Tetanus ………………………. …../…../……….. Polio ………………………. …../….../………. Name and Address of your GP I declare that to the best of my knowledge I have no infections or contagious or debilitating medical conditions and that I know of no reason relating to my health which could in any way restrict my ability to carry out the functions and duties required in Health Profession. I am aware that it is my responsibility to maintain up to date immunisation against infectious disease. I do not know of any reason which, on medical grounds, would prevent me from giving care or assistance to a member of the public. I hereby confirm that I am not currently in receipt of sickness benefit from any employer or from the state.
Tetanus ………………………. …../…../……….. Polio ………………………. …../….../………. Name and Address of your GP I declare that to the best of my knowledge I have no infections or contagious or debilitating medical conditions and that I know of no reason relating to my health which could in any way restrict my ability to carry out the functions and duties required in Health Profession. I am aware that it is my responsibility to maintain up to date immunisation against infectious disease. I do not know of any reason which, on medical grounds, would prevent me from giving care or assistance to a member of the public. I hereby confirm that I am not currently in receipt of sickness benefit from any employer or from the state.
Amberline-application-form.docx