I hereby give my permission for Mike Ball Dive Expeditions to contact either the above Companies or the Referees provided in my Resume to obtain a reference: Yes
Mike Ball Dive Expeditions may keep my Application, Resume and relevant paperwork on file for six months from the date of this submitting this employment application submission: Yes
Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES.
Do you regularly take prescription or non-prescription medication?:---YesNo
History of diving accidents or decompression sickness?:---YesNo
Asthma?:---YesNo
A high cholesterol level?:---YesNo
Frequent or severe attacks of hayfever or allergy?:---YesNo
Frequent colds, sinusitis or bronchitis?:---YesNo
Any form of lung disease?:---YesNo
Pneumothorax (collapsed lung)?:---YesNo
History of chest surgery?:---YesNo
Epilepsy, seizures, convulsions or take medications to prevent them?:---YesNo
Recurring migraine headaches or take medications to prevent them?:---YesNo
History of blackouts or fainting (full/partial loss of consciousness)?:---YesNo
Do you frequently suffer form motion sickness (seasick, carsick, etc)?:---YesNo
History of recurrent back problems?:---YesNo
History of diabetes?:---YesNo
History of back, arm or leg problems following surgery, injury or fracture?:---YesNo
Inability to perform moderate exercise (eg: walk one mile within 12 minutes):---YesNo
History of high blood pressure or take medicine to control blood pressure?:---YesNo
History of any heart disease?:---YesNo
History of ear disease, hearing loss or problems with balance?:---YesNo
History of bleeding or other blood disorders?:---YesNo
History of any type of hernia?:---YesNo
History of ulcers or ulcer surgery?:---YesNo
History of drug or alcohol abuse?:---YesNo
History of skin disorders, dermatitis, melanomas, skin cancer, etc?:---YesNo
Please supply a copy of:
Note: If successful in your application the above certifications must be valid for more than a 90 day period.
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Mike Ball Dive Expeditions
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