PRE-EMPLOYMENT MEDICAL EVALUATION

Applicant Details:

Full Name: [Your Name]	Position Applied For:
Date of Birth:	Contact Number:
Address:	Email Address:

Medical Evaluation Criteria:

To ensure the health and safety of all employees, Human Resources conducts a pre-employment medical evaluation. This evaluation assesses an individual's fitness for the position they have applied for.

General Health Assessment:

Criteria	Observations	Remarks
Height	6 feet 1 inch	Normal
Weight
Blood Pressure
Vision
Hearing

Laboratory Tests:

Test	Result	Remarks
Blood Sugar Level
Cholesterol Level
Complete Blood Count

Musculoskeletal Evaluation

Criteria	Observations	Remarks
Range of Motion
Strength
Flexibility

Additional Tests/Notes:

1. No respiratory or cardiovascular concerns noted.

Based on the medical evaluation conducted, the applicant is medically fit and is cleared for the position of IT Specialist at Human Resources.

Signature of Medical Examiner:

Medical Practitioner

License Number:

[Month Day, Year]

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Acknowledgment by Applicant:

I, [Your Name], acknowledge that the above information is accurate to the best of my knowledge. I have not withheld any medical information related to my health status.

Signature:

[Your Name]

[Month Day, Year]

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