Scribd
Upload
42 views2 pages

gp form

This document is a medical examination certificate for a candidate seeking temporary, contract, or permanent employment with the Republic of Kenya. It includes sections for the candidate's personal information, medical history, and certification of fitness by a medical officer. The form must be completed in duplicate, with one copy returned to the originating Ministry or Department.

Uploaded by

moonlightkisiwabranch
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
42 views2 pages

gp form

This document is a medical examination certificate for a candidate seeking temporary, contract, or permanent employment with the Republic of Kenya. It includes sections for the candidate's personal information, medical history, and certification of fitness by a medical officer. The form must be completed in duplicate, with one copy returned to the originating Ministry or Department.

Uploaded by

moonlightkisiwabranch
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

(To be completed in DUPLICATE)

G.P.69

REPUBLIC OF'KENYA

PARTI
(Name and address of N{inistryiDepartmeui)

To: The Medical Officer ilc


Name: *Mr'/lvli ss/llrs is sent herervith for medical cxamination as a
candidate for "ternporary/co,ttract/permailellt empioyrnentlfittress to extend tour by months
(C.O.R.N.20(l)as.............. inthis *Ministr,'rDeparilnent.
(Signature)
(Designation)
Part.:
CERTITICATE OF MI4DICAL EXAIIIINATION
I HEREBY CERTIFY that I have this dar exanrined the above narned candidate and that in ury
opinion *he/she is {'fit/unfit for +temporar},,'contract/perman.rnt servicelextension of
..............;.'. Months (C.O.R. N20 (1): as.......'t...i........r ln
A1
Govemment Adrainistration.
. i*. r3.v.q.ff'..i... lK. I c........, Station ....*.u*.o,.. ..01"u" g..Medical
........1 o..(. S..................., 20 -J i"
Notes
tp/s.An**.
Part 1 of the forrn to i: ' comoleted in dui tic:ate by the officer scnding the candidate for p
Part 2 of the form to b* completed by the.N{edical officer, who will return one copy to the )(20 2
Ministry/Ilepartment u,hich sent the candidate.
Particulars on reverse trr be filled in by candidate btfcre appearing for Medical Examination.
''Delete whichever is inapplicable.
t
a

Candidatc's full namc (in BLOCL letters)


,KA {.i s.V"q t l|:rli]rl i4 t s.
Thc following questions to bc ansrvercd by the candidate:
t have you ever been an in-patient irr hospital or nursing home sutl'ering frorn any disease or injury?
If so, give dates, state nature of disease or injury, rvhich hospital or nursing home. Name of
doctor{s) rvho treated you and rvhether an operation u,as performed

2 Apaft from above, have you ever received medical treatment for any serious disease or injury? If
so, give particulars.

20

Signature of Candidntc

GPK

L{

You might also like