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    Application Form Rev

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    Chetan
    1) The document is an application form for a position at the Government Dental College & Research Institute in Bangalore. 2) It requests information such as the applicant's name, date of birth, qualifications, experience, publications, and certifications. 3) If selected, the applicant agrees that any concealed or incorrect information provided could result in termination without notice or compensation.

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    Application Form Rev

    Uploaded by

    Chetan
    21 views2 pages
    1) The document is an application form for a position at the Government Dental College & Research Institute in Bangalore. 2) It requests information such as the applicant's name, date of birth, qualifications, experience, publications, and certifications. 3) If selected, the applicant agrees that any concealed or incorrect information provided could result in termination without notice or compensation.

    Original Description:

    Government Dental Collage Application

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    1) The document is an application form for a position at the Government Dental College & Research Institute in Bangalore. 2) It requests information such as the applicant's name, date of birth, qualifications, experience, publications, and certifications. 3) If selected, the applicant agrees that any concealed or incorrect information provided could result in termination without notice or compensation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    21 views2 pages

    Application Form Rev

    Uploaded by

    Chetan
    1) The document is an application form for a position at the Government Dental College & Research Institute in Bangalore. 2) It requests information such as the applicant's name, date of birth, qualifications, experience, publications, and certifications. 3) If selected, the applicant agrees that any concealed or incorrect information provided could result in termination without notice or compensation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    GOVERNMENT DENTAL COLLEGE & RESEARCH INSTITUTE,

    BANGALORE
    APPLICATION FORM FOR THE POST OF
    Notification No.:

    1
    2
    3
    4
    5
    6

    8
    9
    10
    11

    12
    13
    Sl.
    No.

    Name of candidate (in capital letters)


    Name of Father/Mother/Husband
    Date of Birth as recorded in the SSLC
    Certificate
    Qualification (Subject)
    Sex
    Category, SC/ST, Cat-I/IIA/IIB/IIIA/IIIB
    Specify with Certificate along with respective
    Horizontal reservation
    Whether the candidate belong to Hyderabad Yes/No
    Karnataka local region (Bidar, Gulburaga,
    Bellary, Koppal, Raichur and Yadgir)? if so,
    furnish the relevent Certificate issued by the
    competent authority
    Nationality
    Postal Address for Correspondence (Mobile
    No., E-mail I.D., if any, can also be given)
    Studied Kannada as 1st /2nd language
    Particulars of Registration with State Dental
    Council to be furnished along with PG
    registration date
    Details of D.D. drawn (Name of the Bank,
    Branch, Amount & date)
    Details of the Qualifications :
    Qualification

    Marks/
    Grade etc

    Percentage

    Name of the College & University & year of


    passing

    14
    15

    Higher
    Qualification
    Experience
    Designation

    Period
    (DD/MM/YYYY)

    From

    To

    Total
    no. of
    years

    Name of the College & University

    Assistant Professor/
    Lecturer
    Dental Health Officer

    16. Present Employment


    if any
    17. WHO Fellow ship in
    the same subject/
    University Gold Medal
    18. Number of
    Publications in
    National/Indexed
    Journals
    19. Number of
    Publication in
    International Journals
    20.
    Presentation
    of
    Papers/Lectures
    in
    State/National/Internatio
    nal Conferences

    I certify that Information furnished above is correct and complete to the best of my
    knowledge and nothing has been concealed. If I am found to have furnished
    concealed/distorted/factually incorrect information, my appointment shall be liable to
    termination without notice/compensation.
    Place:
    Date:

    Signature of the Candidate

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