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Med"ical Officer

Ayush Mo

Hospital Manager

Staff Nurse

X-Ray Technician

ECG Technician

Lab Technician

MO Medicine

Degree/Diploma in Anesthesia

MBBS

BAMS/BUMS

Any medical graduate with one year experience of Hospital administration GNM Bsc Nursing

Retd X-ray technician

Experience of ECG technician at least one year BSc DMLT

75000+ 111 ~.::

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75000+ 83

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60000 483

30000 183

35000 86

20000 1841

17000 77

17000 66

17000 132

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National Health Mission Deputy Director Health services Thane

APPLICATION FORM District/Corporation name:

(All fields in the forms are mandatory to be filled.An incomplete form submitted will be treated as rejected.)

Exact Name Of Position Applied For:

Name: Father's/Husband's Name:

Date of Birth (00/MM/YYY): Blood Group: Gender: Marital Status: Existing NHM Nationality: Religion: Applying for Which

(Yes/No) Category Category

Address/Contact Details:(Name of the District and Pin code is compulsory) Address(Present): Address(Permanent):(Write same if same as

present Address) State: Pin: State: Contact No: Pin:

· Contact No:

E-mail Id For Correspondence: Alternate E-mail Id for correspondence (If any):

Languages English Hindi Marathi Others (please Specify below) Known: (Write •y• I "W)

I Computer Proficiency:

Academic/Professional Education Summary: Starting from most recent)

From To Degree/Diploma University/ Specialization/ Final Year Final Year (MM/YY) (MM/YY) Institute Subjects Total Marks Percentage

& Obtained Marks

(Work/Experience Summary:( Starting from current/most recent)

Sr.No. From To Organization Designation Responsibilities (MM/YY) (MM/YY) (Min.30and Max.50 Words)

Total Experience (In years & Month): Relevant Experience to the post applied (In Years & Months):

Notice Period/Joining Time (Days):

Details of internshipMlorkshops/Conferences/Trainings Attended(lf any):

Declaration: I hereby declare that all statements made in the application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found untrue/false/incorrect or I do not satisfy the eligibility criteria my candidature will be cancelled, without assigning any reason thereof. I have read the content of the advertisement and agree to abide by the rules, regulations and procedures for appointment to the post applied for.

Name: Place: Date:

Signature

Disclaimer: The applicants are required to submit the duly filled application on or before the due date and time, failing which the application of the said applicant shall be treated as-responsive.NHM shall not b responsible for late receipt or non-receipt of applications for any technical reason or whatsoever. The applications· received after due date and time shall not be considered.