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Profile Form

This document contains an application form for a position at the International Institute for Health Management Research (IIHMR) in Jaipur, India. The form requests personal details like name, address, contact information, as well as educational background and professional experience. It also asks for language proficiency, expected salary, notice period required if offered the position, references, and a declaration signed by the applicant.

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vgarg Garg
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19 views

Profile Form

This document contains an application form for a position at the International Institute for Health Management Research (IIHMR) in Jaipur, India. The form requests personal details like name, address, contact information, as well as educational background and professional experience. It also asks for language proficiency, expected salary, notice period required if offered the position, references, and a declaration signed by the applicant.

Uploaded by

vgarg Garg
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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1, Prabhu Dayal Marg, Near Sanganer Airport, Jaipur-302029

Tel: 91-141-2791432-34 Fax: 91-141-2792138, E-mail: jobs@iihmr.org

Profile Form
(Application form is meant to obtain minimum information required for being considered for the post applied for. Candidates may furnish additional
relevant information that they consider necessary, on separate sheets marked along with the enclosures.)

Affix here a
Passport size
Photograph

Position applied for ……………………………………….……….


Location …………Jaipur.……………………………..

Section A: Personal Information


1. Name in full (in Block Letters): Dr./Mr./Mrs./Ms. … .……………………………………………………………………..…...
2. Father’s/Spouse’s Name: Dr./Mr./Mrs. .…………………………………………………..……………………..
3. Date of Birth(DD/MM/YY): ...……………… 4. Gender (M/F):…………… 5.Marital Status:……....
…………….
6. Mailing Address: ……………………….…………………………………………………………………………………………..
City …………………..……….……..State…………….…………...Pin Code………..…...........................
Mobile No……………………..…….E-mail………………………………………….……………………….
7. Permanent Address:………………………………………………………………………………………………………………..
City …………………..……….……..State…………….…………...Pin Code………..…...........................
8. Nationality……………..…… 9. Category(SC/ST/OBC/PH)………………..................................

Section B: Educational and Professional Qualification


10. Language Proficiency Elementary/Working/Full Professional: i. English……………………………………………….
ii. Hindi …………………………………………………..iii. Other (please specify)…..………………………………………
11. Educational Qualifications (in chronological order starting with the highest degree obtained):
Examination / Percentage of
University / College / Board Subject (s) Year
Degree Marks / Final Grade
11. Professional Experience (in chronological order starting with the most recent Employer):
Yrs. of Experience ……….…..yrs.

Date of Joining Date of Leaving Name of Employer Position(s) held Brief on Job
Responsibilities

12. Current CTC and Perks & Benefits: (Provide last 2 salary slips/salary statements)

13. Expected Remuneration:

14. If selected and offered, how much time you would need to join on the offered position?

15. Please provide two professional references


1.

2.

16. Any other information or fact you feel relevant for submitting this job application:
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Declaration by the candidate:


1. I hereby declare that the information given by me in the Application is true, complete and correct to the best of my
knowledge and belief and that nothing has been concealed or distorted.
2. I do hereby declare that no legal and/or criminal case is pending against me before any court/investigating
agencies neither within or outside India. I, further inform that I have never been convicted of any legal offense
and/or crime by any court of law in the past.
3. I further declare that I do not have bank loan obligations which may have impact on my career at IIHMR
University.
If at any time, I am found to have concealed/distorted any information of given any false statement, my
application/appointment shall be liable to be summarily rejected/terminated without notice and compensation.

Date: ____________

Place: ____________ (Signature of the Applicant)

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