Skill Performance Evaluation Certificate Application Form Page 9
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25______________________________
YOU MUST CAREFULLY READ THE
FOLLOWING INSTRUCTIONS BEFORE CONTINUING
______________________________
The attached MEDICAL EVALUATION SUMMARY must be completed for every Skill
Performance Evaluation (SPE) Certificate applicant.
There are several important points about this Summary that you must adhere to:
1.
As the applicant, you must review and consider every block in Part II and check
every box that applies to the type of duties or the environment you will be
driving/working in.
2.
Only a board qualified or board certified physiatrist (physician who specializes in
physical medicine) OR an orthopedic surgeon (specialist in afflictions of the
skeletal system) can complete and sign the Summary. The signature of a general
practitioner alone is not sufficient.
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