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Medical College, - Application Form For The Post of

This document is an application form for the post of [position] at [Medical College]. The application requests information such as the applicant's name, qualifications, experience, publications, and certifications. If selected, the applicant understands their appointment would be provisional pending Medical Council of India approval and that they will not claim compensation if approval is not granted. The applicant also certifies that the information provided is accurate and complete.

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Casey Jones
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30 views

Medical College, - Application Form For The Post of

This document is an application form for the post of [position] at [Medical College]. The application requests information such as the applicant's name, qualifications, experience, publications, and certifications. If selected, the applicant understands their appointment would be provisional pending Medical Council of India approval and that they will not claim compensation if approval is not granted. The applicant also certifies that the information provided is accurate and complete.

Uploaded by

Casey Jones
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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________________ MEDICAL COLLEGE,________________.

APPLICATION FORM FOR THE POST OF ____________________



Notification No.


1 Name of candidate (in capital letters)

2 Subject
3 Qualifications prescribed for the post
4 Sex
5 Category, SC/ST, Cat-I/IA/IIA/IB/IIB/IIIA/IIIB/GM
specify with certificate

6 Hyderabad Karnataka local person(Bidar, Gulburga,
Bellary, Koppal, Raichur and Yadgir)
Yes/No
7 If yes,Eligibility Certificate issued by Assistant
Commissioner, Revenue

8 Internal Reservation
1. Rural candidate
2. Ex serviceman
3. Physically handicapped
4. Kannada Medium
5. Project Displaced
Certificate enclosed
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
9 Nationality
10 Postal address for correspondence

11 Mobile No
12 E-mail I.D.,
13 Name of Father/Mother/Husband/wife
14 Date of Birth as recorded in the SSLC certificate
15 Studied Kannada as 1
st
/2
nd
language
16 Particulars of registration with State Medical
Council/Dental council no to be furnished along with
PG registration date

17 Details of the Qualifications :



Sl.no.

Qualification

Marks/
Grade etc
Percentage
Name of the College & University &
year of passing















18
Experience
Designation
Period
(DD/MM/YYYY)
Total
no. of
years
Name of the College &
University
From To
Tutor/Demonstrator/Resident/Registrar
Assistant Professor / Lecturer


Associate Professor


Professor

19 Present employment if any Enclosed-Yes/No
20 No Objection Certificate from
Head of the Institution if in the Private
College.
In in Govt. Service NOC has to be obtained from
the Secretariat Dept. of Govt.
Enclosed-Yes/No

21 Higher qualification if any & year of passing,
whether recognized by MCI or not


22 Papers Presented in National/International
conference in the last three Years.
No: Certificate enclosed :yes/No
23 Paper Published in National/Indexed Journal as
1
st
/2
nd
author/corresponding author in the last
three Years.
No: Copies enclosed:yes/No
24 WHO fellowship in the same subject

25 University Gold Medal (if any)

26 Any other information
27





I understand that my appointment is provisional
in nature and subject to the approval given by
Medical Council of India for the year 2014-15. If,
for any reason MCI does not grant permission I
shall not claim any appointment/compensation
Agreed


Signature .

Date ..
28 DD details( Number ,Date and Bank)



I certify that the above Information is correct and complete to the best of my knowledge and nothing has
been concealed/distorted also certify that there are no criminal cases against me, I have not been debarred
from exams/dismissed from service/blacklisted by MCI/KMC/DCI.If I am found to have
concealed/distorted/factually submitted wrong information, my appointment shall be liable to termination
without notice/compensation. I shall not claim TA/DA or any compensation for attending the interview.

Place Signature of the Candidate
Date

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