APPLICATION FORM FOR CONTRACT APPOINTMENT OF DOCTORS ON FIXED PAY “=== —_- Health Department, Government of Khyber Pakhtunkhwa ATTACH Please attach photocopies of: © CNIC ATTACH ¢ Domicile Passport size * All Medical Degrees and Diplomas (MBBS/FCPS/other Specialization) (a Photos) ‘© Completion certificate of House Job ‘* PMC Registration ‘© Experience Certificates/Letters NOTE Important things to note: ‘© Allinformation fields are mandatory; incomplete forms shall not be accepted. If any fields are irrelevant, mark as N/A Please fill up the form in BLOCK letters (Only one position can be applied for by each applicant) Date Position Applied For 14-April-2022 GYNAECOLOGIST First Name Last Name UZMA BAKHTIAR Gender Marital Status Fathers Name ‘Spouse Name BAKHTIAR AHMAD MUHAMMAD KAMRAN Nationality Date of Birth Religion PAKISTANI 1S-APRILA987 ISLAM CNIC No. Domicile 17301-4611778-0 CHARSADDA, Contact Information Residence Phone No. Cell No. 0333-9291918 03159777690 Email Address UBAKHTIAR@YAHOO.COM Permanent Address (For Postal & Communication Please) Country Province PAKISTAN KHYBERPUKHTONKHWA District City PESHAWAR PESHAWAR ‘Address Details 6-D/3 PARK AVENUE ROAD UNIVERSITY TOWN PESHAWAR 1[Page P.T.OEducation (Highest Degree First) Degree Institute «Obtained Grade %4Age Passing Yoar__—_—BoardUniversity Fos HMC 2019 Psp ees KGMC 1260/2000 stv 63% 2010 kMu FSC JINNAH COLLEGE 9890/1100 Al 8090% 2004 BISEP ssc PMs 706/850 AN 8305% 2002 BISEP Professional Information Type Professional Body Number Issue Date Expiry Date Employment History (Most Recent First) 1. Organization Name Designation MSF Medical Doctor Specialist Level 9 Email PhoneNo. Last Salary From To Date Leaving Reason 03425132014 250,000 01-Sep-2019 2. Organization Name Designation HMC Medical Officer Email PhoneNo. Last Salary From To Date Leaving Reason 091-9217140 90,000 M-DEC2018 13012021 EOL 3. Organization Name Designation W.&C Hospital Rajjar Charsadda wMo Email PhoneNo. Last Salary From To Date 93000 19-APRIL2018 10-DEC-2018_ TRANSFERED 4. Organization Name Designation MERLIN wMo Email PhoneNo. Last Salary From To Date Leaving Reason 80,000 Oct2013 FCPS TRAINING 5. Organization Name Designation Email PhoneNo. Last Salary From To Date Leaving Reason Are you currently employed? Please (v) the box Are you currently under any Govt. service? Please (v) the box 21Page Yes % NoO] Yes) No Provide NocCan we approach your current employer? Please (\) the box ves 4 No Do you have any criminal record? Please (1) the box Yes] Noy If yes; please provide details Do any of your relatives/acquaintances currently work in the KP Health Department? Please (9) the box Yes No If yes, please provide details Name Designation Department Dr Sumaira Bakhtiar Consultant LRH Peshawar Languages Read Write ‘Speak English uw uw Zi Urdu w 4 @ Pushto x Y Oo oO Oo References. Name Organization/Department Designation Contact No. _ E-mai DR SHAMSHAD BEGUM HMC Hop 03339965271, dr.shamshadkhan@yahoo.com DR RUKHSANA KARIM HMC Asst Proffessor 0331-9278486 drrukhsanakarim@hotmail.com 1s (if any) Yes] Nom If yes, please specify | certify that the above information is correct to the best of my knowledge. In case of any wrong declaration, wil be liable for any consequences including dismissal without notice. 2 Signature of Applicant: Date: _14-April-2022 3|Page P.T.OFOR OFFICIAL USE ONLY Eligible: 7] Dated: Not Eligible: 7] Interviewed Yes] No[} Called on: Application scrutinized by: Interviewed by: FREQUENTLY ASKED QUESTIONS (FAQs) . 1am interested in applying for more than one position. Do | need to complete a separate application for each position? ‘A. You can only apply for one position and submit one application. Multiple applications will result in a disqualification, Q. Am | required to follow up on my application? ‘A. No, once your application is received and found suitable for the position, you will be contacted by the Department. Q. How | will be informed if short listed? A, Shortlisted candidates will be notified via office letter, and telephone. . Does the Health Department give TA/DA to applicants? ‘A. No TADDA is permissible. 4|Page PLT.