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Chief Medical Officer of Health Jhargram

Attach passport size photo duly

To,

attested

The Chief Medical Officer of Health Jhargram

APPIICATION FOR THE POST OF Medical Officer under ARSH/NHM, Jhargram district.

t. Name of the Candidate (in block letter)

1. Father's/Guardian's Name
   
   
2. Date of Birth (DD/MM/YYYY)
   
   
3. Address i) Present
   
   

i) Permanent

1. Mobile Number (Mandatory)
   
   
2. Emailaddress
   
   
3. Gender
   
   
4. Cast
   
   
5. Registration No.
   
   
6. Academic Qualification
   
   
7. Experience in Govt. Sector/Reputed Organization only (must have appointment letter and experience certificate): Orsanization Govt./PrivateA',lGOs Desigrration Period From Period To Total Year
   
   

Exam. Passed	Board/University	Year of	TotalMarks	Marks	% of Marks
		Passing		Obtained	(without
					additional)

(Date) (Date) & Month

12. Details of Draft: Draft No. Date Drawn Bank Branch Amount

Declaration: I hereby declare that I have carefully read the condition of eligibility mentioned in the advertisement. These conditions are acceptable to me and I fulfil these conditions. The details mentioned in the. application are true and I shall furnish the necessary certificates in original whenever required. lf any information/details found to be incorrect/false at any stage of the selection process of if any fact found to have been concealed by me or detected even after the appointment, my service may be terminated.

Date:

Place: (Signature of the Candidate)

b,oz

Date: 31.08.2017

: ^I M"ro No. cMoHA GMlzorT / 2-q1+/ rcD

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^t . ' l, if.'g s"bhadhipbti, Jhargram ^{with request to publish this notice in his office notice board' ,i _{I 'i. 1rj oistrla Magistrate, Jhargram withirequest to publish this notice in his office notice board'}}

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;i i, , E. ff,ESpo,Jha'lgramwithrequesttopdblishthisnoticeinhisofficenoticeboard' ^''

, i, ⁱ [. inj iur.r'^i[lno.n,, Jhargram ^{District Hospitat with request to publish this notice in his office notice board' _i ,,' 5; ThQ ACMoH,',1:hargram with request to publish this notice in his office notice board' i, _I bi 1,3 tMoH (A1), Jhargram District with requeit to publish this notice in his office notice board'}

_{I rij rr cell, Swasthy, ehu*un with request to} publish this notice in the departmental Web site

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^, ,i _", B. Notice Boardiof this office

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