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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.

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366 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
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(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{

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