Csc Form 211 - Medical Certificate For Employment - Philippine Civil Service printable pdf download

Csc Form 211 - Medical Certificate For Employment - Philippine Civil Service

CSC FORM 211 (Revised August 1998)

PHILIPPINE CIVIL SERVICE

MEDICAL CERTIFICATE

For Employment

__________________________________________________________________________________

INSTRUCTIONS

1. This medical certificate should be accomplished by a government physician.

2. Attached this certificate to original appointments and reinstatements.

__________________________________________________________________________________

FOR PROPOSED APPOINTEE

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 Psychiatric Examination

NOTE: ALL RESULTS OF THE EXAMINATIONS MUST BE ATTACHED TO THIS 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

CERTIFICATE

OTHER INFORMATION ABOUT THE

PRINTED NAME/SIGNATURE OF PHYSICIAN

NUMBER

PROPOSED APPOINTEE

OFFICIAL DESIGNATION

HEIGHT

WEIGHT

BLOOD

(Bare Feet)

(Stripped)

Type

AGENCY

DATE EXAMINED

Csc Form 211 - Medical Certificate For Employment - Philippine Civil Service

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