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  • Affidavit of Fit To Work

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    Tomo Itable
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    Affidavit of Fit to Work

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    756 views1 page

    Affidavit of Fit To Work

    Uploaded by

    Tomo Itable

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Republic of the Philippines]

    City of __________ ]
    Province of __________ ]
    x--------------------------------x

    AFFIDAVIT
    (of Fit to Work)

    I, ___________________, of legal age, single, Filipino, and a resident of


    _________________________, after being duly sworn to in accordance with law,
    hereby depose and state that:

    1. I am an applicant and a proposed appointee for the position of


    ______________ in the _____________________;

    2. That among the requirements that a proposed appointee need to submit


    is the copy of the latest Medical Certificate (CSC Form No. 211) with attached
    original copy of the proposed appointee’s laboratory results;

    3. I was able to complete my physical examination however, only the results


    for my Blood Test, Urinalysis, Chest X-Ray and Drug Test were released.

    4. That the result for my blood test, urinalysis, and chest x-ray yielded
    normal while my drug test result show negative. Attached hereto are the copies
    of the above mentioned laboratory results;

    5. That, given the results of my physical examination I am deemed consider


    healthy and fit to perform the duties and responsibilities mandated under the
    position I am applying with;

    6. That I am executing this Affidavit for the purpose of attesting to the truth
    of all the foregoing and in support of such application.

    IN WITNESS WHEREOF, I have hereunto set my hand and signature this


    _______________, in the City of _____________, ________, Philippines.

    Affiant

    SUBSCRIBE AND SWORN TO before me this ___________________, at the


    ________________. Affiant had exhibited to me her competent proof of identity to
    wit; _____________ with No.________________.

    Doc. No.:
    Page No.:
    Book No.:
    Series of _____

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