Online Recruitment Applicant Form

ONLINE APPLICATION FOR COMPULSORY 1 YEAR RURAL POSTING
UNDER NHM, ASSAM

The fields, which are marked with asterisk (*) are mandatory fields.

*Post Applied for

*Name of Applicant

*Father's Name/Guardian's Name

Address for Communication

*Vill/Town:

*Post Office:

*District:

Enter District Name

*Enter District Name:

*PIN:

*Mobile No

*E-Mail ID

*Date of Birth (As per Matriculation Cerftificate)

*Name of Medical College from where MBBS Course passed :

*Year of passing MBBS Course :

*Details of Marks in the MBBS Course

1st MBBS 2nd MBBS Final MBBS (Part 1+Part2)

Total Marks Marks Obtained Percentage Total Marks Marks Obtained Percentage Total Marks Marks Obtained Percentage

*AMC Registration No.:

Whether interested to serve in difficult area : Yes No

*Upload Passport size Photo (Max file size 50 KB, Only .jpg/.gif/.png format allowed)

*Upload ID Proof (Max file size 1 MB, Only .jpg/.gif/.png/.pdf format allowed)

*Upload AMC/MCI Regd Certificate (Max file size 1 MB, Only .jpg/.gif/.png/.pdf format allowed)

*Upload Internship Completion Certificate (Max file size 1 MB, Only .jpg/.gif/.png/.pdf format allowed)

*Upload Marksheet 1 (Max file size 1 MB, Only .jpg/.gif/.png/.pdf format allowed)

*Upload Marksheet 2 (Max file size 1 MB, Only .jpg/.gif/.png/.pdf format allowed)

*Upload Marksheet 3 (Max file size 1 MB, Only .jpg/.gif/.png/.pdf format allowed)

*Upload Marksheet 4 (Max file size 1 MB, Only .jpg/.gif/.png/.pdf format allowed)

*Upload Any Other Document (Max file size 1 MB, Only .jpg/.gif/.png/.pdf format allowed)

***In case of multiple marksheets in a single year, please include those marksheets in a single pdf file.

Declaration

I hereby declare that all statements made in this 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 or incorrect at any stage of my not satisfying any of the eligibility criteria stipulated, my candidature is liable to be cancelled.




The fields, which are marked with asterisk (*) are mandatory fields.
*Post Applied for
*Name of Applicant
*Father's Name/Guardian's Name

*Name of Medical College from where MBBS Course passed :
*Year of passing MBBS Course :

Declaration
I hereby declare that all statements made in this 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 or incorrect at any stage of my not satisfying any of the eligibility criteria stipulated, my candidature is liable to be cancelled.