Special Circumstances Form

Full Name *
Contact Number *
National Insurance *
Please notify us of medical conditions or any special requirements you may have, so we can make reasonable adjustments for you.

Medical Circumstances
Are you asthmatic or do you have other breathing difficulties?
Problems with vision? (Mention if you need glasses.)
Hearing Impaired, Would you need hearing aid?
Will you be taking medication during work?
Will you be taking any medical equipment to work?

Yes No
Any other medical circumstances ?
If you have answered yes to any of the questions above please provide us with you GP details.

Mobility
Do you have any mobility difficulty?

Learning Difficulty
Do you have any known learning difficulties?

Dietary
Dietary Requirements (This information is requirement if we cater for your meals during festivals etc)?

Confirmation of details provided.
Anti-spam check *
I confirm the above is true and consent to Security Scotland processing this information in line with GDPR and the Security Scotland Privacy Policy *

I confirm and accept
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