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The document is a medical history questionnaire required by the School District of Palm Beach County for applicants who have received a conditional job offer. It aims to gather information about the applicant's physical and mental health conditions that may affect their ability to perform the job. The questionnaire includes various health-related questions, requires detailed explanations for any affirmative answers, and emphasizes compliance with the Americans with Disabilities Act. It also includes an authorization for the release of medical information and affirms the accuracy of the provided information.
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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your Employee ID #, First Name, Middle Name, Last Name, and Date in the designated fields.
  3. Carefully review each medical condition listed. For each condition you have experienced, select 'Yes' or 'No'.
  4. If you answer 'Yes' to any question, use the space provided to explain further details such as diagnosis and treatment.
  5. Complete sections regarding any medications you are taking and any past treatments for drug addiction or alcoholism.
  6. Sign and date the form at the bottom to affirm that all information is accurate before submitting.

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An online form is an electronic application in which data is entered by the person filling it out for recording and further processing via predefined data fields. Such electronic forms can be found, for example, on websites or as attachments in e-mails.
Online Application Form means the electronic sign-up form which is available on the Companys website (the websites) and which a prospective Client has to complete in order to become the Companys Client.
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