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Name of Employee:
Address:
Name of Company:

lnstruction:

1. You are schedule on Medical Examination on

2. Pls, Bring the ff. 2 clean boiled bottles. One must contain
a thumbsize sample of stool and the olher is empty.
3. 2 pcs. of2x2 pictures ( colored )
4. The examinations to be paid are indicated at the back of page.
5. Non-complainance of the above instruction may eause delay of the
processing of your application.

NOTE: Pls. Bring 1 valid lD for drug test examinfition.

PLEASE ASK FORAN OFFCIAL RECEIPT OF ANY PAYMENT GIVEN

Please Check _Application paid
_ Billed Agency

Frint Name and Signature of Designation

Authorized Official
 I. LAND BASED
Five (5) basic Pre-employment Medical Examination
t. Complete physical Examination (PE)
2. Ghest X - ray using 11 x14 plates
3, Complete Blood Count
4. Urinalysis
5. StoolExarnination

II. OTHER LABORATORY

1. HIV/AIDS Test
2. Pregnancy test (urine)
3. Drug Test
4. Hepa B screening

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