​​Clinical Implementation Facilitator Vic​

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DECLARATION OF PRE-EXISTISTING INJURIES OR DISEASES

General Information: In accordance with section 41 of the Workplace Injury Rehabilitation and Compensation Act 2013 (the Act), you are required to disclose all pre-existing injuries or diseases suffered by you, of which you are aware, that you could reasonably be expected to foresee could be affected by the nature of the proposed employment. By completing this declaration, you acknowledge that you have provided an accurate account of your fitness for the role you have applied for. I confirm that I have been requested to disclose all pre-existing injuries or diseases suffered by me, of which I am aware, that I could reasonably be expected to foresee could be affected by the nature of the proposed employment. I am aware that failure to disclose any such pre-existing injuries or diseases, or the making of a false or misleading disclosure, will mean that section 41(2) of the Act will apply and, in the event that I suffer any recurrence, aggravation, acceleration, exacerbation, or deterioration of any pre-existing injuries or diseases arising out of or in the course of or due to the nature of the proposed employment, I will not be entitled to compensation under the Act.

Declaration: I have read the position description of the proposed employment and understand the inherent physical and/or psychological demands of the proposed employment.

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