Government of Rajasthan

Dr. S.N. Medical Collage & Associated Group of Hospital Jodhpur

NURSE GRADE-II (UTB)
Form Number: 211705073783

(Student Copy)

A. PERSONAL DETAILS
1. Name of Candidate:-     Dr Preeti Chouhan

2. Father's Name:-     Pyarelal Thakur

3. Date of Birth:-     1988-09-28

4. Age:-     33 Years

5. Category:- UR

6. Sub-Category:- Not Applicable

7. Gender:- Female

8. Tehsil:- Jodhpur

9. District:- Jodhpur

10. Address (Permanent):- 193 aartinagar near ashapurna city pal road jodhpur

11. Contact Number:- 7976805561

12. Email:- 23preetithakur@gmail.com

13. Aadhar Number:- 884176692618

14. Marital Status:- Married

15. Number of Children:- 0

B. PROFESSIONAL QUALIFICATION

Professional Qualification:- BSC     INC/RNC Reg No:- RN-85847RM-76629     Valid Upto:- 2024-12-31

C. EDUCATIONAL QUALIFICATIONS

  Obtained Percentage
S.N. Course/Degree Univ/Board Max Marks
 Year  Marks (%)
Board of secondary education ,
1. Secondary (X) 2003 500 345 69.00
Madhyapradesh Bhopal M.P
Board of secondary education
2. Senior Secondary (XII) 2005 450 376 83.56
Madhyapradesh Bhopal
BSC (Nursing)
Govt colg of nursing /Devi ahilya
3. 2009 2200 1434 65.18
(Fill Total of All 4 Years) University Indore
4. M.Sc. Nursing 2012 Barkatullah University Bhopal M.P 1300 949 73.00
RSCIT/Recognized Diploma in National institute of electronics and
5. 2018 100 70 70.00
Computer information technology ( NIELIT)

D. UNDERTAKING
(1.) All the information filled by me is correct and I will produce all the original documents along with attested copy during my
Document Verification, failing which my candidature at any time will be treated cancelled.
(2) I declare that i have filled only one
application form, if any duplicate form is filled by me, my candiature will be trated cancelled.

Date: 2022-06-07 21:17:05