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Application & Admit Card Format For Mbbs in English

This document is an application form for the position of Junior Resident (Non-PG) MBBS at Safdarjung Hospital & VMMC in New Delhi. The form requests information such as name, address, category, educational qualifications, internship details, and requires attachments of various certificates. It includes an undertaking by the applicant to declare the truth of the information provided and that they have not completed more than one year of previous junior residency elsewhere. The final page provides a template for an admit card to be filled out by applicants.

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Priya Hari
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162 views

Application & Admit Card Format For Mbbs in English

This document is an application form for the position of Junior Resident (Non-PG) MBBS at Safdarjung Hospital & VMMC in New Delhi. The form requests information such as name, address, category, educational qualifications, internship details, and requires attachments of various certificates. It includes an undertaking by the applicant to declare the truth of the information provided and that they have not completed more than one year of previous junior residency elsewhere. The final page provides a template for an admit card to be filled out by applicants.

Uploaded by

Priya Hari
Copyright
© © All Rights Reserved
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
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GOVERNMENT OF INDIA

OFFICE OF THE MEDICAL SUPERINTENDENT


SAFDARJUNG HOSPITAL & V.M.M.C.
NEW DELHI-110029

No. 4-1/2019- Academic Date:-

APPLIED FOR THE POST OF Junior Resident (Non-PG) MBBS:-

Affix recent
passport
size photo
& sign
across it
1. Name (IN BLOCK LETTERS) :-

2. Father’s/Husband’s Name :-

3. Postal Address for Correspondence :-

4. Permanent Postal Address :-

5. Contact Telephone No. :-

6. E-Mail :-

7. (i) Date of Birth- (ii) Nationality-

8. Category (GEN, EWS,OBC, SC, ST & PWD) :-

(i) For EWS candidates please attach certificate should be issued by Tehsildar or
above rank officer of State Govt/Central Govt. of India.

(ii) OBC Candidate must attach certificate from appropriate authority, which is meant
for the post under the Central Government of India, and certification that the
candidate does not belong to Creamy Layer. Date of issue of Certificate should not be
earlier than 01.04.2019.

(iii) SC, ST candidates attach Certificate issued by Tehsildar or a rank above


Tehsildar in the format of State Govt./Central Govt. of India.

(iv) PWD – Certificate must be issued by State/Central Govt. Hospital

9. Year of passing MBBS & Name of University :-

10. Date of Completion of Internship (after 01.07.2017) and Name of Institute:-


Page 1 of 3
11. Permanent DMC (Original/Receipt) Registration No. & Place :-

12. Payment Receipt No. (To be Attached with application):- Mandatory


(Candidate Must be write your name & father’s/husband’s name on the back of
Payment Receipt)

14. Junior Residency (House Job) done previously,


If so, period, department name and name of Institution: - Mandatory

15. UNDERTAKING:

I solemnly verify and declare that the above mentioned statements made by
me are correct to the best of my knowledge and belief. In the event of any information
found incorrect my candidature shall stand cancelled and the authorities of VMMC and
Safdarjung Hospital may take necessary action against me.

I also declare that I have not completed ONE YEAR of Junior Residency (Non-PG) in
any other government hospital.

16. Check list (Please tick in the box given below as proof of enclosures).
Permanent Internship EWS/Caste Payment Admit Card All Educational
Registration Completion Certificate/ Receipt Certificates Attested
Certificate Certificate PWD by Self

Signature of Applicant

Page 2 of 3
GOVERNMENT OF INDIA
OFFICE OF THE MEDICAL SUPERINTENDENT
SAFDARJUNG HOSPITAL & V.M.M.C
NEW DELHI-110029

Junior Resident (Non-PG) (Admit card to be filled by the candidates).

Name
(In block letters)
Fathers Name
Photo
Sex 4cm×5cm
Cross signature
Category
(GEN, EWS, OBC,
SC,ST, PWD)
Date of Birth

Permanent Address Signature

Nationality

Post Applied For JR(MBBS)


Roll. No.
(To be allotted by the
Institute)

Note: - Candidates kindly download the Admit Card from the Hospital website
www.vmmc-sjh.nic.in.

Page 3 of 3

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