Terms & Conditions:

1. Reservation policy is applicable as per Central Government rules.
   
   
2. The number of vacancies can be changed at any time without any intimation.
   
   
1. Selected candidates must have to sign an Agreement of Terms & Conditions on Rs. 100/non-judicial stamp paper before joining and candidate will bear the applicable cost of stamp
   
   
2. paper, notary charges etc.
3. Selected candidate shall deposit the Security Deposit of Rs. 10,000/-(Rupees Ten Thousand only) in the form of Demand Draft in favour of ESIC Fund A/c No. 1 payable at Ahmedabad from any Nationalised Bank before signing the Agreement.
   
   
4. No accommodation facility will be provided by ESIC for such selected candidates.
   
   
5. The competent authority reserves the right to fill up all or not to fill up any of the vacancies.
   
   
6. The contract period of one year is extendable for further one year on mutual consent of both the parties on the basis of satisfactory performance.
   
   
7. The selected candidates will engage himself/herself in the work assigned to him efficiently and diligently to the best of his/her ability. He/she will devote his/her whole time to his/her work and duties and will not be engage directly or indirectly in any trade, business or occupation.
   
   

-SD-

Medical Superintendent

.... /ESIC GENERAL HOSPITAL x

/EMPLOYEES STATE INSURANCE CORPORATION

APPLICATION FORM

1. Name of the Post Applied _______________________________ Affix recent passport
   
   
2. NAME (in capital letters) _______________________________
   
   

size photo

1. Fathers /Husbands Name _______________________________
   
   
2. Category (SC, ST, OBC, General): _________________________
   
   
3. Age (as on 01.10.2017) _____Years______Months_____Days Signature of the Candidate
   
   
4. Date of Birth (in figures) _______________________________ (in words) _____________________________________
   
   
5. (a) Religion ______________________(b) Nationality _______________________
   
   
6. Mailing Address ____________________________________________________
   
   

___________________________Pin: _____________________

9. Permanent Address ____________________________________________________

___________________________Pin: _____________________ 10.E-Mail Id (If any) ____________________________________________________ 11.UID (Aadhaar) No. ____________________________________________________ 12. PAN no. ____________________________________________________ 13.Contact Details (Cell no.) _________________ (Phone no.) ______________

14.Sex: (Male (01) & Female (02)):

15.(i) (a) If physically handicapped (Orthopedically handicapped) (b) If yes, % of Disability	Yes / No
16.Whether Ex-serviceman	Yes / No
17.Essential Educational Qualification:

Sl. No.	Name & Address of University/College	Duration		Degree / Diploma Passed	% of marks obtained
		From	To

18.Date of Completion of compulsory Rotating Internship: _______________________ 19.Date of Registration with MCI / SMC / DCI : _______________________ 20.Details of past Experience in Chronological order:

Name of the Organisation (please specify whether Central/State Govt./Autonomous body/Pvt. Sector)	Position (s) held and to whom reporting	Period of Service	Nature of Work done & reasons for leaving	Scale of Pay	Basic Pay	Gross Pay

21. Particulars of DD: No._______ Date_______ Bank_______________ Amount_____

I hereby declare that the details provided in this application are true, complete and correct to the best of my knowledge and belief.

I understand that in the event of any information found false or incorrect at any stage, my candidature / appointment shall be liable to be cancelled / terminated summarily without notice or any compensation in lieu thereof.

I also affirm that No Objection Certificate from the present employer for applying this post has been applied for/taken and I know that the same will be submitted to the competent authority at the time of joining, if selected.

Place: __________________

Date: __________________ ______________________________ Signature of the Candidate

Enclosure Checklist:

1. DD of Rs. 250/-(Application Form Fee).
   
   
2. Matriculation Certificate as proof of Date of Birth.
   
   
3. Photo copies of Educational Qualifications.
   
   
4. Photo copies of Past Experience Certificates.
   
   
5. Photo copies of Registration Certificates.
   
   
6. Photo copy of Caste Certificate.
   
   
7. Photo copy of PAN.
   
   
8. Photo copy of UID Card (Aadhaar).