Persons transferred to Government service from a Local Fund which is not administered by Government will be treated as joining a first post under Government and their previous service will not count as duty peformed. [The State Government] may, however, allow previous service in such cases to count as duty performed on such terms as it thinks fit.
[Subs. by G.O.Ms.No. 12, Fin. & Plg., Dt. 7-2-95]
[Not Printed]
(For Executive Posts)
[See Rule 10]
(This form is to be used by every candidate who is required by the Andhra Pradesh Public Service Commission to produce a certificate of physical fitness. It must be signed by a Medical Officer not below the rank of a Civil Surgeon or a District Medical and Health Officer).
Note : —A candidate who resides outside the Andhra Pradesh State and who is unable to produce a certificate from a Medical Officer employed in the Andhra Pradesh State may produce it from a Medical Officer of a corresponding rank outside the State. Such certificate should contain the following particulars :
(i) The State under which the Medical Officer is employed and the name of the institution in which he is employed and his rank;
(ii) Register number of the certifying Medical Officer in the Register in which his name is registered;
(iii) The Official Stamp Seal of the institution in which the certifying Officer is employed;
The certificate produced will be subject to acceptance after scrutiny by the Director of Medical Education/Director of Health, Andhra Pradesh.
Name and rank of the officer granting the certificate.....
I do hereby certify that I have examined (Full name)..... a Candidate for employment under the Government of Andhra Pradesh, in the ..... service, as ..... and cannot discover that he/she
has any disease, constitutional, affliction, or bodily infirmity except that his/her weight is in excess/below the standard prescribed, or except.
I do/do not consider this a disqualification for the employment he/she seeks.
I do further certify that in my opinion his general physical condition is such as to enable him to perform efficiently the active duties of executive service.
I also certify that he/she has marks of small pox/vaccination .
| on full inspiration | |
| Chest measurement in centimetres | on full expiration |
| difference (expansion) | |
| Height.....Cms. | Cms. Cms. |
| Weight.....Kgs. | |
| His/her vision is normal. |
Hypermetropic (.....)
(Here enter the degree and defect, and the strength of correction glasses)
Myopic (.....)
(Here enter the degree of defect and the strength of correction glasses).
Astigmatic (simple or mixed ) (.....)
(Here enter the degree or defect and the strength of correction glasses).
Hearing is normal, defective (much or slight).
Urine — Does chemical examination show (i) albumen, (ii) sugar, state specific gravity.
Personal marks (atleast two should be mentioned)
Station :
Signature :
Dated :
Rank :
Designation :
The candidate must make the statement required below prior to his/her medical examination and must sign the declaration appended thereto in the presence of the Medical Officer. His attention is specially directed to the warning contained in the note below :
State your name in full.
State your age and place of birth.
(a) Have you ever had smallpox, intermittent or any other fever, enlargement or suppuration of glands, spitting of blood, asthma or inflammation of lungs, heart disease, fainting attacks, rheumatism, appendicitis ? OR
(b) any other disease or accident requiring confinement to bed and medical or surgical treatment ?
When were you last vaccinated ?
Have you or any of your near relations afflicted with consumption, scrofula, goyt, asthma, fits, epilepsy or insanity ?
Have you suffered from any form of nervousness due to over-work or any other cause?
Have you been examined and declared unfit for Government service by a Medical Officer/Medical Board, within the last three years (To be filled in only in the cases of candidates for subordinate services)
Furnish the following particulars concerning your family :— I declare all the above answers to be, to the best of my belief, true and correct.
| Father's age, if living and state of health | Father's age at death and cause of death. | Number of brothers living, their ages and state of health. | Number of brothers dead, their ages and cause of death. |
|---|---|---|---|
| --------------------------------------------- | ------------------------------------------- | ------------------------------------------------------------ | --------------------------------------------------------- |
| Mother's age, if living and state of health | Mother's age at death and cause of death. | Number of sisters living, their ages and state of health | Number of sisters dead, their ages and cause of death |
|---|---|---|---|
| --------------------------------------------- | ------------------------------------------- | ---------------------------------------------------------- | ------------------------------------------------------- |
I also solemnly affirm that I have not received a disability certificate pension on account of any disease or other condition.
Candidate's Signature :
Signed in my presence :
Signature of Medical Officer :
Note (1) : —The candidate will be held responsible for the accuracy of the above statement. By wilfully suppressing any information, he will incur the risk of loosing the appointment, and if appointed, of forfeiting all claims to superannuation allowance or gratuity.
Note (2) : —The candidates selected by the Andhra Pradesh Public Service Commission for direct recruitment to the Andhra Pradesh Police Service or Andhra Pradesh Civil Service (Executive Branch), otherwise than from the Andhra Pradesh Revenue Subordinate Service will be examined by a Medical Board before appointment.
(For other than executive posts and posts in the A.P. Ministerial Service, the A.P. Judicial Ministerial Service and the A.P. Secretariat Service)
(This form is to be used by every candidate who is selected by the Andhra Pradesh Public Service Commission to produce a certificate of physical fitness. It must be signed by a Medical Officer not below rank of Civil Surgeon or a District Medical and Health Officer).
Name and rank of officer granting the certificate.....
I do hereby certify that I have examined (Full name)..... a Candidate for employment under the Government of Andhra Pradesh, in the ..... service, as ..... and cannot discover that he/she has any disease, constitutional, affliction, or bodily infirmity except that his/her weight is in excess/below the standard prescribed, or except.
I do/do not consider this a disqualification for the employment he/she seeks.
I do further certify that in my opinion his general physical condition is such as to enable him to perform efficiently the active duties of executive service.
I also certify, that he/she has marks of small pox/vaccination . His/her vision is normal.
| on full inspiration | ||
| Chest measurement in centimetres | on full expiration | |
| difference (expansion) | ||
| Height.....Cms. | Cms. | Cms. |
| Weight.....Kgs. |
Hypermetropic (.....)
(Here enter the degree of defect, and the strength of correction glasses)
Myopic (.....)
(Here enter the degree of defect, and the strength of correction glasses).
Astigmatic (simple or mixed ) (.....)
(Here enter the degree of defect, and the strength of correction glasses).
Hearing is normal, defective (much or slight).
Urine — Does chemical examination show (i) albumen, (ii) sugar, state specific gravity.
Personal marks (atleast two should be mentioned)
Station :
Signature :
Dated :
Rank :
Designation :
The candidate must make the statement required below prior to his/her medical examination and must sign the declaration appended thereto in the presence of the Medical Officer. His attention is specially directed to the warning contained in the note below :
State your name in full.
State your age and birth place.
(a) Have you ever had smallpox, intermittent or any other fever, enlargement or suppuration of glands, spitting of blood, asthma or inflammation of lungs, heart disease, fainting attacks, rheumatism, appendicitis ?
OR
(b) any other disease or accident requiring confinement to bed and medical or surgical treatment ?
When were you last vaccinated ?
Have you or any of your near relations afflicted with consumption, scrofula, gout, asthma, fits, epilepsy or insanity ? Have you suffered from any form of nervousness due to over-work or any other cause?
Have you been examined and declared unfit for Government service by a Medical Officer/Medical Board, within the last three years (To be filled in only in the cases of candidates for subordinate services)
Furnish the following particulars concerning your family :—
| Father's age, if living and state of health | Father's age at death and cause of death. | Number of brothers living, their ages and state of health. | Number of brothers dead, their ages and cause of death. |
|---|---|---|---|
| --------------------------------------------- | ------------------------------------------- | ------------------------------------------------------------ | --------------------------------------------------------- |
| Mother's age, if living and state of health | Mother's age at death and cause of death. | Number of sisters living, their ages and state of health | Number of sisters dead, their ages and cause of death |
|---|---|---|---|
| --------------------------------------------- | ------------------------------------------- | ---------------------------------------------------------- | ------------------------------------------------------- |
I declare all the above answers to be, to the best of my belief, true and correct.
I also solemnly affirm that I have not received a disability certificate pension on account of any disease or other condition.
Candidate's Signature :
Signed in my presence :
Signature of Medical Officer :
Note : —The candidate will be held responsible for the accuracy of the above statement. By wilfully suppressing any information he will incur the risk of loosing the appointment, and if appointed, of forfeiting all claims to superannuation allowance or gratuity.
(For posts in the A.P. Ministerial Service, the A.P. Judicial Ministerial Service and the A.P. Secretariat Service)
(This form is to be used by every candidate who is selected by the Andhra Pradesh Public Service Commission to produce a Certificate of Physical Fitness. It must be signed by a Medical Officer not below the rank of Civil Assistant Surgeon employed under the Andhra Pradesh Government or by an Honorary Assistant Surgeon and Physician appointed by the Andhra Pradesh Government to a Government Medical Institution).
Note : —A candidate who resides outside the Andhra Pradesh State and who is unable to produce the certificate from a Medical Officer employed in the Andhra Pradesh State may produce it from a Medical Officer of corresponding rank outside the Andhra Pradesh State. The certificate so produced will be subject to acceptance after scrutiny by the Director of Medical Services, Andhra Pradesh.
Name and rank of officer granting the certificate..... I do hereby certify that I have examined (Full name)..... a Candidate for employment under the Government of Andhra Pradesh, in the ..... service, as ..... and cannot discover that he/she has any disease, constitutional, affliction, or bodily infirmity except that his/her weight is in excess of/ below the standard prescribed, or except.
I do/do not consider this a disqualification for the employment he seeks.
I also certify that he/she has marks of small pox/vaccination .
| on full inspiration | |
| Chest measurement in centimetres | on full expiration |
| difference (expansion) | |
| Height.....Cms. | Cms. Cms. |
| Weight.....Kgs. |
His/her vision is normal.
Hypermetropic (.....)
(Here enter the degree of defect, and the strength of correction glasses)
Myopic (.....)
(Here enter the degree of defect, and the strength of correction glasses).
Astigmatic (simple or mixed ) (.....)
(Here enter the degree or defect, and the strength of correction glasses).
Hearing is normal, defective (much or slight).
Urine — Does chemical examination show (i) albumen, (ii) sugar, state specific gravity.
Personal marks (atleast two should be mentioned)
Station :
Signature :
Dated :
Rank :
Designation :
The candidate must make the statement required below prior to his/her medical examination and must sign the declaration appended thereto in the presence of the Medical Officer. His attention is specially directed to the warning contained in the note below :
State your name in full.
State your age and birth place.
(a) Have you ever had smallpox, intermittent or any other fever, enlargement or suppuration of glands, spitting of blood, asthma inflammation of lungs, heart disease, fainting attacks, rheumatism, appendicitis ? OR
(b) any other disease or accident requiring confinement to bed and medical or surgical treatment ?
When were you last vaccinated ?
Have you or any of your near relations afflicted with consumption, scrofula, gout, asthma, fits, epilepsy or insanity ?
Have you suffered from any form of nervousness due to over-work or any other cause?
Have you been examined and declared unfit for Government service by a Medical Officer/Medical Board, within the last three years (To be filled in only in the cases of candidates for subordinate services)
Furnish the following particulars concerning your family :—
| Father's age, if living and state of health | Father's age at death and cause of death. | Number of brothers living, their ages and state of health. | Number of brothers dead, their ages and cause of death. |
| --------------------------------------------- | ------------------------------------------- | ------------------------------------------------------------ | --------------------------------------------------------- |
| Mother's age, if living and state of health | Mother's age at death and cause of death. | Number of sisters living, their ages and state of health | Number of sisters dead, their ages and cause of death |
| --------------------------------------------- | ------------------------------------------- | ---------------------------------------------------------- | ------------------------------------------------------- |
I declare all the above answers to be, to the best of my belief, true and correct.
I also solemnly affirm that I have not received a disability certificate pension on account of any disease or other condition.
Candidate's Signature :
Signed in my presence :
Signature of Medical Officer :
Note : —The candidate will be held responsible for the accuracy of the above statement. By wilfully suppressing any information, he will incur the risk of loosing the appointment, and if appointed, of forfeiting all claims to superannuation allowance or gratuity.
[Not Printed]
