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["附件1"]
["考生本人患病经历和有关情况承诺表"]
["测试时间：    日第    场（    时    分至    时    分）第     号"]
["考\n生\n基\n本\n信\n息","姓  名",null,"曾用名",null,"性  别",null,"照  片"]
[null,"出生日期",null,"民  族",null,"籍  贯"]
[null,"政治面貌",null,"婚姻状况",null,"宗教信仰"]
[null,"身份证号码",null,null,"户籍所在地"]
[null,"通讯地址",{"$nulls":3},"联系电话"]
["考\n生\n健\n康\n状\n况","患病经历"]
[null,"病  名","有/无","治愈时间","病  名","有/无","治愈时间","备  注"]
[null,"心脏病","□ 有  □ 无",null,"精神病","□ 有  □ 无"]
[null,"高血压病","□ 有  □ 无",null,"神经官能症","□ 有  □ 无"]
[null,"血液系统疾病","□ 有  □ 无",null,"夜游症","□ 有  □ 无"]
[null,"结核病","□ 有  □ 无",null,"精神活性物质\n滥用和依赖史","□ 有  □ 无"]
[null,"肺气肿","□ 有  □ 无",null,"吸毒史","□ 有  □ 无"]
[null,"支气管扩张","□ 有  □ 无",null,"结缔组织病","□ 有  □ 无"]
[null,"支气管哮喘","□ 有  □ 无",null,"血吸虫病","□ 有  □ 无"]
[null,"胰腺疾病","□ 有  □ 无",null,"血丝虫病","□ 有  □ 无"]
[null,"严重消化\n系统疾病","□ 有  □ 无",null,"颅脑畸形\n颅脑损伤","□ 有  □ 无"]
[null,"急慢性肝炎","□ 有  □ 无",null,"慢性骨髓炎","□ 有  □ 无"]
[null,"肝硬化","□ 有  □ 无",null,"胆结石","□ 有  □ 无"]
[null,"恶性肿瘤","□ 有  □ 无",null,"泌尿系统结石","□ 有  □ 无"]
[null,"急慢性肾炎","□ 有  □ 无",null,"性  病","□ 有  □ 无"]
[null,"肾功能异常","□ 有  □ 无",null,"艾滋病","□ 有  □ 无"]
[null,"糖尿病","□ 有  □ 无",null,"癫  痫","□ 有  □ 无"]
[null,"甲  亢","□ 有  □ 无",null,"严重外伤史","□ 有  □ 无"]
[null,"内分泌系统病","□ 有  □ 无",null,"文  身","□ 有  □ 无"]
["家\n庭\n成\n员\n信\n息","姓  名","与本人关系","身份证号码",null,"工作单位及职务"]
[]
[]
[]
[]
[]
[null,"家庭成员指父母、未婚兄弟姐妹。学生就读学校、未就业人员住址、已故人员信息等请在“工作单位及职务”栏标注。"]
["考\n生\n表\n现\n情\n况","曾受到刑事处罚或者依据刑法被免予刑事处罚，或者曾被劳动教养、收容教养或者收容教育。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾被开除团籍或者被开除学籍。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾在国家法定考试中被认定有舞弊等严重违纪违规行为。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾有泄露国家秘密，或者有危害国家安全、荣誉和利益的行为。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾组织、参加、支持暴力恐怖、民族分裂、宗教极端、邪教、黑社会性质等非法组织，或者参与相关活动。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾组织、参加、支持非法集会、游行、示威等活动。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾组织、参加反对党的理论和路线方针政策的网络论坛、群组、直播等活动。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾通过网络组党结社，参与或动员不法串联、联署、集会等网上非法活动。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾编造、散布违反国家法律法规的信息、有害信息，或者参加国家禁止的政治性组织等。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾组织、参与或者支持色情、吸毒、赌博、迷信等活动。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾因结伙斗殴、盗窃、诈骗、哄抢、抢夺、敲诈勒索等行为受到行政拘留处罚。",{"$nulls":5},"□ 有    □ 无"]
[null,"已取得或者正在申请国（境）外永久居留权、长期居留许可。",{"$nulls":5},"□ 有    □ 无"]
[null,"个人档案中表明出生日期、入党（团）时间、学历、经历等重要材料缺失，且在规定的考察期限内，因考察对象个人原因无法补齐或者涉嫌涂改造假无法有效认定。",{"$nulls":5},"□ 有    □ 无"]
[null,"严重违反社会公德、家庭美德，社会责任感和为人民服务意识较差。",{"$nulls":5},"□ 有    □ 无"]
[null,"不具有中共党员或共青团员身份，且已加入其它政治性团体或组织。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾在国（境）外留学、工作、生活，对其在国（境）外期间经历和政治表现难以进行有效考察。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾组织、参加、支持有害气功组织或者宗教非法活动。",{"$nulls":5},"□ 有    □ 无"]
[null,"有省级及以上公安机关确定的不宜录取为公安院校公安专业学生的其他情形。",{"$nulls":5},"□ 有    □ 无"]
["家\n庭\n成\n员\n表\n现\n情\n况","曾有危害国家安全、荣誉和利益的行为。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾因故意杀人、故意伤害致人重伤或者死亡、强奸、抢劫、贩卖毒品、放火、爆炸、投放危险物质罪等社会影响恶劣的严重犯罪，或者贪污贿赂犯罪，受到刑事处罚。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾组织、参加、支持暴力恐怖、民族分裂、宗教极端、邪教、黑社会性质的组织，或者参加相关活动。",{"$nulls":5},"□ 有    □ 无"]
[null,"曾组织、参加、支持有害气功组织或者宗教非法活动。",{"$nulls":5},"□ 有    □ 无"]
[null,"有省级以上公安机关确定的其他影响考生今后被录用为公安机关人民警察的情形。",{"$nulls":5},"□ 有    □ 无"]
["声\n\n明","本人承诺，以上信息均真实、准确。如有不实，愿承担一切后果。"]
[{"$nulls":3},"承诺人（考生签字）：",null,null," 年     月     日"]
["    本表打印后使用黑色碳素笔填写，一式三份，一份考生本人留存，两份政审时交考生户籍所在地县级公安机关政工部门。"]