APPLICATION FORM FOR THE RECRUITMENT OF SPECIALIST DOCTORS(GYNAECOLOGY,ANAESTHESIA)

AND OTHER STAFF(STAFF NURSE,SECURITY STAFF AND SUPPORTING STAFF).

[
APPLICATIOKN FOR THE POST OF :----------------------------------------------------------

1. FULL NAME IN BLOCK LETTERS ::

Affix the Latest
2. FATHERS/HUSBANDS NAME :: Pass Port Size
3.DATE OF BIRTH ::
Photo

4. AGE ::

5. SOCIAL STATUS ::

6.GENDER ::

7.QUALIFICATION(IF SPECIALIST DOCTOR)

(a)Details of PG in OBG/Anaes(Degree/Dipl) ::

(b)Date of passing of MBBS,PG ::

PG&MBBS Registation No. ::

(d)Date of completion of Internship ::

(e)MCI Regn.& Degree Certificate. ::

(f)PG&MBBS Marks ::

(g) Details of Rural Service(Sr.Resident) ::

mention period and place. ::

OTHER CATEGORY
(A)ACADEMIC ::

(B)TECHNICAL ::

8. PRESENT ADDRESS ::

9. PERMANENT ADDRESS ::

10. MOBILE NO. & E.MAIL ID ::

DECLARATION
I hereby declare that all the information given above is true and to the best of my knowledge. I am solely responsible
if any information is found incorrect.

Place:

Date: SIGNATUE OF THE APPLICANT