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["方山县2021年教育系统“人才回引”\n面试考生健康状况、行程登记表暨考生承诺书"]
["近14天内本人及共同居住的家属是否有境外或国内高、中疫情风险地区旅居史，或在其他有病例报告社区的居住史？（对选择项打“√”）",{"$nulls":8},"是\n(  )","否\n(  )","本人是否在集中隔离医学观察场所留观过？（对选择项打“√”）",{"$nulls":7},"是\n(  )","否\n(  )"]
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["近14天内本人及共同居住的家属是否接触过确诊病例、疑似病例或无症状感染者，与他们共同生活、学习、工作、乘坐同一交通工具等近距离接触？\n（对选择项打“√”）",{"$nulls":8},"是\n(  )","否\n(  )","近14天内是否出现过发热、乏力、干咳、腹泻等症状？（对选择项打“√”）",{"$nulls":7},"是\n(  )","否\n(  )"]
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["近14天内本人及共同居住的家属是否接触过来自境外或国内高、中疫情风险地区人员，或是否接触过来自有病例报告社区的发热或有呼吸道症状患者？\n（对选择项打“√”）",{"$nulls":8},"是\n(  )","否\n(  )","近14天内本人是否去过医院就诊？（对选择项打“√”）若有，症状或疾病：",{"$nulls":7},"是\n(  )","否\n(  )"]
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["本人承诺以上所填写情况属实。如有不实愿承担相关法律责任。"]
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["考生签名：                 （手写签名并按手印）             时间：     年    月    日"]

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