1. I, __________________ (name in block letters), agree to answer a pre-employment medical questionnaire at the request of the company evaluating my application for a job ("potential employer"), which will be analyzed and interpreted by the software Med Technology pre-employment which is intended to (i) narrow down the number of candidates for whom a standard face-to-face pre-employment medical examination is required, (ii) identify targeted interventions for physical limitations for a job for which I am qualified, and (iii) identify the type of work that could be assigned to me in order to validate my ability to provide the potential employer with a regular and sustained work performance;
  2. I affirm that the answers I give to the pre-employment medical questionnaire will be accurate and truthful. I acknowledge that any omission or misrepresentation in my answers may result in consequences with respect to any hiring decision made by the potential employer, my work performance with the potential employer and/or my eligibility for continued employment with the potential employer;
  3. I understand that my answers to the pre-employment medical questionnaire will not be disclosed or processed in the context of a medical consultation;
  4. I understand that my answers to the pre-employment medical questionnaire constitute personal information, including information regarding my medical condition;
  5. I authorize the company Med Technology Inc. to collect and use my personal information for analysis by the software Med Technology pre-employment for the purposes mentioned in point 1 and to ensure their storage on secure servers hosted in Canada;
  6. I authorize Med Technology Inc. to forward to the potential employer a recommendation for exemption or not from a face-to-face pre-employment medical examination based on the analysis of my answers to the pre-employment medical questionnaire, using a secure portal, as well as, if applicable, the potential restriction(s) that will have to be assessed;
  7. I acknowledge and agree that Med Technology Inc. does not determine whether a candidate is fit or unfit for employment by the potential employer (with or without restrictions), that decision is left to the potential employer or the employer's designated medical examiner;
  8. I understand that Med Technologies Inc. does not make any decisions regarding my potential hiring by the potential employer, such hiring decisions being entirely at the discretion of the potential employer;
  9. I understand that I can consult Med Technology Inc.’s Privacy Policy for any questions related to the processing of my personal information at Med Technology Inc;
  10. I understand that I must contact the employer for any further questions regarding this questionnaire and the hiring process;
  11. I acknowledge that I have had sufficient time to review this consent form, that I have not signed it under any form of duress and that my consent is free and informed.