Government Medical College Datia(M.P.)

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Recruitment For Nursing Officer under Medical College, Datia(M.P.)

Fields marked with * are mandatory

Instructions
Documents to be furnished in original at the time of verification of documents along with one set of photocopies should be self attested and a copy of online submitted application form / Receipt
Applying for Post*
Post Type*

Personal Details
Applicant's Name*
Father's/Husband's Name*
Mother's Name*
Domicile of MP:*		Category:* Note:-OBC Creamy Layer candidate apply as UR.		Nationality:*
Gender*		Date of Birth(DD/MM/YYYY)*	(In DD/MM/YYYY)	Age as on 01/01/2022	- -(yy-mm-dd)
Marital Status*	WIDOWSINGLEMARRIEDDIVORCEE		Marriage Date* (In DD/MM/YYYY)
Note:- More than one married candidate will not be eligible if the first marriage is not severed or died.
No. of Children		Last child birth date (In DD/MM/YYYY)		Is Your Last Child Born Twins	YESNO
Are you working in government / corporation / board / autonomous institution staff / City Soldier?*
Are You an Ex Serviceman*			Are You Physically Handicapped ?*
Type Of Physically Handicapped			Handicapped Percentage

Educational Qualification (Kindly attached self attested photocopies of all Mark Sheets and Documents.)

Qualification	Name of Certificate/Diploma/Degree	Passing Year (YYYY)	University/Board	Institute/College Name	Obtained Percentage (In 00.00 Format)
10^th*	10th
12^th*
Qualification obtained*
Post Graduation
Others
For GNM, It is Compulsory to add internship marks for calculation of percentage.

Do You have alive registration in MP nurses council Bhopal*	YES	If yes,Registration No.*
Alive registration number of employment office*

* In case your University/Institute does not award marks, please convert grades(CGPA) to Percentage marks and fill.

* Write % of marks with two digits after the decimal. The second digit after the decimal should be rounded off. e.g., if Marks is 60%, then write 60.00%. If marks are 68.938% then write 68.94%.

Have you ever worked as Samvidha employee on the same post?*

YESNO

Sno	Department Name	From Date (In DD/MM/YYYY)	To Date (In DD/MM/YYYY)	Year (yy/mm/dd)
1

Total Experience(yy/mm) -

Experience Details

Organization Name	Field Name	Department Type	From date (In DD/MM/YYYY)	To date (In DD/MM/YYYY)	Total experience
					YY 0 MM 0
					YY 0 MM 0
					YY 0 MM 0
					YY 0 MM 0
					YY 0 MM 0
Total work Experience in Years-Month :- 0 -0

Communication Address
Address*		State*
District Name*	Division*	Pin No.*
Email id*	Mobile No.*	Phone No.

Permanent Address(Same as Communication Address)
Address*		State*
District Name*	Division*	Pin No.*
Mobile No.*	Phone No.

Bank Details
Account Number *		Bank Name *
Account Holder Name *		IFSC Code *

City Preference
Exam City1 *		Exam City2 *		Exam City3 *

Attachment*

Attach Photo with Signature*


Upload Image

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Declaration *
I HEREBY DECLARE THAT ALL THE INFORMATION GIVEN IN THE AFOREMENTIONED APPLICATION FORMAT IS TRUE TO THE BEST OF MY KNOWLEDGE. I UNDERTAKE AND ACCEPT THAT IF ANY OF THE INFORMATION GIVEN BY ME IS FOUND TO BE INCORRECT, THEN MY APPLICATION WILL BE REJECTED AND IF APPOINTED, THEN MY APPOINTMENT WILL BE TERMINATED & ACTION MAY BE TAKEN ACCORDINGLY.