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Get Medical Examination Form For Employment

Tallman sau70. org PRE-EMPLOYMENT MEDICAL EXAMINATION Ref policy GBGA All School personnel shall be required to have a pre-employment medical examination by a licensed qualified physician. This examination must be completed and a written statement from the physician submitted to the Superintendent of Schools prior to the first day of work. Please ask your physician to complete the bottom half of this form and send it to the Superintendent of Schools 41 Lebanon Street Suite 2 Hanover NH 03755. It can also be faxed to the SAU 603 643-3073. TO THE PHYSICIAN The physical should be limited to whatever you feel is necessary for you to certify that the employee is medically capable of performing his/her designated assignment. School Administrative Unit 70 41 Lebanon Street Suite 2 Hanover NH 03755 603 643-6050 ext. 2003 fax 603 643-3073 e-mail Amy. Tallman sau70. org PRE-EMPLOYMENT MEDICAL EXAMINATION Ref policy GBGA All School personnel shall be required to have a pre-employment medical examination by a licensed qualified physician* This examination must be completed and a written statement from the physician submitted to the Superintendent of Schools prior to the first day of work. Please ask your physician to complete the bottom half of this form and send it to the Superintendent of Schools 41 Lebanon Street Suite 2 Hanover NH 03755. It can also be faxed to the SAU 603 643-3073. TO THE PHYSICIAN The physical should be limited to whatever you feel is necessary for you to certify that the employee is medically capable of performing his/her designated assignment. Examining Physician s Name Please print New Employee s Name Position Title I have examined the above-named individual who is found to be medically capable of performing the duties of the position named above. Date Physician s Signature Dresden and Hanover NH and Norwich VT Dec* 4 2012 Pre-Employment Medical Exam form*doc. School Administrative Unit 70 41 Lebanon Street Suite 2 Hanover NH 03755 603 643-6050 ext. 2003 fax 603 643-3073 e-mail Amy. Tallman sau70. org PRE-EMPLOYMENT MEDICAL EXAMINATION Ref policy GBGA All School personnel shall be required to have a pre-employment medical examination by a licensed qualified physician* This examination must be completed and a written statement from the physician submitted to the Superintendent of Schools prior to the first day of work. Tallman sau70. org PRE-EMPLOYMENT MEDICAL EXAMINATION Ref policy GBGA All School personnel shall be required to have a pre-employment medical examination by a licensed qualified physician* This examination must be completed and a written statement from the physician submitted to the Superintendent of Schools prior to the first day of work. Please ask your physician to complete the bottom half of this form and send it to the Superintendent of Schools 41 Lebanon Street Suite 2 Hanover NH 03755. Please ask your physician to complete the bottom half of this form and send it to the Superintendent of Schools 41 Lebanon Street Suite 2 Hanover NH 03755. It can also be faxed to the SAU 603 643-3073. TO THE PHYSICIAN The physical should be limited to whatever you feel is necessary for you to certify that the employee is medically capable of performing his/her designated assignment.

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