Basirhat Health District

Online Applycation Form

TO
The CHIEF MEDICAL OFFICER OF HEALTH
BASIRHAT HEALTH DISTRICT

* Application for the Post of :

* Memo No :

* Applicant Name:

* Father's/Husband's Name :

* Sex :

* DOB:

* Caste :

* Nationality:

* Mobile No :

* Email Id:

Permanent Address :

Same Mailing Address

Mailing Address :

Educational Qualification :

EXAMINATION	Year of Passing	Board/University/Degree	Total Marks (Excluding Optional)	Marks Obtained (Excluding Optional)	% of Marks	Chance taken to pass
* Madhyamik (10th)
* HS (10+2)
Graduation
Post GraduaationGNM
DiplomaANM
Computer Course

driving licence No :

Experience :

1. Government Experience :
Name of Institution(s)/Organization(s) :
Total Government Experience : Years Months

2. Private Experience :
Name of Institution(s)/Organization(s) :
Total Private Experience : Years Months

* Passport Size Image Upload:
**Note:Passport Size Image width 120 pixel x height 160 pixel; size not more then 600Kb

* Signature Upload:
**Note:Signature jpeg/jpg file format; width 160 pixel x height 60 pixel; size not more then 500Kb)

* Uplaod all of relevant documents in one file :

**Note:Suport only pdf file ; size not more then 4.5 mb, Upload all relevant documents in one file [ (a) Age proof document (b) All document related to Academic Qualifications like Marksheet, Certificate etc, (c) Experience Certificate (if any) (d) Caste Certificate (if applicable) (e) Address Proof, (f) Driving Licence (if applicable) (g) Registration Certificate of Professional Qualifications (for MBBS, ANM, GNM courses) ]

* Application Fee's Payment Details Amount(In Rs.) :

* Transaction Deails: