Certificate of medical exmination form 2026

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The document is a Certificate of Medical Examination form used by the United States Civil Service Commission. It requires applicants to provide personal information and disclose any medical conditions that may affect their job performance. The form includes sections for the applicant, appointing officer, and examining physician to complete, detailing functional requirements and environmental factors related to the job position. The examining physician must assess the applicant's health and fitness for duty based on these criteria.

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Click ‘Get Form’ to open it in the editor.
Begin with Part A, where you will enter your personal information. Fill in your name, social security number, sex, and date of birth. Ensure accuracy as this information is crucial.
Indicate if you have any medical disorders that may affect your job performance by selecting 'YES' or 'NO'. If 'YES', provide a detailed explanation for the examining physician.
In Part B, the appointing officer will specify the purpose of the examination and position title. They should also describe job requirements and circle relevant functional and environmental factors.
Finally, Part C is for the examining physician to complete. They will document their findings and sign off on the examination. Make sure all sections are filled out before submitting.

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