Medical Form

1
I do hereby certify that I have examined a candidate for employment in the Department and cannot discover that he/she has any disease, constitutional affection or bodily infirmity except I do not consider this as a disqualification for employment in . the Office of .............. Signatufe of Candidate Paste photograph here Photo attested His/her age according to his/her own statement is ........ years and by appeamnce about years. He/she has a small pox/ vaccination mark. Personal marks of identification Signature : Name: Rei No. : Rank: Designation : Station : Date: Thumb lmpression attested 1) 2l Seal

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Transcript of Medical Form

  • I do hereby certify that I have examined

    a candidate for employment in the

    Department and cannot discover that he/she has any disease,

    constitutional affection or bodily infirmity except

    I do not consider this as a disqualification for employment in

    . the Office of ..............

    Signatufe of Candidate

    Paste photograph here

    Photo attested

    His/her age according to his/her own statement is

    ........ years and by appeamnce about

    years. He/she has a small pox/ vaccination mark.

    Personal marks of identification

    Signature :

    Name:

    Rei No. :

    Rank:

    Designation :

    Station :

    Date:

    Thumb lmpression attested

    1)

    2l

    Seal


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