MEDICAL CONSENT
For the limited purpose of consideration of employment with
, I, the undersigned individual, asserting .
that I am over the age of majority do authorize the following medical examination:
I realize that the medical examination will be conducted for the benefit of my prospective employer and will be included as a part of my prospective employer's determination whether to extend an offer of employment to me.
I release both the medical professional who will conduct such tests and
from all liability for diagnosis
and treatment. I voluntarily authorize this consent without limitation or uncertainty.
Signature
Date
electronic form 2005
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