Once a conditional job offer is made, please be aware all persons may be required to furnish health condition information and, if necessary, submit to an examination by a company-designated physician. This information will be used to determine appropriate job placement. It shall not be used to disqualify an otherwise qualified person who may have mental or physical disability.
The following are physical requirements pertaining to the job for which you applying. These physical requirements are essential functions of the job and are in addition to the skills, certification, and years of experience or other qualifications required to perform the job(s) for which you have applied.
Notes: Only those essential functions relevant to the job(s) for which you have applied will be answered below. Are you able to perform the tasks or functions?
Are you physically able to type or work at a keyboard or typewriter most of the day, if required?
—Please choose an option— Yes No
Work at and view a video display terminal for an eight hour or more shift?
—Please choose an option— Yes No
Grip, grasp, and twist using your hands and wrists?
—Please choose an option— Yes No
Lift and / or carry up to 50 lb. regularly during your shift?
—Please choose an option— Yes No
Stand for long periods of time during your shift?
—Please choose an option— Yes No
Climb stairs with loads up to 50 lb. during your shift?
—Please choose an option— Yes No
Work around dust and wear a respirator if required?
—Please choose an option— Yes No
Reach over your head with 20 - 25 lb. loads regularly during your shift, if required ?
—Please choose an option— Yes No
Wear proper safety equipment - hardhat, googles, glasses, respirators, steel-toe boots, etc.?
—Please choose an option— Yes No
Have you ever been employed here before? If yes, give dates and position. If no, please put N/A.