Recruitment of Senior Residents

E.S.I.C. Model Hospital

Paste your recent

APPLICATION FOR THE POST OF SUPER SPECIALIST (PART TIME) ON

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CONTRACT BASIS FOR SPECIALITY ____________________.

  1. Name in full (in Block Letters):______________________________________________
  2. Fathers/Husbands Name: _________________________________________________
  3. Date of Birth (In Christian Era: (In figures)___________________________________ (In words _____________________________________________________________)

(a) Age as on _____________________

  1. Are you a citizen of India by birth and / or domicile: ________________.
    1. Permanent address (In Block letters)
    2. Telephone No: (Land Line) _____________________ Mobile No. -_____________________PIN CODE: _____
    1. Mailing address (In Block letters)
    2. Telephone No: (Land Line) _____________________ Mobile No. -_____________________PIN CODE: _____ E-mail ID _____________________________________
  2. Category you belong to category code Code of Category (UR-01, SC-02, OBC-03, ST-4)
  3. Educational Qualification:-
  4. Experience/particulars of previous and present employment.
Sr. No. Qualification University/Board % age of Marks obtained No. of attempts.
1 PG Degree
2 DM/ MCH
Sr. No. Name and Full address of the employer Designation Period of employment Total Experience
From TO
09 List of enclosures:
1 4.
2 5.
3. 6.

I hereby declare that the information furnished as above in the application is true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage, my candidature/appointment is liable to outright cancellation/termination without notice or any compensation in lieu thereof.

Date Signature of the candidate Place Name_____________

Paste your recent

APPLICATION FOR THE POST OF SPECIALIST (PART TIME/ FULL

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TIME) ON CONTRACT BASIS FOR SPECIALITY ____________________

  1. Name in full (in Block Letters):______________________________________________
  2. Fathers/Husbands Name: _________________________________________________
  3. Date of Birth (In Christian Era: (In figures)___________________________________ (In words _____________________________________________________________)

(a) Age as on _____________________

  1. Are you a citizen of India by birth and / or domicile: ________________.
    1. Permanent address (In Block letters)
    2. Telephone No: (Land Line) _____________________ Mobile No. -_____________________PIN CODE: _____
    1. Mailing address (In Block letters)
    2. Telephone No: (Land Line) _____________________ Mobile No. -_____________________PIN CODE: _____ E-mail ID _____________________________________
  2. Category you belong to category code Code of Category (UR-01, SC-02, OBC-03, ST-4)
  3. Educational Qualification:-
  4. Experience/particulars of previous and present employment.
Sr. No. Qualification University/Board % age of Marks obtained No. of attempts.
1 MBBS (% age all professions)
2 PG Degree
3 PG Diploma
Sr. No. Name and Full address of the employer Designation Period of employment Total Experience
From TO
10 List of enclosures:
1 4.
2 5.
3. 6.

I hereby declare that the information furnished as above in the application is true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage, my candidature/appointment is liable to outright cancellation/termination without notice or any compensation in lieu thereof.

Date Signature of the candidate Place

Name_____________

APPLICATION FOR THE POST OF SENIOR RESIDENT UNDER RESIDENCY SCHEME FOR SPECIALITY__________________.

Paste your recent passport size

  1. Name in full (in Block Letters):__________________________________________
  2. Fathers/Husbands Name: ____________________________________________
    1. Date of Birth (In Christian Era: (In figures)______________________________ (In words _________________________________________________)
    2. (a) Age as on ___________________________
  3. Are you a citizen of India by birth and / or domicile: ________________
    1. Permanent address (In Block letters) _______________________________
    2. ___________________________________________________PIN CODE: _________________
  4. Mailing Address _______________________________________________________________ ___________________________________________________PIN CODE: _________________ Telephone No: (Land Line) ________________ Mobile No. -___________________________ E-mail ID _____________________________________
  5. Category you belong to category code Code of Category (UR-01, SC-02, OBC-03, ST-4)
  6. Educational Qualification: -
  7. Experience / particulars of previous and present employment.
  8. List of Enclosures:
Sr. No. Qualification University/Board % age of Marks obtained No. of attempts.
1 MBBS (% age all professions)
2 PG Degree
3 PG Diploma
Sr. No. Name and Full address of the employer Designation Period of employment Total Experience
From TO

1. 4.

2 5.

3. 6. I hereby declare that the information furnished as above in the application is true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage, my candidature/appointment is liable to outright cancellation/termination without notice or any compensation in lieu thereof.

Date Signature the candidate Place Name___________________

APPLICATION FOR THE POST OF SENIOR RESIDENT FOR ONE YEAR ON CONTRACT BASIS FOR SPECIALITY _______________________.

Paste your recent passport size

  1. Name in full (in Block Letters):__________________________________________
  2. Fathers/Husbands Name: ____________________________________________
    1. Date of Birth (In Christian Era: (In figures)______________________________ (In words _________________________________________________)
    2. (a) Age as on ___________________________
  3. Are you a citizen of India by birth and / or domicile: ________________
    1. Permanent address (In Block letters) _______________________________
    2. ___________________________________________________PIN CODE: _________________
  4. Mailing Address _______________________________________________________________ ___________________________________________________PIN CODE: _________________ Telephone No: (Land Line) ________________ Mobile No. -___________________________ E-mail ID _____________________________________
  5. Category you belong to category code Code of Category (UR-01, SC-02, OBC-03, ST-4)
  6. Educational Qualification: -
  7. Experience / particulars of previous and present employment.
  8. List of Enclosures:
Sr. No. Qualification University/Board % age of Marks obtained No. of attempts.
1 MBBS (% age all professions)
2 PG Degree
3 PG Diploma
Sr. No. Name and Full address of the employer Designation Period of employment Total Experience
From TO

1. 4.

2 5.

3. 6. I hereby declare that the information furnished as above in the application is true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage, my candidature/appointment is liable to outright cancellation/termination without notice or any compensation in lieu thereof.

Date Signature the candidate Place Name___________________

APPLICATION FOR THE POST OF SPECIALIST (PART TIME) FOR

Paste your recent passport size

SPECIALITY ____________________ FOR ESIC MODEL DISPENSARY CUM DIAGNOSTIC CENRE, RAJPURA/ BARNALA.

  1. Name in full (in Block Letters):______________________________________________
  2. Fathers/Husbands Name: _________________________________________________
  3. Date of Birth (In Christian Era: (In figures)___________________________________ (In words _____________________________________________________________)

(a) Age as on _____________________

  1. Are you a citizen of India by birth and / or domicile: ________________.
    1. Permanent address (In Block letters)
    2. Telephone No: (Land Line) _____________________ Mobile No. -_____________________PIN CODE: _____
    1. Mailing address (In Block letters)
    2. Telephone No: (Land Line) _____________________ Mobile No. -_____________________PIN CODE: _____ E-mail ID _____________________________________
  2. Category you belong to category code Code of Category (UR-01, SC-02, OBC-03, ST-4)
  3. Educational Qualification:-
  4. Experience/particulars of previous and present employment.
Sr. No. Qualification University/Board % age of Marks obtained No. of attempts.
1 MBBS (% age all professions)
2 PG Degree
3 PG Diploma
Sr. No. Name and Full address of the employer Designation Period of employment Total Experience
From TO
10. List of enclosures:
1 4.
2 5.
3. 6.

I hereby declare that the information furnished as above in the application is true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage, my candidature/appointment is liable to outright cancellation/termination without notice or any compensation in lieu thereof.

Date Signature of the candidate Place Name_____________



Important Dates

Start Date End Date
Notification Issued 13-Feb-2018
Interviews 22-Feb-2018


Notification Issued By

  • Organization : E.S.I.C. Model Hospital
  • Organization City, State : ludhiana, punjab
  • Organization Website : www.esichospitals.gov.in
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