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    Government of Telangana Medical & Health Department-Jayashankar Bhupalpally District

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    bmtelugvideos

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    Government of Telangana Medical & Health Department-Jayashankar Bhupalpally District

    Uploaded by

    bmtelugvideos
    19 views4 pages

    Original Title

    2024022855

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    Copyright:

    © All Rights Reserved
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    19 views4 pages

    Government of Telangana Medical & Health Department-Jayashankar Bhupalpally District

    Uploaded by

    bmtelugvideos

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    GOVERNMENT OF TELANGANA

    MEDICAL & HEALTH DEPARTMENT- JAYASHANKAR BHUPALPALLY DISTRICT


    RECRUITMENT OF CONTRACT & OUTSOURCING POSTS UNDER NATIONAL HEALTH MISSION

    POST APPLIED FOR ________________________________________________________________

    APPLICATION FORM

    REGISTRATION NO:
    (TO BE FILLED BY THE OFFICE)

    Name of the
    1.
    Candidate

    2.a Name of the Father

    2.b Name of the Mother Paste Photograph


    here and
    Name of Husband/ sign across it
    2.c
    Wife (if Married)

    Sex
    3. MALE FEMALE
    (Put Tick Mark)

    4. Date of Birth

    Social Status OC BC-A BC-B BC-C BC-D BC-E SC ST


    5.
    (Put Tick Mark)

    Whether Physically
    6. Handicapped YES NO
    (Put Tick Mark)

    If yes please
    6.a mention Category HH OH VH
    (Put Tick Mark)

    Whether Ex-Service
    7. YES NO
    Man/Women
    DETAILS OF SCHOOL EDUCATION:

    YEAR OF NAME OF THE SCHOOL &


    CLASS MANDAL DISTRICT
    STUDY VILLAGE

    IV

    VI

    VII

    VIII

    IX

    DISTRICT TO WHICH CANDIDATE BELONGS


    AS PER PRESIDENTIAL ORDER

    EDUCATIONAL QUALIFICATIONS:
    QUALIFICATION YEAR OF PASSING NAME OF THE COLLEGE / UNIVERSITY

    MARKS OBTAINED IN THE QUALIFYING EXAMINATION:


    Qualifying Examination /
    Total Marks Marks Obtained % of Marks Obtained
    year wise

    1st Year

    2nd Year

    3rd Year

    4th Year

    Grand Total

    REGISTRATION NO &
    DATE OF RESPECTIVE COUNCIL
    ADDRESS PARTICULARS:

    Name of the Candidate :


    Father Name :
    Mother Name :
    Husband Name :
    House No :
    Street No & Name :
    Village / Town :
    Mandal :
    District :
    Mobile No :
    Email Id :

    DECLARATION

    I, Smt/Kum/Sri ………………………………………………………………………………………….…………………. D/o,


    s/o …………………………………………………………….……………………….. Certify that above particulars furnished
    by me are correct to the best of my knowledge. I also agree that in the event of any of the particulars
    furnished in my application being found to be incorrect or false at a later date my candidature will be
    cancelled summarily.

    NAME AND SIGNATURE OF THE CANDIDATE

    FOR OFFICE USE ONLY

    Date of Receipt of application:

    Candidate has submitted all the attested copies of the certificates as per instructions. All the
    particulars submitted by the individual are verified with respect to the certificates and found
    correct.

    Name and Signature of the Clerk Name and Signature of the Supervisor
    Acknowledgement
    Acknowledgement
    Received application from ___________________________________________________
    for the post of _________________________________________________ on contract basis on
    _____________________ (date) ________________________ (time) copies of the following
    certificates are found.

    1 S.S.C or Equivalent Examination Yes/No

    2 Intermediate or 10+2 Examination Yes/No

    3 Qualifying Examination Pass Certificate Yes/No

    4 Marks memos of all the years (Qualifying Examination) Yes/No

    Certificate of Clinical training for one year those who


    5 Yes/No
    acquired qualification through vocational course

    6 Registration Certificates of respective Council Yes/No

    Latest Caste Certificate issued by the Tashildar/MRO


    7 Yes/No
    concerned by Mee-Seva

    Study Certificate for the years from 4th Class to 10th Class
    8 and in case of private study residence certificate from the Yes/No
    Tashildar/MRO concerned

    PH Certificate issued by “SADARAM” in respect of


    9 Yes/No
    candidates claiming reservation under PH Quota

    10 1 Photograph duly pasted on the application form Yes/No

    11 Acknowledgement card Yes/No

    Name and Signature of Assistant


    Receiving the application form

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