Notification for Engagement Of Medical Non-Specialist consultant(GDMO) in ECL on Fixed Tenure contract basis

Page(1/2) of Application Form Annexure II Application form for the post of Medical Non - Specialist ( GDMO ) Consultants from fresh M edical Professionals on full time basis with or without pos t qualification experience on contract basis Registration No: Post applied for Medical Non - Specialist ( GDMO ) Consultants Recent Passport size self - attested Photograph Name: Gender: Father’s / Spouse’s Name: Nationality: Date of Birth: Category: << SC/ ST/ OBC(NCL)/ EWS >> Religion: Address for Communication District: P IN : Permanent Address District: P IN : Mobile No.: e - Mail ID: PAN No. A ADHA R No. Qualification Details (MBBS/ BDS & above) Sl.No. Examination Passed Specialization (if applicable) Year of Passing Name of the Institute Board/ University % of Marks Page(2 /2) of Application Form Experience Details since beginning of the career (Use separate sheet, if required) Sl. No Name of Organization Type of Organization Post held Employee No. From Date To Date Enclosures: The following documents are to be enclosed along with the application form in 2 copies: 1.

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