SELF-REPORTING QUESTIONNAIRE (SRQ)
TERMS AND CONDITION:
In compliance with the Data Privacy Act (DPA) of 2012, you understand and agree that by providing your personal data, you are agreeing and giving your full consent to MindWell, a part of CML Centre for Mastery and Life-long learning group to collect, store, access and/or process any personal data you may provide herein, such as but not limited to your name, mobile number and email address, whether manually or electronically, for the period allowed under the applicable law and regulations, and solely for the purposes of the psychological service/s required. You acknowledge that the collection and processing of your personal data is necessary for such purposes. You are aware of your right to be informed, to access, to object, to erasure or blocking, to damages, to file a complaint, to rectify and to data portability, and you understand that there are procedures, conditions and exceptions to be complied with in order to exercise or invoke such rights. All such information shall be purged from our records after the closure of your engagement with us as prescribed by the laws.
When completing this information form, you accept the responsibility for and agree on the following:
- Supplying, checking, and verifying the accuracy and correctness of the information provided on this system in connection with your registration, and consent to the collection and use of your personal information.
- You understand that any problems with internet availability or connectivity are outside our control and thus, we can not make any guarantee that such services will be available or work as expected. If something occurs to prevent or disrupt any scheduled appointment/s due to technical complications and the session cannot be completed via online video, you agree that we will either use the in-session video chat to troubleshoot or will call you back through a different platform to complete the session.
- Should there be at any point you have a need for psychological support after our session, you are most welcomed to contact and schedule for our psychological support at http://m.me/mindwellph.
- With foreseen cancellation of schedule, you agree that you may receive notification of earlier available slots for an appointment schedule through SMS or email, subject for your confirmation. This schedule is again subjected on a first come, first served basis.
- You are only allowed to postpone your schedule at least 3 days before the scheduled appointment.
This confirms you agree to the following stipulations and rights had been clearly explained to you as a test taker.
- I certify that I have freely appeared to undergo psychological assessment for employment at the date and time scheduled, which I personally arranged or was made known, and which I concurred.
- I agree to the use of technology for the session/s. This is to be done through a HIPAA compliant platform that uses video and audio technology through a webcam on my device, and my device to connect us securely. Moreover, I understand that I am solely responsible for maintaining the strict confidentiality of my user ID and password and not allow another person to use my ID to access this services. I also understand that I am responsible for using this technology in a secured and private location so that others cannot hear my conversation and distract me during test taking. Furthermore, I understand that I am not allowed to do any recording, screenshots, or any kind of record keeping of any part of this session/s and committing such are grounds for termination of this procedure.
- Through the terms and conditions and consent form, I understand clearly that CML, as the service provider for psychological assessment for employment to determine on an on-going basis whether the conditions for the continuation of the process is appropriate for me in consideration of the information gathered, assessment process, purpose of the activity, duration of the session, and specific instructions to be on an online session.
- I agree that the professional may determine that due to certain circumstances, my option to undergo this psychological assessment for employment could at any point of my session/s be no longer appropriate and I agree to resume session/s in-person.
- The duration of the session has been shared with me as part of my schedule. However, the length of psychological interview and the timing of the eventual termination of the procedure will depend on the completion of the battery of psychological tests and interview, which will depend on the questions or validating/follow through queries I or the professional may have.
- I have access to evidence-based and standardized assessments which will be administered by a certified and/or licensed psychometrician and/or mental health professional, who will provide up-to-date protocols and modalities free from discrimination based on ethnicity, race, gender, socio-economic status, or sexual orientation.
- When completing forms and/or online examination, I understand that I may not use textbooks, course notes, or receive any help from another source during the examination or session. I understand that I can not stop and return to it if not finished within the session.
- This form confirms my consent to disclose to the Human Resources of the organization I applied for the result of the assessments and use this for my employment.
- I consent that my information may be for research and/or educational purposes where my identity will not be specified nor disclosed.
- I have been assured that the results of this session including but not limited to the interview, presenting concerns, test results, and all other information shall be kept confidential and shall not be disclosed to anyone without my consent and approval in writing. However, I understand that CML will be required to disclose by law in specific situations that are life threatening, in an emergency, or an impending danger to self or others, where there is abuse, or inability to care for themselves, or other legal circumstances.