EmailMeForm
Short Term Applicant Health Questionnaire
Name
First
Last
Are you able to walk 5-6 miles a day?
*
Yes
No
Are you underweight or over weight?
*
Are you under medical supervision at this time, or presently taking any medication?
*
Yes
No
If yes, please list medications and reasons for medical supervision
Do you have any dietary limitations of which we should be aware?
*
Are you asthmatic?
*
Yes
No
Do you have any allergies?
*
Are you able to work outdoors in high temperatures?
*
Yes
No
Would you consider yourself to be in generally good health?
*
Yes
No
Please make additional comments regarding your health or special limitations affecting physical capabilities.