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Reliance Industries Limited Pre-Employment Medical Examination
Reliance Industries Limited Pre-Employment Medical Examination
Name: ____________________________________________________________________________
(First) (Middle Name) (Surname)
Address:
2. FAMILY HISTORY : Has anyone of your family suffered from Cancer, Diabetes, Tuberculosis, Epilepsy,
Mental or nervous disease ? _______________
IF LIVING IF DEAD
HEALTH
AGE AGE AT DEATH CAUSE OF DEATH
(GOOD,BAD, FAIR)
Father
Mother
Sister (nos.)
Brothers (nos)
Husband/ Wife
Children (nos.)
3. PERSONAL HISTORY :
Are you in good health and capable of full work :
4. I declare that the above statements are true and complete to the best of my knowledge and belief and I agree that the
results of this medical examination in general terms may be revealed to the company if required, I also fully understand that if
any of the said statements if proved wrong, the company may have unwittingly engaged my services and I shall therefore have
no claim against the company, if for these reasons, I am discharged from its service.
8. Lungs _________________________________________________________________________
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5. X – ray chest
6. E.C.G.
7. Blood Group
P.S. Kindly send the reports to the office of Dr R Rajesh, Medical Advisor at the below
Address.