Engineer Electro Medical (BPS-17) : Application Form

APPLICATION FORM
National Institute of Health Islamabad ..

Applying for: Engineer Electro Medical (BPS-17) OTS REG #
For Official Use
Only
Bank Online Deposit (*Note: Application Form will not be entertained without Original Deposit Slip.)
BANK ALFALAH, HABIB BANK LIMITED,
(ANY BRANCH)
(ANY BRANCH)
_______________
Branch Code
_______________
Deposit Date
Note: Test Center in the desired city will be arranged for minimum of 200 applicants. Passport size Recent
Test City: Karachi Lahore Islamabad Photograph Affix with
(Tick only one) Peshawar Quetta Gum
Note: ALL DATA FIELDS ARE REQUIRED.
Domicile City: ----------------------------------------------- FILL YOUR APPLICATION FORM CAREFULLY.
Domicile Punjab Balochistan Sindh (U) Sindh (R)

Province: KPK Islamabad Capital Territory FATA
(Tick only one) Azad Jammu and Kashmir Gilgit Baltistan Other
1. Personal Information (In Block Letters)

Name (in Full) ____________________________________ Fathers Name ____________________________
Religion: Muslim Non-Muslim Disable: Yes No Gender: Male Female

Armed Forces: Yes No
CNIC/B-Form Only for personnel of Armed Forces of Pakistan
Age: ___________ Marital Status: _______________ Date of Birth: (D/M/Y) :___________________________
Postal Address: ______________________________________________________________________________________

Widows, son or daughter:
_____________________________________________________________ Yes No
(Of Deceased Civil Servant)
Phone #: ___________________ Cell #: ____________________________ Email: ________________________________
2. Academic Information (Note: In case of incomplete academic information, Your Application will be Declined.)
Certificate/Degree Degree Title Major Subjects Year of Marks Total Institution
Passing Obtained Marks Name
SSC (10 years)
HSSC / DAE / A-Level
(12 / 13 years)
Bachelor (14 years)
Bachelor (H) / Master
(16 years)
MS / M.Phil. (18 years)
PhD
Other (Diploma / Certificate)
3. Employment Information (Note: If you need more rows to write your information, you can add an additional page with Application Form.)
Are you already a Government Employ? Yes No Total Years of Experience: __________________
(In case of Yes, You must produce NOC at the Time of Interview.)
Organization Type Organization Name Designation Start Date End Date
(Government / Semi Government / (Name of the Organization / Dept.) (Your Designation / Position (Starting Date) (End Date)
Private) Title)
4. Undertaking by Applicant
I d/s/w of do hereby solemnly
affirm that I have read and understood the conditions for applying in the above mentioned Post and that I have
filled the form as per instructions given above and in the event any information contained herein is found to be
untrue, I shall be liable to disciplinary action which may result in cancellation of my candidature &test.
Signature & Date: .. Thumb Impression (Left Hand):
Document Check list:
Tick if Attached / selected:

Photograph is Attached
Original bank Deposit Slip is Attached on the back side of Application Form
CNIC Copy is Attached on the back side of Application Form
Instructions:
Application Fee (Service Charges) is nonrefundable / nontransferable. Bank Online Deposit of Rs. 199/- must be
attached with application form.
In case of more than one apply use separate application form along with original deposit slip.
Application must reach OTS office latest by last date of submission of application form.
OTS will not be responsible for l ate receiving of application through courier / Pakistan post etc.
Attach your recent photograph, CNIC copy, original bank deposit slip with this application form.
Without Signature & Thumb impression, your application form will not be entertained.
Without photograph your application form will not be entertained.
In-complete forms will not be entertained. (All the fields are mandatory / Required)
By hand sub mission n of Application form is n o t allowed.
Mobile phones are n o t all ow e d in test center premises.
Please visit OTS website a cc or din g to the test schedule to c heck your status.
Cut Address box given below and affix it with gum on the envelope.
Send Registration Form to:
Manager Operations, (NIH-A)

Open Testing Service (OTS),
93, Street # 03, Block-A, Media Town, (Adjacent to PWD), Islamabad.
Help Line: 051-2375081 Email: info@ots.org.pk, Website: www.ots.org.pk
199 199
One Hundred & Ninety-Nine One Hundred & Ninety-Nine
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APPLICATION FORM

National Institute of Health Islamabad ..

Domicile Punjab Balochistan Sindh (U) Sindh (R)

1. Personal Information (In Block Letters)

Religion: Muslim Non-Muslim Disable: Yes No Gender: Male Female

Age: ___ Marital Status: _ Date of Birth: (D/M/Y) :_____________________

Postal Address: ______________________________________________________________________________________

Phone #: _ Cell #: Email: ______________

Other (Diploma / Certificate)

Signature & Date: .. Thumb Impression (Left Hand):

Document Check list:

Tick if Attached / selected:

Send Registration Form to:

Manager Operations, (NIH-A)

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