THIS FORM IS TO BE COMPLETED BY CANDIDATE.

1 candidate PRE-PLACEMENT HEALTH questionnaire Saudi Aramco 9328 (05/2016) Saudi Aramco: Company General Use 1 | PageTHIS FORM IS TO BE COMPLETED BY candidate . Information requested on this candidate Pre-Placement Health questionnaire ( questionnaire ) is collected pursuant to Saudi Arabian Oil Company ( Saudi Aramco ) corporate guidelines. The purpose of this questionnaire is for you to provide your health and work history so Saudi Aramco can determine: (1) Whether you are medically able to perform the job for which you have applied. It is not intended to exclude anyotherwise qualified individual from obtaining employment.(2) Whether any health issues or disabilities may affect your residency in Saudi you need extra space to provide any additional information, use a separate sheet of paper. Please include your name, indicate the question number to which your answer refers, and sign/date each sheet. I. PERSONAL INFORMATIONC ountry Passport Issued By Job Title Name (last name, middle name, first name) Badge No Date of Birth (M/D/Y) Gender Marital Status Weight (kg) Height (cm) E- Mail AddressAddress & Telephone No MEDICAL HISTORY1.

2 ACTIVE CONDITIONSHave you ever had, or do you currently have any of the following active conditions?Condition Yes No Condition Yes No Allergies ( latex, medicines, environmental/seasonal, foods) Gastroenterology problems ( Crohn s disease, colitis) Arthritis Hearing impairment Asthma / obstructive sleep apnea Heart/vascular or circulatory problem Autoimmune/connective tissue disease ( SLE) High blood pressure Back pain, injury, or disk disease Infectious disease ( HIV, Hepatitis B/C, syphilis) Blood disorders ( sickle cell, thalassemia) Kidney function impairment Cancer or tumors Mobility ( walking, running, using stairs) Chest pain Mental or emotional illness ( anxiety, depression, nervous breakdown, personality) Chronic obstructive pulmonary disease (COPD) Multiple sclerosis (MS) Chronic productive cough ( pertussis) Shortness of breath Diabetes Skin problems ( psoriasis, eczema) Dizziness/vertigo or frequent severe headaches / migraines Sleep Disorder ( sleep apnea)

3 Drug or alcohol or narcotic dependency Stroke/transient ischemic attack Eating disorder ( bulimia, anorexia, etc) Tuberculosis RehireNew HireSingleMarriedMaleFemaleCANDIDATE PRE-PLACEMENT HEALTH questionnaire Saudi Aramco 9328 (05/2016) Saudi Aramco: Company General Use 2 | PageCondition Yes No Condition Yes No Epilepsy/seizure disorder Ulcers, digestive or stomach problems Fractures (specify body parts) Vision impairment ( visual impairment, color blindness, tunnel vision) 2. TREATMENT AND MEDICATIONYes No a. Have you ever been admitted to a specialty medical facility or hospital?Date Treatment Diagnosis/Condition/Outcome b. Have you ever had been advised to undergo a medical operation within the last five years?Date Type of Surgery Diagnosis/Condition Outcome c. Have you ever been disqualified for duty in, or discharged from the Armed Services for medical reasons?Date Reason for disqualification or discharge d.

4 Do you presently have any impairment or disability or health condition not mentioned above?Date of onset Impairment/Disability/Health Condition Treatment e. Are you taking any prescribed medication?Date Medication Dosage Reason f. Do you drink alcoholic beverages? (include average number of drinks per day)g. Do you smoke? (i nclude average number of cigarettes per day and the number of years of smoking)h. Have you ever been assessed or treated by any medical mental specialists within the last 5 years?Treated by Treatment Diagnosis/Condition/Duration of Treatment Date i. Have you ever been refused insurance because of a medical condition?Date Medical Condition candidate PRE-PLACEMENT HEALTH questionnaire Saudi Aramco 9328 (05/2016) Saudi Aramco: Company General Use 3 | Page3. OCCUPATIONAL INJURY OR ILLNESSa. Have you ever filed a compensation claim or received benefits as a result of an occupational injury ordisease?

5 Yes No Date Nature of injury or disease b. Have you lost time from work for more than five days due to illness or occupational injury in the past twoyears?Date Nature of injury or illness Duration of time lost c. Have you ever been placed on work restriction due to occupational injury or illness?Date Nature of injury or illness Restriction and duration 4. MEDICAL REPORTSFor any positive response indicated in this Section II, please provide a corresponding report as indicatedbelow. Each report must be dated within 90 days of this submission and include information such asonset, etiology, treatment, prognosis, diagnosis, any admissions, and current Report A. ArthritisRheumatology B. Asthma / COPDP ulmonology report with Pulmonary Function Test problem or any fracturesNeurosurgery and/ or orthopedic disorderHematology report with hemoglobin A1C & fasting blood sugar report or severe headaches/dizzinessNeurology /ENT report impairmentAudiogram and if any major problems or surgery provide ENT report or circulatory problemsCardiology report and appropriate investigations, ECHO, stress test, EKG diseasesLab findings and detailed infectious disease report M.

6 Mental or emotional illnessPsychiatric /psychologist report (depends) sclerosis (MS)Neurology disorder ( sleep apnea)Pulmonology report with sleep study P. StrokeNeurology (uncorrectable by spectacles)Ophthalmology candidate PRE-PLACEMENT HEALTH questionnaire Saudi Aramco 9328 (05/2016) Saudi Aramco: Company General Use 4 | HISTORYP lease list your previous jobs, starting with the most Industry Job title Employer address Dates of employment 2 Industry Job title Employer address Dates of employment 3 Industry Job title Employer address Dates of employment 4 Industry Job title Employer address Dates of employment LICENSE OR CERTIFICATEIf you are professionally licensed or certified to perform your current job (pilot, ship crew, respirator user, craneoperator, fire fighter and others) please attach a copy of your professional license or AND RELEASE AUTHORIZATIONI, the undersigned, hereby affirm that I have given true and complete information to the best of myknowledge regarding my medical history.

7 I understand and accept that if, after having beenemployed, any false statement or misrepresentation or omitted material information will constitute avalid reason for my immediate employment termination by Saudi Aramco without , the undersigned, hereby authorize the release of (1) the information I have provided herein, and (2)the results of any required medical examination, including the opinions and evaluations of theexamining physicians, to Saudi Aramco and to Johns Hopkins Aramco Healthcare (JHAH) and theiremployees and authorized , the undersigned, do voluntarily agree to release and hold Saudi Aramco, JHAH and their employeesand authorized agents harmless from any claim, demand, or cause of action for damages arising fromthe review and release of my medical information for the purpose of consideration for of candidate Date Pri nt Your Name candidate PRE-PLACEMENT HEALTH questionnaire Saudi Aramco 9328 (05/2016) Saudi Aramco: Company General Use 5 | PageSaudi Aramco Employment candidate Medical Information Confidentiality Waiver Form I, the undersigned, hereby authorize the release of my medical information to Saudi Aramco and the Johns Hopkins Aramco Healthcare (JHAH) for the purpose of consideration for employment.

8 Furthermore, as a condition of being considered for employment, I understand and consent to having my medical personnel involved in my hiring decision. I, the undersigned, do voluntarily agree to release and hold Saudi Aramco, JHAH and their employees and authorized agents harmless from any claim, demand or cause of action for damages arising from the review and release of my medical information for the purpose of consideration for employment. Signature of candidate Date Print Your Name Signature of Witness Date Print Your Name