Have you had any condition, problems, injury, illness, disability or condition that would have affected your ability in the past or may affect your ability to carry out fully the functions and responsbilities of the position applied for?
YesNo

Are you on any medication or under treatment or regularly ingest any substances that may affect your ability to carry out fully the functions & responsbilities of the position applied for?
YesNo

Have you ever suffered from a back injury?
YesNo

Have you ever suffered from any injury requiring time off work?
YesNo

Have you ever claimed accident compensation?
YesNo

Are you suffering from any infectious disease or have any condition which is capable of being passed on to children and is likely to have a detrimental effect if passed on to them?
YesNo

Do you smoke?
YesNo

Do you have any physical or other conditions that would make it difficult for you to:
YesNo

Hear a child cry from 6 metres away?
YesNo

Sit on the floor without support?
YesNo

Move very quickly?
YesNo

Be on your feet for several hours?
YesNo

Be outside for more than 2 hours at a time?
YesNo