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Health Declaration for Biodata Application
Helper Health Declaration
Please enter your information
Your Full Name
Your Phone Number
Your FIN (i.e. G1234567A) or Passport Number
What is your highest education level that you completed?
Primary
Secondary
University
Bachelor
Master
Health Declaration
Do you have any allergies?
Yes
No
Please describe your allergies
Have you taken your Measles, Mumps, Rubella (MMR) Vaccination?
2 doses (completed)
1 dose only
No
Past and existing illnesses (including chronic ailments and illnesses requiring medication):
Mental illness
Yes
No
Epilepsy
Yes
No
Asthma
Yes
No
Diabetes
Yes
No
Hypertension
Yes
No
Tuberculosis
Yes
No
Heart disease
Yes
No
Malaria
Yes
No
Operations/Surgery
Yes
No
HIV
Yes
No
VDRL/Syphilis
Yes
No
Others (Any ongoing and past medications):
Physical disabilities (if any):
Criminal Records and Loan Declaration
1) Do you have any criminal record or other record at the Police of Singapore or in any other country?
Yes
No
2) Do you have an ongoing loan with another employment agency or money lenders in Singapore?
Yes
No
Declaration
*I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application or immediate termination of employment.
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