Online Registration and Application Form

Six-Month Bridge Program (Certificate) in Community Health Under State Health Society,
National Health Mission, Uttar Pradesh

Application No.: SAMSUPNHM0027485

Post Applied for: Community Health Officers
Candidate's Name: Mr. Vikram Singh Kharwal
Father's/ Husband's Name: NARAYAN SINGH KHARWAL
Gender: MALE
Date of Birth (DD/MM/YY): 07-May-1992
Mobile Number: 7023620215
Alternate Number:
Email ID: vikramsinghkharwal74485@gmail.com
Are you fall in the category of differently abled? NO
Category: OBC
Domicile State: Rajasthan
Domicile District: SAWAI MADHOPUR
Preference:

2. Address:

Correspondence/ Current Address with Pin Code: Permanent Address with Pin Code:
VILLAGE DAULATPUR POST UDAI KALAN TEH GANGAPUR VILLAGE DAULATPUR POST UDAI KALAN TEH GANGAPUR
CITY 322201 CITY 322201

3. Educational Qualification Details:

Essential Qualification*

Name of the Degree/ Passing Marks (in

Name of University/ Institute Mode Of Course
Diploma Year %)
B.Sc. Nursing RUHS JAIPUR Full Time MAR-2016 69.82

Other Qualifications

Name of the Degree/ Specialization & Name of University/ Passing Marks (in
Mode Of Course
Diploma Principal Subjects Institute Year %)
10th ALL SUBJECT BSER AJMER Full Time JUL-2009 60.33
12th PCB BSER AJMER Full Time MAY-2011 60.92

4. Work Experience:

Key Ares of Experience &

Name of Organisation Designation / Title Experience Duration
Job Responsibilities

Declaration by Candidate: I hereby declare that the information furnished above is true to the best of my knowledge
and any misrepresentation, falsification or omission of information used to secure employment shall be grounds for
rejection of this application and I would liable for legal action, also immediate discharge if I am employed by NHM, UP
regardless of the time elapsed before discovery.

Date: 18-May-2019