Scribd
Upload
61 views

Gmch32 App Nov12

This document contains an application format for the position of Junior Resident at the Government Medical College Hospital in Chandigarh, India. The 14-point application requests information such as the applicant's name, date of birth, address, educational qualifications including degrees earned and dates, internship details, previous work experience, medical registration and licensure details, and a declaration signed by the applicant. Supporting documents including degree certificates, mark sheets, caste certificate, and an application fee payment must be attached for consideration.

Uploaded by

nareshjangra397
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
61 views

Gmch32 App Nov12

This document contains an application format for the position of Junior Resident at the Government Medical College Hospital in Chandigarh, India. The 14-point application requests information such as the applicant's name, date of birth, address, educational qualifications including degrees earned and dates, internship details, previous work experience, medical registration and licensure details, and a declaration signed by the applicant. Supporting documents including degree certificates, mark sheets, caste certificate, and an application fee payment must be attached for consideration.

Uploaded by

nareshjangra397
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

CHANDIGARH ADMINISTRATION DEPARTMENT OF MEDICAL EDUCATION & RESEARCH, GOVT. MEDICAL COLLEGE HOSPITAL, SECTOR 32-B, CHANDIGARH.

APPLICATION FORMAT FOR THE POST OF JUNIOR RESIDENT


1. Full Name (BLOCK LETTERS) : __________________________________________________ (Surname) 2. 3. 4. Fathers/Husband's name : (First Name) (Second Name) Affix attested Photograph

__________________________________________________ : ________________________________ _________________________________

Date of birth (Date/ Month/ Year) with documentary evidence Age (as on the 01.01.2012) :

5.

(a) Permanent Home Address with Telephone/Mobile No.

: ________________________________________ ________________________________________

(b) Correspondence/Mailing Address with Telephone/Mobile No. ________________________________________

________________________________________ 6. 7. (Whether belongs to Gen./ SC / OBC (with documentary evidence) :

Gen.

SC

OBC

UNDERGRADUDATE/ POSTGRADUATE CAREER (attach attested copies of certificates/degrees in support of qualifications) Examination Passed Year Passing of Overall Marks Obtained in all professionals Overall Maximum Marks in all professionals Overall % age Of marks in all Professionals University/ Institution

M.B.B.S./B.D.S

8.

Marks in Final Professionals(I & II) (including EYE, ENT & SPM) (for MBBS)

________________ Marks obtained

________________ Maximum Marks

________ Percentage

9.

Date & Year of Completing Internship with the Name of University/College/Hospital Detail of previous house jobs, if any Post held (indicate temporary/ From permanent)

________________________________________________

10.

Period To

Years

Total Period Months Days

Pay Scale

Employers Address

11. 12.

Whether MBBS/BDS degree is recognised by Medical Council of India

Yes / No

Whether registered with State Medical Register or Indian Medical Register (with documentary proof) (a) Registration No. with the Medical Council _______________________________________________

(b) State in which registered ________________________________________________ 13 I hereby attach attested copies of MBBS/BDS Degree Certificates attested copies of educational qualifications, experience, date of birth certificate, character certificate, Medical registration certificate with Medical Council of India/State Medical Council, internship completion certificate, Mark Sheet of MBBS, First Prof., Second Prof., Final Prof. Part-I & II, Caste/Community Certificate, issued by the competent authority etc. along with latest photograph and application fee of Rs. 100/- (25/- for SC/ST candidates if applied against reserved category) 14. Place : Dated : DECLARATION BY THE CANDIDATE Details of Application Fee :Demand Draft No. ________________ Dated ____________ Amount Rs.___________. (Signature of Candidate)

I hereby declare that the above information is true, complete and correct to the best of my knowledge and belief. I have not suppressed any material, fact or factual information. I have never been debarred from appearing at any examination nor have I ever been arrested, prosecuted or convicted by criminal court or involved in any other case registered by the police. I understand that my candidature is liable to be rejected in the event of any mis-statement/ discrepancy in the particulars being detected and after my appointment in such an event, my services are liable to be terminated without any notice to me or reason thereof. I undertake not to make any claim or compensation if at any stage of my selection, my ineligibility for candidature is detected and my candidature is cancelled as a result thereof.

Place: Dated:

(Signature of Candidate)

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy