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Baba Farid University of Health Sciences, Faridkot Application Form

This document is an application form for Baba Farid University of Health Sciences in Faridkot, Punjab, India. It requests information such as contact details, educational qualifications, work experience, and other personal details from applicants. The last date to submit the application is April 20, 2015. Incomplete applications are liable to be rejected.

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Jeshi
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
76 views

Baba Farid University of Health Sciences, Faridkot Application Form

This document is an application form for Baba Farid University of Health Sciences in Faridkot, Punjab, India. It requests information such as contact details, educational qualifications, work experience, and other personal details from applicants. The last date to submit the application is April 20, 2015. Incomplete applications are liable to be rejected.

Uploaded by

Jeshi
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Tel.: 01639-256232, 256236, E-mail:[email protected].

in Fax: 01639-256234

Baba Farid University of Health Sciences, Faridkot


Sadiq Road Faridkot 151203 (Pb) India
Application form
Advt.No. 03/15

Last Date: 20.04.2015

Details of Application fee


DD No. Date and Amount

Note:
1.

1.

Affix Attested
Passport size
Photograph

Incomplete applications are liable to be rejected.

2.

Application for the post of ___________________in______________________


(Subject/Specialty)
Applicants Name (IN BLOCK LETTERS)

3.

Fathers Name (IN BLOCK LETTERS)

4.

i) Date of Birth of Applicant


(attach proof)
ii) Age: (as on last date for
Receipt of application)

DAY

MONTH

YEAR

YEARS

MONTHS

DAYS

5.

Write in the box ONLY ONE category out of SC/ST/BC/GEN


To which you belong (attach proof if SC/ST/BC ):

6.

Nationality:____________7. Religion_____________8. Marital Status;____________Sex__________

9. Educational/Academic Qualification: (attach attested copies certificates)


Examination
Year of passing
Marks obtained/
Percentage
No. of attempts
Passed
Max marks

Institution
Name

* Please attach proof of Recognition of MBBS/MD/MS degree by medical Council of India, candidate
possessing degree/PG degree not recognized by MCI will not be allowed to appear for interview.

10. No. of papers published :


(please attach proof)

National

International

11. Details of prizes, Medlas, Scholarships &


National/ International Awards and Additional
Qualification such as membership of scientific
society etc.
12. Chronological details of upto date appointments after obtaining qualification
(attach experience certificate):
Post held

From

To

Total period

Employer's address

13. (a) Central/State Medical Council with which the


applicant is registered (attach proof)
:_______________________________
(b) Medical Registration Number
14. Punjabi upto Matric standard (Y/N)
15. Permanent Address

:__________________________
__________________________
16. Correspondence Address

Pin Code
Email:

Pin Code
E. Mail

Mobile No.
17. Details of enclosures attached: 1.__________________2.__________________3._______________
4._________________5._______________6._______________7._______________8._______________
I hereby declare that I am Indian National and all statements made in this application are true, complete and correct to
the best of my knowledge and belief. I understand that in the even of any information being found false or incorrect,
my appointment will be liable to be terminated without any reason or prior notice. I also understand that in case of my
final selection, my appointment will be provisional subject to satisfactory police verification.
Date:_________________
Place:_________________

Signature of the applicant


CERTIFICATE BY THE PRESENT EMPLOYER
(In case of candidate who is already in service)
N o.________________Date_______________

Forwarded with the remarks that here is no objection to the selection/appointment of Dr.
______________________________to the post applied for at BFUHS, Faridkot.
Signature of the employer with
Office Stamp & date

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