MEDICAL CERTIFICATE For Employment PHILIPPINE CIVIL SERVICE 1. This medical certificate should be accomplished by a government physician. 2. Attach this certificate to original appointments and reinstatements. Pre - Employment Medical - Physical Tests 1 Blood Test 2 Urinalysis 3 Chest X-Ray 4 Drug Test 5 Neuro - Psychiatric Examination (if necessary) HEIGHT WEIGHT BLOOD (Bare feet) (Stripped) Type AGENCY DATE EXAMINED for employment. individual and found her/him to be physically and medically fit / unfit I hereby certify that I personally examined the abovenamed PRINTED NAME/ SIGNATURE OF PHYSICIAN CERTIFICATE NUMBER OTHER INFORMATION ABOUT THE PROPOSED APPOINTEE Here FOR THE PHYSICIAN OFFICIAL DESIGNATION INSTRUCTIONS FOR THE PROPOSED APPOINTEE AGENCY/ADDRESS AFFIX Documentary Stamp NOTE: ALL RESULTS OF EXAMINATION MUST BE ATTACHED TO THIS FORM. ADDRESS NAME (Last, First, Middle, or if married woman, Maiden Name) PROPOSED POSITION CIVIL STATUS SEX AGE