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Form preview Third party authorization form... MERCHANT MARINER CREDENTIAL APPLICATION THIRD PARTY AUTHORIZATION I (print full name), authorize the U.S. Coast Guard National Maritime Center (NMC) to disclose information and/or records regarding
Form preview Medical certificate to support... Family Caregiver Leave: available as of October 29, 2014 to employees to provide care or support to certain individuals who have a serious medical condition.
Form preview Form fv medical certificate to... FORM FV MEDICAL CERTIFICATE to be submitted by the selected candidates only No. , Dated: Place of Issue Application No. : Name of Candidate: Photograph of the candidate Fathers Name: Sex: Age: (on
Form preview Medical certificate csu form Medical Certificate Request According to Colorado Springs Utilities Rules and Regulations, a customer may provide a signed Medical Certificate to postpone the discontinuance of utility service. A
Form preview Diving medical certificate 201... UCPA DIVING MEDICAL CERTIFICATE FOR FITNESS TO DIVE I, undersigned, Dr. Qualified as: Medical doctor, general practitioner Medical doctor approved by FFESSM, Medical doctor with a French Mdecine du
Form preview Work capacity medical certific... Work Capacity Medical Certificate V12A SEP 2010 Information for health practitioners The Work Capacity Medical Certificate provides Work and Income case managers with information to help them determine
Form preview Section 5 medical certificate... SECTION 5 MEDICAL CERTIFICATE PADCA Form 2 To be completed by MEDICAL PRACTITIONER PATIENTS FULL NAME: AGE: 1. SEX: WEIGHT: Serious medical conditions (eg previous coronary or CVA) 2. Operations (eg
Form preview Fssai medical certificate form MEDICAL FITNESS CERTIFICATE FOR FOOD HANDLERS FOR THE YEAR/MONTH See Para No.10. 1. 2 Part-II Schedule-4 of FSS Regulations 2011 Signature of the Food Handler It is certified that Shri/Smt/Miss. employed with M/s. coming in direct contact with food items has been carefully examined by me on date. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. 5. Any test required to confirm any communicable or infectious disease which the person suspected to be suffering from on clinical examination*. employed with M/s. coming in direct contact with food items has been carefully examined by me on date. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. 5. Any test required to confirm any communicable or infectious disease which the person suspected to be suffering from on clinical examination*. employed with M/s. coming in direct contact with food items has been carefully examined by me on date. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. 5. Any test required to confirm any communicable or infectious disease which the person suspected to be suffering from on clinical examination*.
Form preview Medical certificate for physic... FORM III Medical Certificate in respect of an Orthopedically (Physically) Handicapped or spastic candidate For the purpose of concessions granted to Orthopedically (Physically), handicapped or spastic.
Form preview Medical certificate under arti... MEDICAL CERTIFICATE UNDER ARTICLE 49 CIVIL SERVICE REGULATIONSI do hereby certify that I have examine .. ....................................................................................................................................... ...........................................................................................................................................................
Form preview Initial medical review annual... INITIAL MEDICAL REVIEW ANNUAL MEDICAL CERTIFICATE For use of this form, see PAM 40502; the proponent agency is OTSG. DATA REQUIRED BY THE PRIVACY ACT OF 1974 AuthoritySection 133, Title 10, United
Form preview Medical certificate for leave... FORM 4 Medical Certificate for nonGazetted Officer recommended for leave or extension or commutation of leave Signature of Government servant (nonGazetted): WE / I, members of Medical Board / Civil

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