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How do I fill this out?
To fill out this form, begin by ensuring you have all necessary personal information at hand. Carefully read each question and respond truthfully. Provide explanations where necessary, especially for 'yes' answers.

How to fill out the Medical Examination and History Report for Employment?
1
Gather all required personal information.
2
Read each question carefully.
3
Answer truthfully.
4
Provide detailed explanations for 'yes' answers.
5
Submit the completed form to the examining facility.
Who needs the Medical Examination and History Report for Employment?
1
Job applicants needing a medical examination before employment.
2
Veterans applying for positions requiring medical history disclosure.
3
Individuals undergoing public safety employment evaluations.
4
Candidates for law enforcement roles.
5
Those requiring a fitness test as part of their employment process.
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Editing this PDF on PrintFriendly is easy and intuitive. Simply upload the document, make your changes in the required fields, and review your edits inline. Once satisfied with the changes, you can download the updated PDF.
1
Upload the PDF document to PrintFriendly.
2
Navigate to the fields you wish to edit.
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What are the instructions for submitting this form?
To submit this form, ensure all sections are completed and reviewed. You can submit it via fax to the examining facility or email it directly, depending on the provided instructions. For postal submission, mail it to the specified address included on the form.
What are the important dates for this form in 2024 and 2025?
No specific impactful dates apply to this form for 2024 or 2025, but timely submission following your medical examination is essential for employment consideration.

What is the purpose of this form?
The purpose of the Medical Examination and History Report is to collect comprehensive health information from candidates. This ensures that all individuals meet the necessary health standards for their respective job roles. Completing this form accurately and thoroughly is crucial to the hiring process.

Tell me about this form and its components and fields line-by-line.

- 1. Selectee's Name: Full name of the individual completing the form.
- 2. SSN/ID Number: Social Security Number or Identification Number.
- 3. Date of Birth: Date of birth of the applicant.
- 4. Current Employer: The name of the applicant's current employer.
- 5. Medical History Questions: A series of questions to assess past medical conditions and treatments.
What happens if I fail to submit this form?
Failing to submit this form could result in disqualification from the employment process. It is crucial to complete and submit the form as instructed without any omissions.
- Disqualification: Not submitting may lead to being ineligible for the position.
- Incomplete Information: Missing data may result in delays in the hiring process.
- Failure to Disclose Conditions: Not disclosing necessary medical history could result in future complications.
How do I know when to use this form?

- 1. Pre-Employment Medical Evaluation: Candidates must complete this form as part of their pre-employment requirements.
- 2. Veteran Disclosure: Veterans applying for roles must include their medical history.
- 3. Health Standards Compliance: The form ensures candidates meet required health standards.
Frequently Asked Questions
What is this form used for?
This form is used to gather necessary medical history and examination details required for employment.
Who should fill out the form?
Job applicants, particularly in law enforcement, should fill out this form.
Can I edit the PDF directly?
Yes, you can easily edit the PDF using our PrintFriendly editor.
How do I submit the completed form?
You can submit your form to the designated examining facility as per the provided instructions.
What if I have a medical condition to disclose?
You must provide details in the appropriate sections of the form.
Is there a deadline to submit the form?
There may be deadlines depending on the specific position; check with your employer.
Can I save my changes to the PDF?
After editing, you can download your changes directly.
What if I missing information?
Ensure all required fields are filled out before submission.
Is this form mandatory?
Yes, it is required for those seeking employment in specific fields.
How do I contact support for issues?
You can reach out via our contact page for assistance.
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