APPLICATION FOR CONTRACTUAL APPOINTMENT OF DOCTORS UNDER NRHM In response to the advertisement published in _______________________ inviting Applications from eligible candidates for appointment as _________________ on contract basis. I am hereby submitting my particulars: 1. Name of Post ______________________________________ 2. Advertisement notice no./ date ___________________________ 3. Name of candidate _____________________________________ 4. Parentage _____________________________________________ 5. Permanent Address _____________________________________ 6. Present Address _______________________________________ 7. Marital Status _________________________________________ 8. Date of birth : Day _______________ Month ______________ Year______________ 9. Name & Address of husband of Female candidate , if married 10. Details of Educational Qualification from Matric onwards : Examination passed Examining body Year/ Session of passing Subject offered Marks obtained / Max Marks Percentage of marks obtained S.No. of the Certificate Details of Technical / Professional Qualification Examination passed Examining body Year/ Session of passing Subject offered Marks obtained / Max Marks Percentage of marks obtained S.No. of the Certificate 11. Experience , if any Enclosure : Attested photocopies of : i. ___________________ iv. ___________________ ii. ___________________ v. ___________________ iii. ___________________ vi. ___________________ DECLARATION You will be required to supply documentary evidence, which supports the statements you have made above. The form should be accompanied with a self addressed postal envelop for sending interview call letters. Date : Place: (Signature of the Candidate)
