Application Form For Employment In Echs
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4APPLICATION FORM FOR EMPLOYMENT IN ECHS
POST APPLIED FOR_________________________________
Name of Polyclinics applied for__________________________
Affix recent
1.
Name
__________________________________
passport size
photographs
(If Ex-serviceman No _______________ Rank________
Arms/Service ____________ Unit last served_________
2.
Date of birth __________________________________
3.
Sex: M/F
__________________________________
4.
Postal Address_________________________________
_____________________________________________
Pin_____________Mob No__________________ E-mail ID_______________
5.
Education Qualification (Phtocopies duly attested to be attached)
Qualification
Year of
Place of
No of
% marks
Passing
Passing
Attempts
(a)
(b)
(c)
(d)
(e)
6.
Work experience(Experience certificate must be attached for consideration)
Place of work/Hospital
Period of Employment Reason for leaving to Job
7.
Registration No and date of registration with Indian/State Medical Council
____________________ (Photocopy of registration to be attached).
8.
Honours and Awards(Professional & Service)
9.
Details of previous service in Army/Central/State Govt (Photocopy of ESM PPO
& Discharge book to be attached duly attested).
10.
Total pd of serving (including SSC if any)_________________________
11.
Details of Previous service if any with ECHS and reason for termination
_____________________________________________
DECLARATION
1.
I hereby solemnly declare that all the statement made in the above application
are true and correct to be best of my knowledge and belief.
2.
I fully understand and that in the events of any information furnished being found
false or incorrect, action can be taken against me.
Place :___________________
Signature___________________
Date :___________________
Name of applicant____________
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