directorate of health services jammu division jammu - Department of ...

APPLICATION FORM FOR ENGAGEMENT (CONTRACTUAL) FOR NCD PROGRAMME(JAMMU DIVISION)Post applied for and S.No. of post__________________________District for which applied ________________________________1. Name of the candidate ________________________2. Parentage __________________________________3. Date of birth ________________________________4. Age as on 1.1.2013 ____years ____months ____days5. Sex _____________________________6. District Domicile ____________________________7. Address Present ________________________________________Permanent ___________________________________8. Telephone no./ Mobile no. __________________9. E‐mail address___________________________________10. Educational qualificationName of theexaminationUniversity / boardNameRecognizedYes / NoSessionAttested Passport sizephotograph to beaffixedMarks obtained (sum upthe total of all thesemesters / years)TotalmarksMarksobtained%age/gradeFull time /correspondence11. Details of experience (use separate sheet if required) starting with your presentemployment list in the reverse order all the employment you have had with jobresponsibilities(Fill separate forms if applying for more than one post.)I certify that all statements made by me to the above questions are true, complete andcorrect to the best of my knowledge.Place:Date:Signature of the candidateName in block letters.