Scribd Logo
Upload

Welcome to Scribd!

  • 40 views

    MedicalDeclarationFormpdf 1699856618260

    Uploaded by

    nitin patidar
    The document is a job application from Nitin Patidar for the position of Business Development Manager. It requests personal details like name, date of birth, location, and medical information. It instructs the applicant to fill all details accurately as the information will impact employability eligibility. It also notes that any incorrect statements could invalidate the application. The applicant then provides answers to questions regarding their medical history, conditions, treatments, and family history. At the end, the applicant declares that all information provided is true and authorizes the company to obtain medical information for recruitment purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    MedicalDeclarationFormpdf 1699856618260

    Uploaded by

    nitin patidar
    40 views3 pages
    The document is a job application from Nitin Patidar for the position of Business Development Manager. It requests personal details like name, date of birth, location, and medical information. It instructs the applicant to fill all details accurately as the information will impact employability eligibility. It also notes that any incorrect statements could invalidate the application. The applicant then provides answers to questions regarding their medical history, conditions, treatments, and family history. At the end, the applicant declares that all information provided is true and authorizes the company to obtain medical information for recruitment purposes.

    Original Title

    MedicalDeclarationFormpdf-1699856618260

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document is a job application from Nitin Patidar for the position of Business Development Manager. It requests personal details like name, date of birth, location, and medical information. It instructs the applicant to fill all details accurately as the information will impact employability eligibility. It also notes that any incorrect statements could invalidate the application. The applicant then provides answers to questions regarding their medical history, conditions, treatments, and family history. At the end, the applicant declares that all information provided is true and authorizes the company to obtain medical information for recruitment purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    40 views3 pages

    MedicalDeclarationFormpdf 1699856618260

    Uploaded by

    nitin patidar
    The document is a job application from Nitin Patidar for the position of Business Development Manager. It requests personal details like name, date of birth, location, and medical information. It instructs the applicant to fill all details accurately as the information will impact employability eligibility. It also notes that any incorrect statements could invalidate the application. The applicant then provides answers to questions regarding their medical history, conditions, treatments, and family history. At the end, the applicant declares that all information provided is true and authorizes the company to obtain medical information for recruitment purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    Name of the Candidate (Full name): NITIN PATIDAR Position applied for: Business Development Manager

    Location Indore Date of birth 18-07-1997

    Important instructions:

    a. Please fill all details in block letters


    b. All the questions are mandatory
    c. Please ensure information accuracy as this may impact your employability eligibility with the organisation
    d. The application will be considered invalid in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure of any
    material fact, particularly the Resume/ CV submitted along with supporting documents such as but not limited to proof of employment, academic mark
    sheet, declaration etc. If you have any queries or are unsure of any question, please seek assistance by writing to us at [email protected]
    within 3 days of receiving this communication.

    Sr. No. Question Answer Remark

    Please provide following details- You may refer any of the online videos to know the correct
    method of measurement

    1 Weight (in kg) 85

    Height (in cms) 178

    Hip circumference (in cms) 36

    Do you have a history of or were recently diagnosed with conditions related to following body
    system

    Diabetes No

    High BP or any heart ailmento No

    High cholesterol No

    Asthma or COPD No

    Thyroid No

    Bone and muscle disorder No

    Mental disorders such as but not limited to depression,


    bipolar disorder, anxiety disorder, alcohol use disorder, No
    2
    substance abuse, drug abuse etc.

    Learning disability No

    Immunological disorders: Allergy or any autoimmune


    No
    disease

    Any blood disorder: Anaemia, Thalassemia, Leukemia No

    Tuberculosis, Hepatitis No

    Cancer (any type) No

    Do you have any lump or abnormal growth in the body


    No
    or benign tumour

    Any other disease No


    Do you have a history of or were recently diagnosed with conditions related to following body system

    Cardiovascular system No

    Respiratory system No
    3
    Gastrointestinal system No

    Neurological system Yes

    Any other body system No

    Did you undergo any medical/ surgical treatment in the past or recently? If
    4 No
    yes, please mention the treatment type in the Remark section.

    HIV

    5 Have your undergone a HIV test ever No

    Have you been tested positive of HIV No

    6 Are you on any medication? If yes, pleas mention the result/ medication
    No
    details in the Remark section

    7 Does any of your family members have any of the above-mentioned


    medical conditions? If yes, please mention the conditions in the Remark No
    section

    8 Are you a person with special needs? If yes, please mention the medical
    No
    condition in the Remark column

    Declaration:

    I hereby declare, on my behalf that the above statements, answers and/ or particulars given by me are true and complete in all respects to the best of my
    knowledge and that I am authorized to propose on behalf of these other persons. I understand that the information provided by me will form the basis of my
    employment eligibility and consideration with Aditya Birla Capital & it’s subsidiary. I further declare that I will notify in writing any change occurring in the
    occupation or general health at all times (event during my employment with the organisation, if offered).

    I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on me or from any past
    or present employer concerning anything which affects my physical or mental health.

    I authorize the company to share information pertaining to my application including the medical records for the sole purpose of recruitment and with any
    Governmental and/or Regulatory authority

    Name NITIN PATIDAR

    Location Indore Date 10-11-2023 15:11

    Signature
    Miscellaneous Information Declaration

    A. Do you have an advisor code? No


    If yes, do provide your AMFI / Advisor Code:

    B. Mention Total Years of Experience: 000

    C. Do you have any relatives working with the Aditya Birla No


    Capital ?

    If yes, kindly provide the following info:

    S No. Name Designation Department Company

    Name NITIN PATIDAR

    Signature

    You might also like