Csc Form 211 Medical Certificate For Employment
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1PHILIPPINES CIVIL SERVICE
I N S T R U C T I O N S
NAME ( Last, First, Middle, or if married woman, Maiden Name)
AGENCY / ADDRESS
ADDRESS
AGE
SEX
CIVIL STATUS
PROPOSED POSITION
Pre-Employment Medical - Physical Test
1. Blood Test
2. Urinalysis
3. Chest X-Ray
4. Drug Test
5. Neuro-Phychiatric Examination (If necessary)
NOTE: ALL RESULTS OF EXAMINATIONS MUST BE ATTACHED TO THE FORM.
FOR THE PHYSICIAN
I hereby certify that I have personally examined the above named
AFFIX
individual and found her / him to be physically and medically fit / unfit for
Documentary
employment.
Stamp Here
OTHER INFORMATION ABOUT
THE PROPOSED APPOINTEE
PRINTED NAME / SIGNATURE OF PHYSICIAN: CERTIFICATE NUMBER
OFFICIAL DESIGNATION
HEIGHT WEIGHT
BLOOD
Bared Foot
Stripped
Type
AGENCY
DATE EXAMINED
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Parent category: Medical