BHARAT PETROLEUM CORPORATION LTD

Mumbai Refinery
Application No.
(For office use)
Affix recent
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APPLICATION FORMAT FOR MALE NURSE (GRADE-!
[ Put a tick ( ) mark in the appropriate box ]
1. P"#$ a%%&ie' f"r MALE NURSE ( GRADE -
2.
Name "f $)e *an'i'a$e
(In B&"*+ &e$$er#!
3.
Se,- Male / Feale
!. Mari$a& S$a$u#- Marrie" / #narrie"
$.
a! A.e (/r#0 C"m%&e$e'!
a# "n 1231435126 %
b!Da$e Of Bir$) && MM ''''
(. Fa$)er7# name -
). a! D"mi*i&e S$a$e - M"$)er T"n.ue -
b! Ca$e."ry (Pu$ a (! $i*+ mar+ in $)e a%%r"%ria$e b",!
x
*+N
,-C
(N"n-*reamy &ayer!
.C ./ P0& ,1 / 21
Percentage of
&isa3ilit4%
5. C"rre#%"n'en*e A''re##- 6. Permanen$ A''re##-
.tate .tate
Pin Co"e Pin Co"e
17. Nearest 8ail9a4 .tation
11.
C"n$a*$ N"03
M"bi&e N"0
12 e-mai& ID
28. 9UALIFICATION DETAILS (Pu$ a (! $i*+ mar+ in $)e a%%r"%ria$e b",!
2802
B0S* Nur#in. (25
TH
S*i : 6 year#! - /ES 3 NO
C"m%u$er ; Me'i*ine In<en$"ry; E=ui%men$
Han'&in.; P)arma*y; Lab"ra$"ry Te*)ni*ian
>"r+ ? @ ( Ray Te*)ni*ian >"r+ - /ES 3 NO
FULL TIME PART TIME CORRESPONDENCE
2805
PERCENTAGE -AAAAAAAAAAAAAAAAAAA
(Please attach photocopies of all Mar:lists/certificates)
2
ST
CLASS 5
ND
CLASS
2808 INSTITUTE NAME- UNIBERSIT/ 3BOARD-
2806 ENGINEERING GRADUATION LICE B0E3 B0TECH 3 AMIE ETC0 ; C,MP<+/+& / ./#&'=N* / N,/ APP<=CA-<+
2804
AN/ OTHER CERTIFICATE 3 9UALIFICATIONS-
260 /EARS OF E@PERIENCE (AS ON 1201405126!-
==.Previous Experience (=n chronological or"er) > (Attach proof )
Nae of ,rganisation Posts hel"
&uration (exact "ates to 3e gi?en) =n"ustr4
Fro /o
Please specif4 9hether refining/
petroleu/ cheical/petrocheical/
fertilizer in"ustr4@ etc

= here34 "eclare that all the stateents a"e in this application are true an" coplete to the 3est of 4 :no9le"ge. =f at an4 stage of the selection
process@ the a3o?e stateents are foun" to 3e false or incoplete@ = un"erstan" that 4 can"i"ature 9ill stan" cancelle".
Da$e - AAAAAAAAAAAAAAAAAAAA Si.na$ure - AAAAAAAAAAAAAAAAAAAAAAAAAAA
A$$a*) %)"$"*"%ie# "f *er$ifi*a$e# men$i"ne' ab"<e an' any "$)er $e#$im"nia&# in y"ur %"##e##i"n#
T)"#e em%&"ye' in G"<$0 De%$0 3 Pub&i* Se*$"r Un'er$a+in.# #)"u&' a%%&y $)r"u.) %r"%er *)anne&0
In$ere#$e' *an'i'a$e# may #ubmi$ $)eir a%%&i*a$i"n# by %"#$ a&"n. Di$) 5 &a$e#$ %a##%"r$ #iEe %)"$".ra%)#; .i<in. a&& %er#"na& 'e$ai&#
Di$) $e#$im"nia&# an' #u%%"r$in. '"*umen$#; in #ea&e' en<e&"%e #u%er#*ribe' Di$) (P"#$ ( MALE NURSE (GR-! $"F
SR0 MANAGER (ER!; BHARAT PETROLEUM CORPORATION LTD0; MUMBAI REFINER/; MAHUL ; MUMBAI ( 611 1G60
LAST DATE FOR RECEIPT OF COMPLETED APPLICATION IS 2H01405126