SREE CHITRA TIRUNAL INSTITUTE (Only for office use)

FOR MEDICAL SCIENCES AND TECHNOLOGY

Trivandrum - 695 011, Kerala, India. Roll No. :
(An Institute of National Importance under Govt. of India)

Advt. No. : P&A.II/10/JSSC/SCTIMST/2022 DTD. 23.03.2022

Post Applied for : NURSING OFFICER - A
Vacancy for the Category : ST/SC/OBC/UR Application Registration No. : 0296207889

Name of the Candidate : REMYA K R

Email Address : sandeepremya143@gmail.com

Gender : FEMALE

Date of Birth : 04-JUL-92 ( Age : 29 y 6 m 28 d )

Nationality : INDIAN

State/UT : KERALA

Religion : HINDU

Notified Reservation Category to which you belong : SC

Are you claiming age relaxation other than SC/ST/OBC : NO
Age relaxation details : NOT APPLICABLE

Whether a Permanent Employee of this Institute (SCTIMST) : NO

Employee Code : NOT APPLICABLE
Address for correspondence : PANDARAPARAMBIL
EDAPPAL
KOLOLAMBA
MALAPPURAM
KERALA - 679576

Permanent Address : PANDARAPARAMBIL

EDAPPAL
KOLOLAMBA
MALAPPURAM
KERALA - 679576

Contact Number : Landline - NIL Mobile - 7798465379

Details of Application Fee

Whether fee Concession/Exemption claimed : NO (Admissible only to Women/SC/ST/PWD candidates)

Details of fee Concession/Exemption : NOT APPLICABLE

Drawn on (Bank name) : STATE BANK OF INDIA

Payment Mode : ONLINE PAYMENT

SB Collect Reference No. : DUI8798456 Payment Date : 18/04/2022 Amount Paid : 500/-

20/04/2022 03:52:27 pm Page :1 of 3

www.sctimst.ac.in
Details of Benchmark Disability
Are you a person with benchmark disability? : NO
Disability Category : NOT APPLICABLE
Disability Sub-category : NOT APPLICABLE
Percentage of Disability : NOT APPLICABLE

Father's Name : raveendran

Father's Occupation : daily wages
Father's Address : renjubhavan mannapuzha koonamkara p o r-perunad pathanamthitta
689711

Are you Married? : YES

Spouse's Name : sandheep p p
Are you a Professional Certificate Holder (Medical Graduate/Nurse/Pharmacist etc.) : YES
Registration Details : Reg.No : KL01201402724 Date : 22-JUL-14 State : KERALA

Educational Qualification/Experience
1)A Grade Diploma in Nursing & Midwifery.
2)2 years experience in bedside nursing. OR 2-year Post-Basic Nursing Diploma Course.
3) Registration with Nursing Council.
Desirable: Experience in Cardiac/ Neuro bed side Nursing. Knowledge in computer operation.

Details of Educational Qualifications

Examination Speciality Board/University/Council Duration Date No. of Times Percentage
Passed Concerned /Institution in yrs of Passing Attempted of marks
GNM DIPLOMA NURSING COUNCIL 3.6 1/MAR/2014 1 70

Is the required experience gained AFTER possessing essential qualifications : NOT APPLICABLE

Details of Experience
Address of the Employer Post Held Period From Period To Nature of Job & Remarks
KRISHNA INSTITUTE OF MEDICAL SCIENCE STAFF NURSE 01/01/2016 29/06/2019 GOOD
KARAD PUNE MAHARASHTRA
SHREE SAIBABA HEART INSTITUTE AND STAFF NURSE 12/11/2014 06/12/2015 GOOD
RESEARCH CENTER NASHIK

Declaration
I hereby solemnly and sincerely declare that the statements made and information furnished by me in the
application form are true, complete and correct to the best of my knowledge and belief. In the event of any information
being found false or incomplete or incorrect or ineligibility being detected before or after selection, my candidature will
stand cancelled and all my claims for the recruitment/selection forfeited.

Place :

Date : 20/04/2022 SIGNATURE OF THE CANDIDATE

20/04/2022 03:52:27 pm Page :2 of 3

www.sctimst.ac.in
The candidate should bring the System Generated Application Form and other essential documents at the time of written test/Interview only. No Hard
Copy is required to be sent in advance.

20/04/2022 03:52:27 pm Page :3 of 3

www.sctimst.ac.in