Online Applycation Form

TO
The CHIEF MEDICAL OFFICER OF HEALTH
BASIRHAT HEALTH DISTRICT

* Subject: Application for the Post of :
   * Memo No :
* Name:
* Father's/Husband's Name :
* Sex :
* DOB:
* Caste :
* Nationality:
* Mobile No :
* Email Id:
Permanent Address :
Mailing Address :       
Educational Qualification :
EXAMINATION Board/University/Degree Total Marks (Excluding Optional) Marks Obtained (Excluding Optional) % of Marks
* Madhyamik (10th)
* HS (10+2)
Graduation
Post Graduaation
Diploma
Computer Course

Experience :
sl Organization Govt/Private/NGOs Period Total Experience
1 To
2 To
3 To

* 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 (only pdf) (Academic, Experience, proof of age, cast, address etc.) :
**Note:Suport only pdf file ; size not more then 4.5 mb

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