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Application FormNew

This document is an application form for a post at Indira Gandhi Medical College in Shimla, Himachal Pradesh. It requires personal details, educational qualifications, work experience, and a declaration of the accuracy of the information provided. The form also includes sections for office use to determine the candidate's eligibility.

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kashyapragini42
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10 views

Application FormNew

This document is an application form for a post at Indira Gandhi Medical College in Shimla, Himachal Pradesh. It requires personal details, educational qualifications, work experience, and a declaration of the accuracy of the information provided. The form also includes sections for office use to determine the candidate's eligibility.

Uploaded by

kashyapragini42
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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OFFICE OF THE PRINCIPAL

INDIRA GANDHI MEDICAL COLLEGE Photo


SHIMLA, HIMACHAL PRADESH-171001 Paste
PH. 0177-2883212, 01772883204 Here
Website:-www.igmcshimla.edu.in

Sr. No. _________ Diary No. _________________________Date:____________________________

Advt. No._________________________________________________ Date:____________________

Bank Demand Draft No._____________________ Date_________________Amount_____________

1. POST APPLIED FOR: _____________________________________________


2. NAME (IN BLOCK LETTER) : _____________________________________________
3. FATHER’S/ HUSBAND NAME: _____________________________________________
4. PRESENT POSTAL ADDRESS: _____________________________________________
_____________________________________________
_____________________________________________
5. MOB. NO. 1._____________________________ 2. ____________________________________
6. EMAIL ID: ____________________________________________________________________
7. PERMANENT HOME ADDRESS: _________________________________________________
_________________________________________________
_________________________________________________
8. A) NATIONALITY: ____________________ B) GENDER ____________________________
C) CATEGORY: _______________________ D) MARITAL STATUS___________________

9. DATE OF BIRTH: ______ /______ / _________.

10. EDUCATIONAL QUALIFICATION:

S. EXAMINATION BOARD / TOTAL MARKS MARKS PERCENTAGE


NO. PASS UNIVERSITY OBTAINED
1. MATRIC

2. 10+2

3.

4.
5.

11. EXPERIENCE:

SR DEPARTMENT DESIGNATION PERIOD TOTAL


NO. NAME FROM TO EXPERINCE

1.

2.

3.

4.

5.

12. LIST OF THE CERTIFICATES AND TESTIMONALS (PLEASE ATTACH THE ATTESTED
COPIES)
(I) ____________________________________ (V) __________________________

(II) ____________________________________ (VI) __________________________

(III) ____________________________________ (VII) __________________________

(IV) ____________________________________ (VIII) __________________________

CERTIFICATE:

I hereby declare that I have carefully gone through the instruction and the contents of above
application are true and correct to the best of my ability knowledge, understanding and belief. I
understand that in the event of any information being found false or incorrect, my candidature would
be liable to be cancelled and I shall be liable for legal action in accordance with law.

Place:
Date: (Signature of Applicant)

FOR OFFICE USE ONLY

The above Candidate is Eligible or not Eligible due to _______________________________

Signature Signature Signature Signature Signature

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