WorldRemit Service Centre, Ltd.
PRE-EMPLOYMENT PHYSICAL EXAMINATION SCHEDULE FORM
Date Issued:___________________ Valid Until:____________________
Name:__________________________________ Age: ___ Sex: [ ] Male [ ] Female
Pre-EMPLOYMENT PROCEDURES:
[ ] Complete Physical Examination
[ ] Complete Blood Count (CBC)
[ ] Urinalysis
[ ] Fecalysis
[ ] Chest x-ray
[ ] Drug Test
Important Reminders:
• This form may be presented to Aventus Medical Care clinic (please refer below for the address) together with any 2 valid government
issued IDs.
• Urine specimen containers will be provided at the clinic. Kindly collect a mid-stream urine sample during the day of examination and
immediately submit to the laboratory. (Female can submit a specimen at least 7 days after the last day of menstruation)
• The patient should collect a pea sized stool specimen in the morning before proceeding to the clinic and must be submitted to the
Laboratory within 2 hours after collection
• Patients for blood chemistries must fast for 10 hours (No food and water intake)
• A separate urine container will be provided for the Drug Test. It is advisable to have a full bladder for the required level of urine (60ml).
• For the Drug Test, patient is required to present 2 valid ID (company ID, driver's license, Fire arm license, GSIS ID, Integrated Bar of the
Phils., NBI Clearance, Overseas Filipino Worker's ID, Overseas Filipino Worker's Adm. ID, Passport, Police clearance, PRC license, School ID,
Seaman's book, Senior Citizen's ID, Solo Parent ID, SSS ID, TIN, Voter's ID) prior to any availment.
• A patient with prescription eyeglasses and/or contact lenses should bring the same during the examination for Visual Acuity.
• No fees will be collected from the patient. PPE cost are charged through Intellicare.
• All hard copy of PPE results should be forwarded to COMPANY ADDRESS
• Contact Person:
• Repeat examination/clearances (i.e repeat urinalysis, pulmo clearance, cardio clearance) will be shouldered by the patient.
___________________________________ Karlyn Grace Valencia
Applicant’s Signature Over Printed Name Authorized HR Rep's Signature Over Printed Name
clinic's copy
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HR COPY
Confirmation of Pre-employment Examination
(Once the above examination is complete, detach this portion and submit it to HR/Recruitment)
PPE TESTS COMPLETED: YES
WITH PENDING TEST/S: TO COME BACK ON:
Applicant’s printed name: Date: Time:
Applicant’s signature: Aventus Signature of Nurse-on-duty:
*****************************************************************************************************************
CLINIC ADRESS:
AVENTUS MAKATI CLINIC AVENTUS CLINIC-U.N AVENUE
6th Floor Filomena Bldg. 104 Amorsolo Street, Legaspi Village Makati, 5th Floor, Times Plaza Building, U.N. Avenue Cor. Taft Avenue, Manila
Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break) Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break)
AVENTUS CLINIC-ALABANG AVENTUS ORTIGAS CLINIC
2nd Floor Sycamore ARC 1 Building, Unit 16, 18-20 Ground Floor AIC Grande
Buencamino St., Alabang Zapote Road Alabang, Muntinlupa City Tower, Sapphire road, Ortigas Center, Pasig
Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break) Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break)
AVENTUS CLINIC-PCS AVENTUS CALAMBA 2 CLINIC
2/F Philippine College of Surgeons, Edsa, Unit 201-203 SQA Corporate Center, Brgy 1,
Quezon City (beside SM North Annex) National Highway Crossing Calamba Laguna
Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break) Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break)
AVENTUS CLINIC- STA. ROSA AVENTUS CLINIC-CEBU
2nd Floor CARVAJAL Bldg. 2, National Highway, Unit 203 2/F TGU Tower I.T. Park
Balibago City, Sta. Rosa Laguna Asiatown, Apas, Cebu City
Clinic Hours: Monday to Saturday from 7:00 AM to 5:00 PM Clinic Hours: Mon-Sat 8am-3pm
