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    CS Form No. 211 Medical Certificate

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    milesmine
    This medical certificate form is used to document the results of pre-employment medical exams. It requires a licensed government physician to certify if an applicant is physically fit for a proposed position based on examining the applicant and reviewing attached exam results, which must include a blood test, urinalysis, chest x-ray, drug test, and psychological evaluation. The form collects identifying and employment information about the applicant.

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    CS Form No. 211 Medical Certificate

    Uploaded by

    milesmine
    624 views2 pages
    This medical certificate form is used to document the results of pre-employment medical exams. It requires a licensed government physician to certify if an applicant is physically fit for a proposed position based on examining the applicant and reviewing attached exam results, which must include a blood test, urinalysis, chest x-ray, drug test, and psychological evaluation. The form collects identifying and employment information about the applicant.

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    This medical certificate form is used to document the results of pre-employment medical exams. It requires a licensed government physician to certify if an applicant is physically fit for a proposed position based on examining the applicant and reviewing attached exam results, which must include a blood test, urinalysis, chest x-ray, drug test, and psychological evaluation. The form collects identifying and employment information about the applicant.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    624 views2 pages

    CS Form No. 211 Medical Certificate

    Uploaded by

    milesmine
    This medical certificate form is used to document the results of pre-employment medical exams. It requires a licensed government physician to certify if an applicant is physically fit for a proposed position based on examining the applicant and reviewing attached exam results, which must include a blood test, urinalysis, chest x-ray, drug test, and psychological evaluation. The form collects identifying and employment information about the applicant.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
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    CS Form No.

    211
    Revised 2018

    MEDICAL CERTIFICATE
    (For Employment)

    INSTRUCTIONS
    a. This medical certificate should be accomplished by a licensed government physician.
    b. Attach this certificate to original appointment, transfer and reemployment.
    c. The results of the following pre-employment medical/physical/psychological
    must be attached to this form:
    ✘ Blood Test
    ✘ Urinalysis
    ✘ Chest X-Ray
    ✘ Drug Test
    ✘ Psychological Test
    ✘ Neuro-Psychiatric Examination (if applicable)

    FOR THE PROPOSED APPOINTEE


    NAME (Last Name, First Name, Name Extension (if any) and Middle Name) AGENCY / ADDRESS

    ADDRESS

    AGE SEX CIVIL STATUS PROPOSED POSITION

    FOR THE LICENSED GOVERNMENT PHYSICIAN

    I hereby certify that I have reviewed and evaluated the attached examination results, personally examined th
    above named individual and found him/her to be physically and medically £FIT / £UNFIT for employment.
    SIGNATURE over PRINTED NAME OF LICENSED GOVERNMENT PHYSICIAN: OTHER INFORMATION ABOUT THE
    PROPOSED APPOINTEE

    AGENCY/Affiliation of Licensed Government Physician:

    LICENSE NO. HEIGHT (M) WEIGHT (KG)


    Bare Foot Stripped

    OFFICIAL DESIGNATION DATE EXAMINED


    DICAL CERTIFICATE
    (For Employment)

    NSTRUCTIONS

    PROPOSED APPOINTEE
    AGENCY / ADDRESS

    PROPOSED POSITION

    SED GOVERNMENT PHYSICIAN

    evaluated the attached examination results, personally examined the


    e physically and medically £FIT / £UNFIT for employment.

    OTHER INFORMATION ABOUT THE


    PROPOSED APPOINTEE

    BLOOD
    TYPE

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