MEDICAL SUPERINTENDENT

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ANNEXTURE-A

RECRUITMENT FOR THE POST OF SPECIALIST, SENIOR RESIDENT & JUNIOR RESIDENT IN

ESIC MODEL HOSPITAL cum ODC & PGIMSR, ANDHERI, MUMBAI-93.

(To be filled by Candidate) POST: ___________________________ Department: ___________________

1) 2)	NAME DATE OF BI	: RTH	DR.____________________________________________ : ______________________ CATEGORY : UR/ OBC/SC /ST	Affix recent colour photograph
3)	ADDRESS	:

____________________________________ Pin code: _________________ 4) RELIGION: ________________ (CASTE:___________________) 5) CONTACT NO. : ____________________ E-mail :_______________________________________ 6) AADHAR NO. ______________________________________ PAN_________________________ 7) M.B.B.S. (Year of Passing) : ______________________________________________________ 8) POST GRADUATION (DEGREE/DIPLOMA)

SR	DEGREE / DIPLOMA	YEAR OF PASSING	UNIVERSITY / INSTITUTE

9) MEDICAL COUNCIL REGISTRATION NO. :____________________________________________ 10) NAME OF THE MEDICAL COUNCIL :____________________________________________ 11) EXPERIENCE

SR	DESIGNATION	FROM	TO	PERIOD

12) Presently working as Designation _________________________ Name of Institution

___________________________________ Govt. / Private. ___________________________ 13) NOC certificate from present employer taken / PPO copy available _____________________ 14) I hereby declare that the information given above is true & correct to the best of my knowledge and

belief. In case of any information is found false/ incorrect at the later stage of the recruitment/ appointment, I shall be bound by the decision of ESI Corporation.

Date & Place: _________/ _________ (Signature of Candidate)

Annexure B (FORMAT OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA)

This is to certify that Shri/Smt./Kumari _______________________________ son/ daughter of _________________________________of village/town________________________________in District/Division _____________________ in the__________________________State/Union Territory__________________________ belongs to the ________________Community which is recognized as a backward class under the Government of India, Ministry of Social Justice and Empowerments ResolutionNo.______________________________________________________________________dated________ ____* .Shri/Smt./Kumari__________________________ and/or his/her family ordinarily reside(s) in the______________________________ District/Division of the ____________________________ State/Union Territory. This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned in column 3of the Schedule to the Government of India, Department of Personnel & Training OM No.36012/22/93-Estt. (SCT,) dated 08.09.1993**.

Date ________________	District Magistrate/Deputy Commissioner etc.
Seal of Office

*-The Authority issuing the certificate may have to mention the details of resolutions of GOI, in which the caste of the candidate is OBC **-As amended from time to time. Note:-The Term ordinarily reside(s) used here will have the same meaning as in section 20 of the representation of the people act 1950.

List of authorities empowered to issue Caste/Tribe Certificate Certificates:

1. District Magistrate/Additional District Magistrate/Collector/Dy. Commissioner/ Additional Dy. Commissioner/ Dy. Collector/ 1^St Class Stipendiary Magistrate/Sub-Divisional Magistrate/Extra Assist Commissioner/Taluka Magistrate/ Executive Magistrate
   
   
2. Chief Presidency Magistrate/ Additional Chief Presidency Magistrate/ Presidency Magistrate.
   
   
3. Revenue Officers not below the rank of Tehsildar.
   
   
4. Sub-Divisional Officers of the areas where the applicant and of his family normally resides.
   
   

Note I a. The term Ordinarily used here with will have the same meaning as in Section 20 of the Representation of the People Act, 1950.

b.

The authorities competent to issue caste certificate are indicated below :

i.

District Magistrate/Additional Magistrate/Collector/Dy. Commissioner/Additional Deputy Commissioner/Deputy Collector/1^st Class Stipendiary Magistrate/Sub-Divisional Magistrate/ Taluka Magistrate/Executive Magistrate/ Extra Assistant Commissioner (not below the rank of 1^st class Stipendiary Magistrate)

ii. Chief Presidency Magistrate/ Additional Chief Presidency Magistrate/Presidency Magistrate.

iii. Revenue Officer not below the rank of Tehsildar.

iv. Sub-Divisional Officer of the area where the candidate and/or his family resides. Note II The closing date for receipt of application will be treated as the date of reckoning for OBC status of the candidate and also, for assuming that the candidate does not fall in the creamy layer. Note III The candidate should furnish the relevant OBC certificate in the format prescribed for Central Government jobs as per Annexure A above issued by the competent authority on or before the closing date as stipulated in this notice.

Annexure C

Form of declaration to be submitted by the OBC Candidate (in addition to the community certificate)

I Son/daughter of Shri resident of village/town/city district .... State .. hereby declare that I belong to the . Community which is recognized as a backward class by the Government of India for the purpose of reservation in services as per orders contained in Department of Personnel and Training office Memorandum No. 36102/22/93-Estt. (SCT) date 8-9-1983. It is also declared that I do not belong to persons/ sections/ sections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred office Memorandum dated 8-9-1993, O.M. No. 36033/3/2004-Estt. (Res.) dated 9^th March, 2004, O.M. No. 36033/3/2004-Estt (Res.) dated 14^th October, 2008 and OM No. 36033/1/2013-Estt (Res.) dated 27^th May 2013.

Signature: Full Name:..

Address