Certificate Course in Community Health
नोट :-उक्त भर्ती में कई अहर्ताएं एवं निरर्हताये है,यह आवेदन फार्म केवल महिलाओं के लिए है | अतः आवेदन भरने से पूर्व आवश्यक रूप से नियम पुस्तिका का अध्ययन कर ले।
Candidate Details
Applicant Name : * Father's / Husband's Name : *
Are you domicile of Madhya Pradesh ? :* Category : *
Are you handicapped(40% or Above) * Date of Birth (DD/MM/YYYY) (As per your 10th marksheet) :*
Address Line 1 : *
Address Line 2 : * District :*
State :* Pincode :*
Mobile No : * Alternate Mobile No :
Email ID : * Have you Passed B.sc Nursing ?: *
Passing Year Of B.Sc. Nursing: Institute Name : *
Registration No.Of M.P. Nursing council : M.P. Nursing council Registration date(DD/MM/YYYY):
Are you NHM Contractual staff nurse employee ?: * Employee Code(Based on Contractual) :
First Date Of Joining order (Contract)(DD/MM/YYYY) : Total experience :
Examination City Preference
First Preference: * Second Preference : *
Third Preference : *
Note : Candidate should have valid mobile number for further correspondence. *

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