I, , hereby give my consent and express my willingness to undergo a physical examination as requested by . I also consent to the release of the results of the physical examination to .
I acknowledge that the conditional offer of employment dated with is contingent on my satisfactory completion of this physical examination and that if the results of the examination indicate that I cannot physically perform the essential functions of the position that I have been offered, with or without a reasonable accommodation, the conditional offer is revoked and I no longer will be considered a qualified candidate for employment.
I understand that I will receive a copy of the written examination and that I may also provide the examiner with additional information related to my ability to perform the position's duties. I understand that I may ask questions of the examiner and may also stop the examination at any time.
I understand that if I fail to complete the examination or do not authorize the results to be released to within two calendar weeks (14 days) of the date of the conditional job offer, the job offer will be withdrawn. |