The Emirates Group

Guidelines on Pre-Employment medical formalities

In order to satisfy and complete the necessary Pre-Employment medical requirement, which is a pre-condition to the offer of
employment, you are required to have the attached forms completed. Please note below guidelines on the forms attached:

Part – A
Employee Declaration of Health

Please read through the same carefully to fully understand the implications. You will be required to sign & date the form to confirm your
understanding prior to uploading the same on candidate portal.

Part – B
Employee Medical History Declaration

We require you to complete the form in good faith and make a full and honest disclosure of your medical history.

Any medical history marked as “Yes”, will require further details to be specified next to it in remarks section. Once the form is reviewed
by us, you may be asked to provide additional medical report(s)/Information(s), confirming the history & current status of the condition.

Please ensure to sign & date the form to confirm your understanding, prior to uploading the same on candidate portal.

Part – C
Employee Vaccination Information

Outlines the vaccinations which are recommended (not mandatory) for residency in Dubai, U.A.E. Kindly ensure that your vaccinations
records are validated against the same.

Part – E
Employee Basic Medical Examination

Please contact a Clinic/Hospital of your choice to have the Part – E form completed. The medical practitioner will fill the forms after
doing the appropriate tests and will need to provide you with the below lab reports.

You are required to upload Part – E form along with the below lab reports on candidate portal:

 Audiogram report & Graph

 Urinalysis report

Part – G
Employee Respiratory Surveillance

Please contact a Clinic/Hospital of your choice to have the Part – G form completed. The medical practitioner will fill the forms after
doing the appropriate tests and will need to provide you with the below lab reports.

You are required to upload the Part – G form along with the below lab reports on candidate portal:

 Spirometry test report.

Once all the forms have been completed & lab reports obtained (where applicable), please upload them all together on
Candidate Portal.
Steps for Uploading:

1. Log-on to candidate portal & click on “Medical” tab on the left section
2. Click on “Medical Documents” and then “Upload Pre-Employment Medical Forms”
3. Select the correct heading from the Drop-down list of “Select Document type” and upload relevant form(s)/report(s)
4. Click on “Browse” and select the file you want to upload
5. Click on “Upload” button
6. Preferred format to upload is PDF or JPG format (no mobile picture), while ensuring file size remains below “1 MB”

Please ensure uploading clear & legible documents on candidate portal to avoid any delays.

Note:

1. Please read all the forms carefully to understand the implications

2. All form(s) and report(s) should be completed in English and “Hand filled”
3. The Emirates Group will not reimburse any cost related to the Pre-Employment medical/dental formalities, Additional Tests,
Treatments & Vaccinations, that may be required to satisfy the Company standards
4. Once the forms are received and based on the information declared, you may be required to conduct additional medical
test(s) as stipulated by our medical team. However, you will be advised of the same
5. Please ensure to sign & date the form(s) where required prior to uploading them on candidate portal
6. All correspondence regarding your joining formalities will be entertained through the "My Question" link on candidate portal.
Should you require any further clarification, please post your query by clicking Submit a Query link

Other info:

Whilst you have the option of completing the medical requirements at a clinic/hospital of your choice, you can visit the below listed
clinics if you are currently based in Dubai, United Arab Emirates.

1) Al Noor Polyclinic - Al Rashidiya

Behind Bin Sougat Centre, Rashidiya - Dubai, U.A.E.

To book an appointment:

Tel: +971 4 286 2410

email: support@alnoorrashidiya.com

2) Al Noor Polyclinic - Al Qusais

Next to – Hayat Al Madina Supermarket
Bu Hussain Building, Doha Road, Qusais - Dubai, U.A.E

To book an appointment:

Tel: +971 4 261 2248

email: alnoorqusais@gmail.com
 PART – A

EMPLOYEE PRE-EMPLOYMENT DECLARATION OF HEALTH FORM

(TO BE COMPLETED IN ENGLISH ONLY AND UPLOADED ON THE CANDIDATE PORTAL)
IMPORTANT INFORMATION PLEASE READ CAREFULLY BEFORE COMPLETING
THE FORM

1. MANDATORY UAE GOVERNMENT MEDICAL EXAMINATION

Medical tests form part of the U.A.E government mandatory residency visa process. The following
medical tests will be completed as a part of the UAE residence visa / work permit process:

 Blood test for HIV

 Chest x-ray for tuberculosis (TB)
 Blood test for VDRL (Syphilis)*
 Blood test for Hepatitis B surface Antigen*

A UAE residence visa / work permit will not be issued for:

 Positive HIV test result

 Signs of active TB or scarring from previous TB on chest x-ray
 Untreated syphilis*
 Positive Hepatitis B surface antigen*
*Certain categories of staff including but not limited to food handlers (e.g. Cabin Crews, Cabin
Service Agents and Catering staff) and health care workers.

WE RECOMMEND THAT YOU UNDERTAKE A CHEST X-RAY, TESTING FOR HIV, HEPATITIS B
AND VDRL (if in applicable job category) PRIOR TO JOINING OR LEAVING CURRENT
EMPLOYMENT AS FAILURE TO MEET U.A.E VISA REQUIREMENTS WILL LEAD TO THE
TERMINATION OF YOUR CONTRACT AND REPATRIATION AT YOUR OWN EXPENSE.

ADDITIONAL INFORMATION RELATED TO JOB SPECIFIC COMPANY MEDICAL

TESTS/REQUIREMENTS IS INCLUDED WITH YOUR JOINING INFORMATION.

2. PRE–EXISTING MEDICAL CONDITION

Pre-existing medical conditions (defined below), whether identified on joining or confirmed during
employment, are excluded from the Company Medical Insurance Scheme for a period of 6 months
from date of entry into the scheme.

A pre-existing medical condition is defined as any disease, illness or injury for which:

 You have received medication, advice or treatment; or

 You have experienced symptoms, or have become aware or have knowledge of, whether the
condition has been diagnosed or not before the start of your current continuous period of
cover

A waiting period of six months from the date of joining the scheme will apply to these conditions
before they are covered under the Company Medical Insurance Scheme. The company will only
reimburse costs for treatment of pre-existing conditions undertaken after the waiting period has
expired. Following the waiting period the condition/s will be covered within the terms of the policy and
within the policy sub-limit specified.

If you are aware of any pre-existing medical conditions which could be excluded, regardless of
whether Emirates has issued a waiver/exclusion for such condition, it is recommended that you
continue your existing medical insurance cover.

I confirm that I have read and understood the information above relating to:
 Mandatory U.A.E. Government Medical Examination
 Pre – Existing Medical Condition

Name:…………………………………………. Signature: ……………………………………….

Date:……………………………………………

Form Review Date: 01 July 2015 1

 PART – B Page 1
EMPLOYEE MEDICAL HISTORY DECLARATION

(TO BE COMPLETED IN ENGLISH ONLY AND UPLOADED ON THE CANDIDATE PORTAL)

Full Name: Application Number: Sex:

Date of Birth: Age:
Nationality:
Email ID: Marital Status:

Do you have or have you ever had:
1. Frequent or severe headaches or migraines
No Yes For ‘Yes’ provide details on the date of onset of the
condition, diagnosis, past or current treatment details
and the current status and/ or relevant available
medical reports

2. Head injury or concussion

3. Dizziness, fainting or blackouts

4. Fits, convulsions or epilepsy

5.Depression, anxiety, bipolar or any other

mental health disorder or illness
6. Eating disorders e.g. anorexia or bulimia

7. Any tropical diseases e.g. Malaria or

Dengue fever
8. Tuberculosis (TB)

9. Anaemia, sickle cell disease or any other

blood disorders
10. Positive HIV test

11. Positive Hepatitis B surface antigen

(HBsAg) test
12. Positive Hepatitis C antibodies test
(Anti HCV)
13. Positive VDRL (test for Syphilis) or
untreated syphilis
14. Asthma, Hay fever or any other respiratory
problems
15. Any history of allergies to medications,
food or vaccinations. If yes:
a. Do you have a history of anaphylaxis

b. Have you ever required hospitalisation for

reasons of allergy
c. Do you require ongoing carriage of Epipens

16. Heart complaints of any kind e.g. heart

attack, angina, irregular heart beats, heart
surgery, heart disease
17. High blood pressure- If you have had a
recent blood pressure reading , please provide
result
18. Coughing or vomiting blood

19. Stomach pain or bowel problems other

than occasional indigestion e.g. ulcers,
haemorrhoids, acid reflux, etc.

Form Review Date: 6 October 2013 1

 PART – B Page 2

EMPLOYEE MEDICAL HISTORY DECLARATION (continued)

Do you have or have you ever had:
20. Passing blood in urine or faeces
No Yes For ‘Yes’ provide details on the date of onset of
the condition, diagnosis, past or current treatment
details and the current status and/ or available
relevant medical reports

21. Kidney or bladder diseases e.g. kidney

stones
22. Diabetes, impaired glucose regulation,
thyroid disease or any other endocrine
disorders like increased prolactin levels, etc.
23. Raised cholesterol/abnormal lipid profile

24. Sleep problems lasting for more than a few

days or snoring problems (obstructive sleep
apnoea)
25. Corrective eye surgery or eye problems,
other than wearing glasses or contact lenses
26. Nose, Throat, Speech disorders or Sinus
problems
27. Ear or hearing problems or hearing aids

28. Skin diseases

29. Back trouble e.g. lumbago, sciatica,

slipped disc or significant scoliosis
30. Rheumatism, Arthritis, joint or limb
problems
31. Any Surgical operations including cosmetic
procedures
32. Growths, tumours or malignancies

33. If Female; any cervical (PAP) smear issues

Date and results of the last Pap smear test
if undertaken
34. If female, any gynaecological problems

35. Any serious injury, e.g. fracture or

dislocation or any ongoing problems
36. Any admissions to the hospital

37. Any learning disabilities e.g. dyslexia

38. Any illness not mentioned above

39. List any medications/food supplements/

diet pills/herbal treatments or other
substances that you are currently taking with
brief on medical condition
40. Any illness that caused you to take time off
work for a period longer than 20 days in a
single year
41. Have you ever been found medically unfit
for military service or insurance?
42. Have you ever been charged with an
offence relating to drugs or alcohol?

Form Review Date: 6 October 2013 3

 PART – B Page 3

EMPLOYEE MEDICAL HISTORY DECLARATION (continued)

Do you have or have you ever had: No Yes For ‘Yes’ provide details on the date of onset of the
condition, diagnosis, past or current treatment details
and the current status and/ or relevant available
medical reports
43. Family history e.g. heart disease, diabetes,
kidney disease, cancers, glaucoma, epilepsy,
tuberculosis, depression/anxiety or inheritable
diseases or sudden unexplained death
44. Alcohol; Do you drink & how much
per week? (state units)
45. Tobacco: Do you smoke (including pipes,
cigars, sheesha) and how much per day?
46. Please provide your height and weight and Height= Weight= BMI =
calculate your BMI
Weight in kilograms divided by (height x height in
(Do not complete if medical examination is requested)
metres): e.g. 65kg / (1.68x1.68) = BMI 23
47. Declare if currently pregnant in order for us
to provide you details on your Medical Benefits
and HR Policy

I hereby declare that I have completed the questions above accurately and that I have not withheld any relevant
information or made any misleading statement. I understand that if I have made any false or misleading statements in
connection with this application, or fail to provide supporting medical information where required, the company may, at
it’s discretion withdraw my offer of employment or terminate my contract of employment. In addition failure to disclose
pre-existing medical conditions will, in certain circumstances, invalidate insurance policies such as medical insurance,
life and personal accident insurance provided by the company.

I authorize Emirates Medical Services and Emirates Medical Benefits Administration to obtain the medical records,
reports and test results associated with my pre-employment medical declaration, either in original hard-copy form or
via access to electronic data systems, as may be required to determine my medical suitability for participation in the
Emirates medical insurance programme, to determine my medical suitability for proposed employment and in
connection with any future medical care I may obtain from Emirates Medical Services. The information contained on
the form will be held in confidence by Emirates Medical Services and Medical Benefits Administration and used only
for this purpose; however in the event of any doubt as to whether my medical status is compatible with the position I
have been offered, I hereby consent to the release of summary details which will be provided to the recruitment
specialist dealing with my application and to my prospective line manager.

Name (Block Capitals): …….......……..…………….. Date: ............................................

Signature: ................................................................

NOTE: This form is to be countersigned by the physician who will be performing the medical examination
(where applicable).

Name (Block Capitals): …….......……..…………….. Date: ............................................

Signature: ......................................................

Form Review Date: 6 October 2013 3

 PART – C
EMPLOYEE VACCINATION INFORMATION

(TO BE COMPLETED IN ENGLISH ONLY AND UPLOADED ON THE CANDIDATE PORTAL)

Full Name:
Application Number: Sex:

Nationality: Date of birth: Age:

The following vaccinations are recommended for residency in Dubai:

Diphtheria, Pertussis and Tetanus

Polio
Measles Mumps Rubella (MMR)
Typhoid
Hepatitis A
Hepatitis B
Varicella

Please ensure your vaccinations are up to date. Once recruited, please ensure that you bring your vaccination records on
joining.

If during employment you are sent on duty travel outside the UAE, please contact your Line Manager who will refer you to
Emirates Group Medical Services for any additional vaccinations that may be required.

Form Review Date: 1 August 2012 1

 PART – E Page 1

EMPLOYEE MEDICAL EXAMINATION

(TO BE COMPLETED IN ENGLISH ONLY AND UPLOADED ON THE CANDIDATE PORTAL)

Full Name: Application Number: Sex:

Nationality: Date of birth: Age:

1. CLINICAL EVALUATION;
HEIGHT (cm) WEIGHT (kg) BMI NECK PEFR (L/min) PULSE Blood Pressure readings
CIRCUMFERENCE (Peak Expiratory (rate & rhythm) (taken within 15 minutes interval)
(cm) if BMI > 30 Flow Rate)
1. 2.

Description (Please tick) Normal Abnormal Please comment on any abnormal

findings
Head, face, neck and scalp

Ear, nose and throat

Eyes (orbit, adnexa, pupils, ocular motility, fundi)

Respiratory system

Heart (size, rhythm, sounds)

Vascular system (bruits, varicosities, etc.)

Abdomen examination (including hernial orifices)

Anus, rectum (if clinically indicated)

Genitourinary system (if clinically indicated)

Endocrine System (clinical manifestations of thyroid, diabetes

or other endocrine disorders)
Upper Extremities (strength, range of motion, muscle tone)

Lower Extremities (strength, range of motion, muscle tone)

Spine (please comment on range of movement and if presence

of any abnormalities)
Neurology (declare any neurological complaints)

Skin (Please comment on presence of any chronic skin disease)

2. Audiogram:
Frequency (Hz) 500 1000 2000 4000 6000
Right ear (dB)

Left ear (dB)

3. Urinalysis:
Normal Abnormal Glucose Protein Blood Comments
Urinalysis

Form Review Date: 6 October 2013 1

 PART – E Page 1

EMPLOYEE MEDICAL EXAMINATION (continued)

(TO BE COMPLETED IN ENGLISH ONLY AND UPLOADED ON THE CANDIDATE PORTAL)

4. Vision:
Vision Normal Abnormal Comments
1. Visual fields (by confrontation)

2. Visual Acuity Right eye results Left eye results Comments

Distance at 6 metres

a. Uncorrected VA

b. Corrected VA

Near N5 at 30-50 cms

a. Uncorrected VA

b. Corrected VA

3. Color vision by Ishihara with 24 plates If additional advanced color

Result : Pass or Fail (fill one) vision testing carried, please
Mention the number of plates passed out of 24 indicate type and result of test

Spectacles/Contact lenses worn: YES/NO (tick applicable)

Assessment findings (Please include all test reports and specialist reports where applicable):

----------------------------------------------------------------------------------------------------------------------------- ----------------

Date: -------------------- Physician’s name and signature: ----------------------------- Stamp:------------------

Form Review Date: 6 October 2013 2

 PART – G

EMPLOYEE RESPIRATORY SURVEILLANCE

(TO BE COMPLETED IN ENGLISH ONLY AND UPLOADED ON THE CANDIDATE PORTAL)

Full Name: Application Number: Sex:

Nationality: Date of birth: Age:

Part A: Initial questionnaire for Respiratory Surveillance to be completed by the candidate

Please answer the following questions: No Yes For ‘Yes’ provide details on the date of onset of the
condition, diagnosis, past or current treatment details
and the current status and/ or relevant medical reports
1. Do you have any chest problems, such as
periods of shortness of breath, wheezing , chest
tightness or persistent cough
2. Have you ever been diagnosed with asthma

3. Do you believe that your chest has suffered as

a result of any previous employment
4. Do you or have you ever had any of the
following (Do not include isolated colds, flu or sore
throats).
a. Recurring soreness or watering of eyes
b. Recurring blocked or runny nose
c. Recurrent episodes of coughing
d. Chest tightness
e. Wheezing
f. Shortness of breath
g. Any other history of chest/breathing problems
5. Do you smoke? If yes, please state amount

6. Have you ever smoked? If yes, please state

amount, how long and when stopped
7. Do you get any of the following skin conditions

a. Irritation or itching
b. Rashes
c. Sore, cracking or weeping skin

Name of the candidate (Block Capitals): ……... ……..…………….. Date: ............................................

Signature: ............................................................

Part B: To be completed by the Health Professional

1. Spirometry report attached (YES/NO)

2. FEV1/FVC ratio

3. Comments: …………………………………………………………………………………………………….

Name/Designation of the Health Professional (Block Capitals): ……... ……..…………………………………………….

Signature: ............................................................ Date: .................................

Form Review Date: 6 October 2013 1