/ "rade/ 6ationality/ 6o. of #hildren, if any/ Tel.no/ $ate/

$ate of 4irth/ Marital 5tatus/

Email/

Me!"#$l +"' ory 9 ( I7 : Ye':; ple$'e pro8"!e !e $"le! repor ) $o you have or been treated for/ 7., Epilepsy, fits or migraines 9., Psychiatric or psychological disorders ;., Ear, nose 2 throat disorders. <., 4ac. pain 2 =oint $isorders >., *ny .ind of heart disease % ypertension ?., *llergies 2 5.in disorders A., Previous Medical or 5urgical treatment +or any serious inBury, Ye' No 8., *ny history of $iabetes :., Menstrual disorders % $ysmenorrhoea 7E,. Tuberculosis or asthma 77,. 1isual problems 2 #olour 4lindness 79,. $oes the applicant smo.eH 7;,. #urrent medications +prescriptions and @T#, 7<,. *ny other medical illnesses +#ancer, blood disorder, etc.., Ye' No

Me!"#$l E<$m"n$ "on' re%&"re! 4y S $ e o7 Q$ $r9 (To $#%&"re =or> Perm" ,Re'"!en#e ?"'$) 7., #hest &'!ay +C igh !esolution, 9., I1 7 2 9 ;., #1 <., 4s*g + C , #hest &'!ay should not have any lesion including past tuberculosis lesion, scar or calcified node % granuloma. A!!" "on$l Me!"#$l E<$m"n$ "on' Re%&"re! 4y In erCon "nen $l Do6$ 9 GENERAL STAFF 7., E#"/ +D>E yrs., TEC+NICAL STAFF 7., 1isual *cuity % #olour 1ision 9., earing + *udiogram , FOOD +ANDLERS STAFF 7., ep * +Igm, 9., 5tool E(am

Please note: 1.) Any medical condition not declared in the Medical History Questionnaire and detected later may result in termination of your employment. 2.) If, for any reason, you do not pass the Qatar Go ernment medical e!am, this offer of employment "ill #e "ithdra"n and you "ill #e repatriated to your home country. $he company is not responsi#le for any losses sustained or incon enience caused as a conse%uence of failin& the Qatar Medical 'ommission (!amination. *) If you are unsure if you "ill pass the a#o e medical tests, please arran&e for these tests to #e ta+en in ad ance prior to )oinin& the company. Please note that medical e!penses incurred "ill not #e reim#ursed.
De#l$r$ "on @ #on'en o o4 $"n me!"#$l "n7orm$ "on9
I hereby declare that I have carefully considered the statement+s, made above and that I have not witheld any relevant information or made any misleading statement. I understand that if I have made any false representation for the purpose of procuring for myself a medical certificate, I may be guilty of a criminal offence. I hereby consent to the Inter#ontinental $oha Medical #linic obtaining information about my health from any medical advisor or hospital consulted by me.

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