Download - M.sc. Nursing Form
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RAJASTHAN UNIVERSITY OF HEALTH SCIENCES,JAIPUR
Application Form for M.Sc. Nursing Entrance Examination 2011 - 12For Admission to M.Sc. Nursing (2 Year) Course
(To be kept in the Record of the University)
RUHS Registration No.................................................................................................(For Official use )
SUMMARY SHEET
Enter the Category for which application form is being submitted:Category Code
In-Service- General 1 Non-Service General 6In-Service- SC 2 Non-Service SC 7In-Service- ST 3 Non-Service ST 8In-Service- OBC 4 Non-Service OBC 9In-Service- SBC 5 Non-Service SBC 10
1. Full Name (in Capital Letters)
__________________________________________________________
2. (a) Fathers Name
__________________________________________________________
(b) Mothers Name
__________________________________________________________
3. Date of Birth Date Month
Year
4. Sex Male / Female
5. Telephone Nos. (with STD Code) (R) .........................................(O) ...............................................
(M).........................................(Fax) ............................................
6. Are you entitled for benefit under Disabled Category Yes/No .....................................
7. Are you entitled under In-Service Category. Yes/No, If yes(Teaching/Clinical) ...............
8. Date of completion of B.Sc. Nursing / B.Sc. Nursing (Trained & Registered) / Post
Basic B.Sc. Nursing (Hons) (.....................................................) with Aggregate Marks
........................
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Work Experience from ....................................... to ...................... TotalService ...........................
9. Permanent Registration Number with the State Nursing Council.
R.N. R.M. State
Note: - Incomplete application forms due to any shortcoming(s)will be rejected. No further communication will be made to
the candidates in this regard.
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RUHS Registration No. ..............(For Official use) RollNo..........................
(Leave Blank)
Price: 1200/- DD No................................ Dated ............................. DraweeBank .....................................
RAJASTHAN UNIVERSITY OF HEALTH SCIENCES, JAIPURApplication Form for M.Sc. Nursing Entrance Examination 2011 - 12
For Admission to M.Sc. Nursing (2 Years) Course(To be kept in the record of the University)
Enter the Category for which application form is being submitted:
Category CodeIn-Service- General 1 Non-Service General 6In-Service- SC 2 Non-Service SC 7In-Service- ST 3 Non-Service ST 8In-Service- OBC 4 Non-Service OBC 9In-Service- SBC 5 Non-Service SBC 10
1. Full Name (in Capital Letters)
......................................................................................................
2. (a) Fathers Name
......................................................................................................
(b) Mothers Name
......................................................................................................
3. Date of Birth Date Month
Year
4. Sex Male / Female
5. Full Postal Address......................................................................................................
AFFIX YOURRECENT
PHOTOGRAPHduly signed by the
candidate andattested
by Principal of his/herNursing college/orDMHS/Gazetted
Officer
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................................................................................
......................
City ..........................................................Pin ............................
Telephone Nos. (with STD Code) (R) .........................................(O) ...............................................
(M).........................................(Fax) ............................................
6. Are you entitled for benefit under Disabled Category Yes
/No ...................................................
(If yes, please attach a valid certificate)
7. Are you entitled under In-Service Category. Yes/No .................... If yes
(Teaching/Clinical)
(if yes, attach the requisite certificate issued by DMHS, Jaipur)
8. State/Union Territory to which you
belong ............................................................................................
9. Nationality .......................................................................
10. Which Category you belong to
SC/ST/OBC/SBC/General .................................................................
(SC/ST/OBC/SBC candidates must attach an attested copy of the caste certificate)
OBC/SBC certificate should be issued on or after dated 01-04-2011
11. Eligibility criteria of Non-Service Candidate .............................................................see Instruction Booklet for details and attach attested copy of requisite certificatesmust specify following details of Final B.Sc. Nursing Examination of University ofRajasthan / Rajasthan University of Health Sciences, Jaipur / other University.Name ofExamination ...................................................................................................................................Name ofCollege ............................................................................................................................................Whether College is recognized by INC .................................................Attach the certificates from the Principal of the Concerned Nursing College.Attach the certificates of work experience from the Concerned Employer.
12.Permanent Registration Number with the State Nursing Council.
R.N. R.M. State
13. Professional Qualification: Details of Marks obtained in B.Sc. Nursing, B.Sc. Nursing(Trained & Registered) / Post Basic B.Sc. Nursing (Hons) Examination.
14.Attach DD of Rs. 1200/- in the name of "The Registrar, Rajasthan University ofHealth Sciences payable at Jaipur.DD No. ...................................... Dated........................................ DraweeBank................................
Details of Educational QualificationsB.Sc.
NursingName of the
University/InstitutionState in which
College /Institutionsituated
Month & yearof Passing
Percentageof MarksObtained
Total No. of timesappeared in the
examinationincluding the one in
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which passedPart-lPart-llPart-lllPart-lV
Attach attested copies of the Degree / Provisional Certificate and Mark-sheets related to theB.Sc. Nursing, B.Sc. Nursing (Trained & Registered) / Post Basic B.Sc. Nursing (Hons)Examination. mentioned above.
DECLARATIONI hereby solemnly and sincerely affirm that the statements made and
information furnished by me in the application form and also in the enclosuressubmitted by me are true and correct. I have not kept any information secret.Should it, however, be found that any information furnished herein isfraudulent/incorrect or untrue in material particulars, I realize that I am liable tocriminal prosecution. I agree to abide by the Rules and Regulations governingthis examination and as contained in the instruction booklet. I understand thatmy admission will be provisional and if at any later stage, I am found ineligible,it will automatically stand cancelled.
Left Hand Thumb Impression Right Hand Thumb Impression
Signature of theCandidate
Verified by :
(Signature & Seal)
Date: ............................2011Place: ................................... Signature & Thumb Impression should be verified and marked in presence ofPrincipal of School/ College last attended/ Gazetted Officer/Executive Magistrate.Note: Candidate must sign the form and affix Left & Right Thumb Impression failing which the
application form will be rejected.
RUHS Registration No. ...............................(For Official use) RollNo..........................
(Leave Blank)
Price: 1200/- DD No................................ Dated ............................. DraweeBank......................................
RAJASTHAN UNIVERSITY OF HEALTH SCIENCES, JAIPURApplication Form for Pre-M.Sc. Nursing Entrance Examination 2010 - 11
For admission to M.Sc. Nursing (2 Year) Course(To be kept in the record of the Nursing College)
Enter the Category for which application form is being submitted:
In-Service- General 1 Non-Service General 6In-Service- SC 2 Non-Service SC 7
Category Code
In-Service- ST 3 Non-Service ST 8In-Service- OBC 4 Non-Service OBC 9In-Service- SBC 5 Non-Service SBC 10
AFFIX YOUR
RECENTPHOTOGRAPHduly signed by the
candidate andattested
by Principal ofhis/her Nursing
college/orDMHS/Gazetted
Officer
1. Full Name (in Capital Letters)
......................................................................................................
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2. (a) Fathers Name
......................................................................................................
(b) Mothers Name
......................................................................................................
3. Date of Birth Date Month
Year
4. Sex Male / Female
5. Full Postal Address......................................................................................................
................................................................................
......................
City ..........................................................Pin ............................
Telephone Nos. (with STD Code) (R) .........................................(O) ...............................................
(M).........................................(Fax) ............................................
6. Are you entitled for benefit under Disabled Category Yes/No ...................................................(If yes, please attach a valid certificate)
7. Are you entitled under In-Service Category. Yes/No .................... If yes(Teaching/Clinical)(if yes, attach the requisite certificate issued by DMHS, Jaipur)
8. State/Union Territory to which youbelong ............................................................................................
9. Nationality .......................................................................10. Which Category you belong to
SC/ST/OBC/SBC/General .................................................................(SC/ST/OBC/SBC candidates must attach an attested copy of the caste certified)OBC/SBC certificate should be issued on or after dated 01-04-2011
11. Eligibility criteria of Non-Service Candidate See Instruction Booklet for details andattach attested copy of requisite certificates, must specify following details of FinalB.Sc. Nursing Examination of University of Rajasthan / Rajasthan University of HealthSciences, Jaipur / other University.Name ofExamination ...................................................................................................................................Name ofCollege ............................................................................................................................................Whether College is recognized by INC .................................................Attach the certificates from the Principal of the Concerned Nursing College.Attach the certificates of work experience from the Concerned Employer.
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12.Permanent Registration Number with the State Nursing Council.
R.N. R.M. State
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13. Professional Qualification: Details of Marks obtained in B.Sc. Nursing, B.Sc. Nursing(Trained & Registered) / Post Basic B.Sc. Nursing (Hons) Examination.
14.Attach DD of Rs. 1200/- in the name of "The Registrar, Rajasthan University ofHealth Sciences payable at Jaipur.DD No. ...................................... Dated........................................ DraweeBank................................
Details of Educational QualificationsB.Sc.
NursingName of theUniversity /Institution
State in whichCollege /
InstitutionSituated
Month & yearof Passing
Percentageof MarksObtained
Total No. of timesappeared in the
examinationincluding the one in
which passedPart-lPart-llPart-lllPart-lV
Attach attested copies of the Degree / Provisional Certificate and Mark-sheets related to theB.Sc. Nursing, B.Sc. Nursing (Trained & Registered) / Post Basic B.Sc. Nursing (Hons)Examination. mentioned above.
DECLARATION
I hereby solemnly and sincerely affirm that the statements made andinformation furnished by me in the application form and also in the enclosuressubmitted by me are true and correct. I have not kept any information secret.Should it, however, be found that any information furnished herein isfraudulent/incorrect or untrue in material particulars, I realize that I am liable tocriminal prosecution. I agree to abide by the Rules and Regulations governingthis examination and as contained in the instruction booklet. I understand thatmy admission will be provisional and if at any later stage, I am found ineligible,it will automatically stand cancelled.
Left Hand Thumb Impression Right Hand Thumb Impression
Signature of theCandidate
Verified by :
(Signature & Seal)
Date: ............................2011
Place: ...................................
Signature & Thumb Impression should be verified and marked in presenceof Principal of School/ College last attended/ Gazetted Officer/ExecutiveMagistrate.Note:Candidate must sign the form and affix Left & Right Thumb Impression failing which
the application form will be rejected.-5-
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RAJASTHAN UNIVERSITY OF HEALTH SCIENCES,JAIPUR
M.Sc. Nursing Entrance Examination 2011 - 12(for Admission to M.Sc. Nursing (2 Year) Course)
ADMISSION CARD
Roll No. (Leave Blank) ..............................................
[Candidate must fill in his/her name and fathers name in his/her own writing]
Pleaseadmit ..............................................................................................................................................
Son/Daughter of
Mr./Ms./ ...................................................................................................................
to the M.Sc. Nursing Entrance Examination 2010 - 11
AFFIX YOURRECENT
PHOTOGRAPHduly signed by the
candidate andattested
by Principal ofhis/her Nursing
college/orDMHS/Gazetted
Officer
which will be held on 17.07.2011 (Sunday) 08.30 A.M. 11.30 A.M. at ExaminationCentre .................
(..........................................)
The ConvenorM.Sc. Nursing Entrance Examination 2011 - 12
INSTRUCTIONS
1. The M.Sc. Nursing Entrance Examination shall be conducted at Jaipur only. All candidates arerequired to appear at the M.Sc. Nursing Entrance Examination at their own expenses.
2. The candidates are expected to take their seats 30 minutes before commencement of theexamination. No candidate coming after 15 minutes of the commencement of theexamination shall be permitted to appear in the examination.
3. Candidates will be required to produce Admission Card before he/she is allowed to enterthe examination centre.
4. Candidates must bring two black ballpoint pens.
5. Candidates should read the instructions given on OMR Sheet carefully. All entriesmust be filled by ball point pen. Darken the appropriate circles/ovals using blackballpoint pen only. Therefore, the candidates are advised to finalize their choicebefore marking on OMR sheet. Overwriting is not allowed. If any candidate darkenmore than one circle, his/her answer will be treated as wrong. Darkening of morethan one circles/ovals will be treated as wrong. No stray marks should be made onthe OMR sheet. OMR sheet should not be folded. Rough work must not be done onthe OMR sheet. Whitener for correction is not allowed.
6. No candidate shall be allowed to carry any text material written or printed, bits of paper orany other material except the admission card inside the hall. Cellular/Mobilephone/Pager/Calculator or any other electronic device will not be permitted in theexamination hall.
7. The Candidates shall maintain silence and attend to their paper only. Any disturbance by the
candidates at the examination will be deemed as misbehavior and the candidates involved insuch activity shall forfeit their right to continue in the examination. The decision of the CentreSuperintendent shall be final and conclusive in the matter.
8. The University shall arrange for videography/photography of individual Candidates. TheCandidates are required to keep their head in upright position and face the camera duringthis process so that their identity could be clearly established.
9. In order to prevent impersonation, left thumb impression shall be obtained on a biometricmachine during the conduct of examination. In case left thumb impression could not beregistered on the machine due to injury or some other reason, right thumb impression orimpression of any finger, in case other thumb is also injured, shall be registered on themachine.
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10. No Candidates shall be allowed to go outside the examination hall till thecompletion of the examination.
11. Writing anything on the Admission card/Carbon copy of OMR sheet or any stray paper will betreated as unfair means. Candidates should not tamper with the question booklet or tear anypage out of it.
12. If the Candidates have any grievances regarding the ambiguities of the question paper, thesame can be submitted / sent to Office of The Convener, at RUHS, Jaipur up to 5.00 P.M. onthe date of examination or The Center Superintendent just after the completion of theExamination.
13.The Jurisdiction of the court cases will be atJaipur only.-6-
FOR IN-SERVICE CANDIDATESS ONLY
(TEACHING/CLINICAL)
1. Full
Name ................................................................................................
....................
2. Present designation and Place of
Posting ...............................................................
3. Date of Joining and
Place ..........................................................................................
AFFIX YOURRECENT
PHOTOGRAPHduly signed by the
Candidates andattested
by Principal ofhis/her Nursing
college/orDMHS/Gazetted
Officer
DECLARATION
I am serving the Government of Rajasthan continuously since .......................... and havecompleted two years after regular appointment in Government of Rajasthan. As such, I ameligible for admission to M.Sc. Nursing (2 Year) Course in In-Service category.
Dated...........................
Signature of theCandidates
CERTIFICATENo. Date:
This is to certify that
Sh./Miss/Mrs. .......................................................................................................................
Son/Daughter/W of ................................................................................. is posted
as ................................... at ...................................................... She/He was appointed vide
State Government Order No. .......................... dated .................................. and has been in
the State Government Service from ......................... to .............................. and has
completed two years.
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It is certified that he/she is eligible for admission to post graduate courses through theM.Sc. Nursing Entrance Examination 2011 12 under the In-Service category,Government of Rajasthan rules and other directives in force.
Date: ..............................
Place: .............................
DirectorMedical & Health ServicesGovernment of Rajasthan,
Jaipur(Seal)
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FOR IN-SERVICE CANDIDATESS ONLY
(TEACHING/CLINICAL)
1. Full
Name ................................................................................................
....................
2. Fathers
Name ................................................................................................
.............
3. Date of
Birth ..................................................................................................
..............
4. Address .............................................................................................
...........................
.........................................................................................
...............................
.........................................................................................
...............................
AFFIX YOURRECENT
PHOTOGRAPHduly signed by the
Candidates andattested
by Principal ofhis/her Nursing
college/orDMHS/Gazetted
Officer
5. Years of B.Sc. Nursing study from ......................................................
to ..................................................
6. Name of
College .........................................................................................................................
...................
7. University......................................................................................................................
..................................
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8. State .............................................................................................................................
....................................
Signature of theCandidates
Certificate to be given by the Principal of the Nursing College.
This is to certify tha
Sh./Ms .......................................................................................................
Son/Daughter of ................................................................................. has
studied in this institution w.e.f. ........................................
to ....................................... and passed B.Sc. Nursing, B.Sc. Nursing (Trained
& Registered) / Post Basic B.Sc. Nursing (Hons) Examination held
in ............................................. (Month) ......................................... (Year)
under Roll No. ................................. This College is recognized by the Indian
Nursing Council.
Date: ..............................
Place: .............................
PrincipalNursing College
(Seal)-8-
Template for Envelop
APPLICATION FORM FOR M.SC. NURSING ENTRANCE EXAMINATION 2011 -
12
LAST DATE : 2nd July, 2011
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To,
The Convener, M.Sc. Nursing Entrance Examination2010-11
Rajasthan University of Health Sciences
Kumbha Marg, Sec. 18, Pratap Nagar, Jaipur - 302 033
From :
Name: _______________________________________________
Father Name: _________________________________________
Complete address : ____________________________________
_____________________________________________________
Phone : ______________________________________________
Cell No : _____________________________________________
E-mail : ______________________________________________
Note: -This form will not be accepted after 5.00 P.M. of 02nd July,2011