Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1. Personal Details:
Name: _____________________________________ Sex: Male/ Female
No of Children ________________
b) Past History:
(i) Drug Allergy Yes/ No
(vii) Have you suffered from any form of nervousness due to overwork or any other
cause? ______________________________________________________
(viii) Have you been examined and declared unfit for Govt. Service by a Medical
Officer/Medical Board, within the last three years? _______________________
DECLARATION
I declare all the above answers to be, to the best of my belief, true and correct.
Note:
The candidate shall be held responsible for the accuracy of the
above statement/investigations. By willfully suppressing any
information, he will incur the risk of losing the appointment or
forfeiting all claims to superannuation allowance / gratuity, if
appointed.
3
Name: _________________________________
Recent
Sex: Male/ Female Colour
Date of Birth: _________ Age: __________ Photograph of
associate
General Appearance: __________________________
1. General Examination
a) Height: _______________ cm . .
b) Weight: __________ kg c) Chest _______________ cm
d) Temperature: __________C e) Pulse: _______________/min
f) Blood Pressure: __________ mmHg
g) Acuity of Vision:
Without glasses With glasses Colour
Vision
Distant Vision RE
LE Night
Blindness
Near Vision RE
LE
d) Locomotor system:
Deformity /amputation _____________________________________
4. Remarks:
__________________________________________________________________
__________________________________________________________________
____________________