OFFICIAL SENSITIVE PERSONAL (when completed)
Medical in Confidence
INSTRUCTIONS FOR COMPLETING THE MEDICAL SCREENING QUESTIONNAIRE FOR ROYAL AIR FORCE/RESERVES PRE EMPLOYMENT SCREENING
The military environment is arduous and the Armed Forces require anyone who enters service to be medically fit to serve worldwide. Applicants who do not meet the required medical standards will not be permitted to enter service. Further information on medical conditions that preclude entry can be found on the RAF Recruitment website.
To confirm your eligibility to proceed with your application you are to complete the attached questionnaire.
If you answer yes to any question you must complete and return the form to your AFCO/Squadron staff.
Do not hand in the form if the questions do not apply to you, but you must confirm with the AFCO /Squadron staff that you have read the form.
Completed questionnaires are to be placed in a sealed envelope and taken to the AFCO/Squadron. Recruiting staff will send the information to RAF Recruiting and Selection, Department of Occupational Medicine. Medical staff will review your eligibility for service. Your medical history is confidential and will not be given to anyone not authorised to hold this information.
You will be informed of your eligibility to proceed with your application either by the AFCO/Squadron recruiting staff or by the Department of Occupational Medicine.
Any failure to declare your past medical history or any existing medical/health conditions may result in your application being discontinued. If you are found to have concealed or not declared a health issue once employed by the RAF/RESERVES then this may result in employment termination under the terms of Queens Regulations as Services No Longer Required.
MEDICAL SCREENING LEAFLET - GROUND BRANCHES / TRADES
FOR COMPLETION BY APPLICANT
Surname: / First Name: / URN: / Full Address:Date of Birth: / Branch/Trade applied for: / Location/AFCO:
Age:
Current/Previous Serving member of HM Forces? Yes No
If yes, dates: From……………………to………………………
Any information provided on this form may be confirmed with your GP later during the recruitment process.
Please read every question and circle ‘yes’ if applicable to you.
DO NOT annotate this form further.
1 / Do you currently suffer with asthma or wheeze? / Yes2 / Are you currently taking any treatment for asthma or wheeze? / Yes
3 / Have you had any asthmatic symptoms including nocturnal cough or exercise induced wheezing in the past 5 years? / Yes
4 / Have you had any asthmatic symptoms including nocturnal cough or exercise induced wheezing since your 16th birthday? / Yes
5 / Have you used an inhaler (continuously or intermittently) for the control of asthma or wheeze for a period of more than 8 weeks in the 5 years prior to this application? / Yes
6 / Have you been prescribed steroid tablets or syrup for asthma or wheeze since your 5th birthday? / Yes
7 / Have you required admission to an Intensive Care Unit for asthma at any time in your life? / Yes
8 / Have you required hospital admission for more than 24 hours for asthma or wheeze since your 5th birthday? / Yes
9 / Have you taken any medication to prevent or treat migraine within the last 2 years? / Yes
10 / Have you ever been diagnosed with epilepsy? / Yes
11 / Have you ever been diagnosed with diabetes? / Yes
12 / Have you ever been diagnosed with Asperger’s Syndrome or Autistic Spectrum Disorder? / Yes
13 / Have you ever suffered from anorexia bulimia or anorexia nervosa? / Yes
14 / Have you been diagnosed with an anxiety disorder within 12 months of this application? / Yes
15 / Have you ever suffered from depression, low mood, or anxiety, lasting longer than 12 months? / Yes
16 / Have you suffered from depression within 2 years of this application? / Yes
17 / Have you suffered from an episode of self-harm within 3 years of this application? / Yes
18 / Have you ever suffered from 2 or more episodes of self-harm? / Yes
19 / Have you ever been prescribed an adrenaline auto-injector / Epipen for an allergic reaction? / Yes
20 / Do you currently suffer from hip pain? / Yes
21 / Have you had a fracture of your arms or legs (excluding fingers, toes, collar bone) within 12 months of this application? / Yes
22 / Have you had any shoulder dislocations or stabilisation surgery within 12 months of this application? / Yes
23 / Have you suffered from knee pain lasting longer than 3 months, within 12 months of this application? / Yes
24 / Have you ever had an anterior or posterior cruciate ligament (ACL/PCL) rupture or repair or reconstruction? / Yes
25 / Have you had any arthroscopic knee surgery within 12 months of this application? / Yes
26 / Have you had 3 or more episodes of back pain within 12 months of this application? / Yes
27 / Have you ever suffered from back pain lasting longer than 3 months? / Yes
28 / Have you suffered from ankle pain lasting longer than 3 months, within 12 months of this application? / Yes
If you have answered yes to ANY question you must return this form to the AFCO staff in a sealed envelope.
DO NOT hand this form in if the questions are not applicable to you. By not submitting this form you are declaring that these specific questions do not apply to you, and should any of these criteria be identified at future medical appointments or become known to the RAF then you accept that you may be excluded from application.
I confirm I have answered the above questions honestly and to the best of my knowledge
Signature ……………………………… Date …………………………………
OFFICIAL SENSITIVE PERSONAL (when completed)
Medical in Confidence