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["附件3"]
["清镇市2019年公开招聘事业单位工作人员考生体检申报表"]
[]
["申报人姓名",null,"性别",null,"出生年月",null,"备注"]
["现住址",{"$nulls":3},"身份证号"]
["报考单位及岗位",{"$nulls":3},"联系电话"]
["健康状况","有无：发热、乏力、干咳、鼻塞、流涕、咽痛症状等一种疑似症状",null,null,"有(  )           无(  ) "]
["申报当日至前14日活动轨迹","填表前居住地址"]
[null,"填表前14天内所达过的地区"]
[null,"填表前14天内所乘长途交通工具及起止地点和起止时间"]
[null,"填表前14天内是否与湖北武汉人接触过",null,null,"是(  )     否(  )"]
[null,"填表前14天内是否接触过确诊病例或疑似病例",null,null,"是(  )     否(  )"]
[null,"填表前14天内是否与国外（境外）疫区人员接触过",null,null,"是(  )     否(  )"]
["其他情况说明："]
["    提示：根据贵阳市人民代表大会常务委员会《关于依法防控新型冠状病毒肺炎疫情 坚决打赢疫情防控阻击战的决定》（2020年2月13日贵阳市第十四届人民代表大会常务委员会第二十六次会议通过）相关规定，填表人应当自觉遵守法律法规关于疫情防控的规定，履行疫情防控的法律义务，如实填写本表相关内容。如因填表人填报虚假信息，导致出现传染病疫情，各级行政执法机关将严格按照法律、法规规定，对危害公共安全、扰乱疫情防控秩序、隐瞒谎报疫情、编造传播虚假信息等行为追究法律责任。"]
["本人承诺：以上所填报信息全部真实准确。"]
["本人签字："]
[null,null,"申报日期：2020年       月       日"]
["所在居委会（村委会）意见："]
[]
[]
[{"$nulls":5},"单位盖章："]
[{"$nulls":5},"年    月     日"]

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[]
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