MEGA Health Services

Please complete the following questions by ticking the appropriate box. If the answer is ‘yes’, give details including (a) date, (b) amount of time lost from work/school, (c) treatment, as appropriate.

I certify that all entries are true and correct. I understand that all information on this application is subject to verification.  I agree and understand that, in the event of my employment by Mega Health Services, Inc, I shall be subject to dismissal if any information that I have given in this application is false or misleading, regardless of time of discovery. I undertake to notify Mega Health Services, Inc of any changes in my circumstances, including health, criminal convictions and driving license endorsement, which would or could affect my ability to work. I understand that Mega Health Services, Inc may release my personal details to a client in order to secure work or to enable the client to verify my identity or eligibility to work. These details may include name, age, driving license, work history, criminal record, health questionnaire and proof of identity or eligibility to work. I authorize the Mega Health Services, Inc to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position.  I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I hereby acknowledge that I have read and agree to the above statements