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  • Father's Name: Indira Gandhi Institute of Medical Sciences: Sheikhpura: Patna-14

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    Jeshi
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    This document is a proforma or application form for the post of Senior Resident at the Indira Gandhi Institute of Medical Sciences in Patna, Bihar. It requests information such as the applicant's name, father's name, date of birth, educational qualifications including medical degrees and percentages, work experience, any special training, and current employment status. The applicant is asked to provide details of their registration with the MCI or State Medical Council, caste or disability status if applicable, addresses, contact information, teaching experience since obtaining an MD/MS/MDS, and to attach documents like certificates, caste or disability certificates, and a bank draft as proof of application fees.

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    Original Title

    igimsp

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    This document is a proforma or application form for the post of Senior Resident at the Indira Gandhi Institute of Medical Sciences in Patna, Bihar. It requests information such as the applicant's name, father's name, date of birth, educational qualifications including medical degrees and percentages, work experience, any special training, and current employment status. The applicant is asked to provide details of their registration with the MCI or State Medical Council, caste or disability status if applicable, addresses, contact information, teaching experience since obtaining an MD/MS/MDS, and to attach documents like certificates, caste or disability certificates, and a bank draft as proof of application fees.

    Copyright:

    © All Rights Reserved
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    15 views1 page

    Father's Name: Indira Gandhi Institute of Medical Sciences: Sheikhpura: Patna-14

    Uploaded by

    Jeshi
    This document is a proforma or application form for the post of Senior Resident at the Indira Gandhi Institute of Medical Sciences in Patna, Bihar. It requests information such as the applicant's name, father's name, date of birth, educational qualifications including medical degrees and percentages, work experience, any special training, and current employment status. The applicant is asked to provide details of their registration with the MCI or State Medical Council, caste or disability status if applicable, addresses, contact information, teaching experience since obtaining an MD/MS/MDS, and to attach documents like certificates, caste or disability certificates, and a bank draft as proof of application fees.

    Copyright:

    © All Rights Reserved
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    of 1

    INDIRA GANDHI INSTITUTE OF MEDICAL SCIENCES: SHEIKHPURA: PATNA-14

    PROFORMA FOR THE POST OF SENIOR RESIDENT

    1.

    Advertisement No.

    : Adv. No. 07/Sr. Resident/IGIMS/Estt./2015

    2.

    Name of the Post &

    Department applied for:

    Name of the Applicant

    3.

    & Registration Number

    Reg. No.

    (MCI/State Medical Council)

    Affix your recent


    Photograph

    Dated:

    4.

    Fathers Name

    5.
    6.

    Date of Birth (With Proof of Age)


    & Age on cut-off date.
    Whether belongs to SC/ST/EBC

    7.

    Permanent Address

    8.

    Address for Correspondence

    9.
    10.

    Contact Number (Mobile/Land Line) :


    Educational Qualification: Starting from MBBS

    :
    D/O/B:

    Date:

    Month:

    Year:

    Age:

    Yrs.

    ....Months

    Days

    (MBC), BC, BC- (Female) or Handicapped: .........................................Cast Certificate


    issued by the Circle Officer of respective District/Circle for SC/ST candidates along-with Domicile Certificate and Caste Certificate issued by
    Circle Officer for EBC (MBC) and BC candidates with exemption of Creamy Layer, along-with Domicile Certificate should be attached).

    Particular of Qualification

    Marks Obtained

    Percentage of Marks

    Attempt

    Teaching or working Experience, if acquired after obtaining MD/MS/MDS Degree (Attach all Certificates: Photocopy)

    11

    Name of the Institution

    Posted as

    From

    Special Training in the specialty (if any)

    To

    NAME OF THE DEPARTMENT IN CHRONOGICAL ORDER, IF APPLICATIONS ARE FILLED UP IN MORE THAN ONE DEPARTMENT

    12
    1

    ST

    13. Status of Employment:

    14

    (Attach all Certificates: Photocopy)

    Year of
    Passing

    Board/Univ.

    nd

    ..

    rd

    3 ..

    th

    4 .

    CANDIDATE ALREADY EMPLOYED SHOULD GET THE FOLLOWING ENDORSEMENT SIGNED BY HIS/HER PRESENT EMPLOYER

    DatedSignature Designation .
    Details of Bank Draft with Date of issue, Place and Amount

    15

    Name of the issuing Bank

    Place & Date

    D.D. No.

    Amount

    List of Enclosures

    Place:
    Date:
    Signature of the Applicant

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