Start - WebFX

Health Declaration

In order for you to work within the Food Industry we require the following information.

Do you have a doctor?*

Yes
No

Doctors Details

Doctors Name*

Doctors Address

Address Town/City ZIP / Postal Code Country

Doctor's Phone Number

Next of Kin's Details

This is the person we will contact in case of emergency.

Name*

First Last

Address*

Address Town/City ZIP / Postal Code Country

Next of Kin's Contact Phone Number*

Illnesses

Have you ever suffered from any of the following illnesses?*

Typhoid, Para Typhoid, Malaria, Yellow fever, Dust allergy, Nut allergy

Yes
No

Which illnesses?*

(please tick any that apply)

Have you have a recurring conditions, such as:*

Ear infections, Nose infections, Eye infections, Boils, Eczema, Skin infections

Yes
No

Which recurring conditions?*

Have you ever suffered from any other illness or had contact with anything that could affect you working in a food company?*

Yes
No

If yes, please give details:

Declaration*

At the request of WEBFX EMEA Limited or Harrow Club W10, I am willing to undergo a medical and any other necessary steps to ascertain my suitability to work.

I hereby certify that the information I have given is correct to the best of my knowledge. I understand that failure to follow food hygiene practices, or wrongful disclosure of information, could result in a fine, or in certain cases, a prison sentence.

On-boarding Form

Step 1 of 7 - Your Details

Your Details

Your Banking Information

Your Bank Details

Health Declaration

Doctors Details

Next of Kin's Details

Illnesses

48-Hour Opt Out Agreement - Working Time Regulations 1998

Employee Statement

Consent

020 8123 2690