1922021165657EK 3 Sağlık Beyan Formu - 1

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1922021165657EK 3 Sağlık Beyan Formu - 1

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T.C.

ADALET BAKANLIĞI

SAĞLIK BEYANI FORMU (EK-3)

Yok

Hastalığı
Sağlık Sorunu
(Varsa)

Var

Engel Grubu
Yok
(Varsa)

Engellilik
Durumu

Engel Oranı
Var
(Varsa)

İLGİLİ MAKAMA

İlgili yönetmelik hükümleri kapsamında yapılacak personel istihdamına ilişkin ilanda belirtilen
şartlara elverişli olduğumu ve görevimi sürekli yapmama engel olabilecek hastalık veya engelimin
bulunduğunu/bulunmadığını beyan ederim. .…./..…./2021

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İmza
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