Bureau of Teacher Education and Certification
|Bureau of Teacher Education and Certification | | | | | | | |
|California State Board of Education | | | | | | | |
|FORM I-30 |
|(For use in the Employment of Retired Teachers - Education Code Section 44839.5 & 87408.5) |
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| |tuberculosis.| | | | | |
| | | | | | |Signature of Physician |
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| |board of a school district to which the undersigned has applied for employment, and representatives of any of them, |
| |any and all information you may have regarding my physical or mental condition, including but not limited to the |
| |history, findings, diagnosis, treatment given, present condition, and prognosis. |
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