Other Personal Details

The Living Room Group Ltd is committed to an equal opportunities policy in employment and will assess applicants for jobs without regard to disability, marital status, race or sex.

1. Disabilities

   If you are registered disabled, please give your number:
   
   Nature of your disability:
2. Have you been abroad recently?
   Yes  No
   If yes - where:
3. Do you or have you ever suffered from:
   
   Typoid fever

   Yes  No
   Paratyphoid fever

   Yes  No
   Fits or blackouts since the age of 5

   Yes  No
   Recurring ear infections

   Yes  No
   Recurring skin trouble affecting the hands, arms or face

   Yes  No
   Recurring disabilities affecting standing, walking, lifting or use of hands:

   Yes  No
4. At present are you suffering from:
   
   A discharging ear:

   Yes  No
   Boils, styles or septic fingers:

   Yes  No
   A cough with phelgm:

   Yes  No
   Abdominal pain, diarrhea or flu:

   Yes  No
   Skin trouble affecting the hands, arms or face:

   Yes  No