GOVERNMENT OF WEST BENGAL

OFFICE OF THE SUB'DTVISIONAL OFFICER

KURSEONG, DARJEELING
KURSEONG: DAR^IEELING:WB -7 342o3

Memo No. 313/GEN/H/18 Date: 29-O5-2O18

NOTICE FOR ENGAGEMENT OT'ASHA
On behalf of the ASHA Selection Committee, Kurseong Sub-Division,
applications are hereby invited in the prescribed form (Annexure A) from the
piospective and interested candidates for engagement as Accredited Social Health
Activist(ASHA) on purely temporary basis under NRHM for different areas under all the
Health Sub-Centres (attention: Annexure B) under Sukuna BPHC, Kurseong
Development Block under Kurseong Sub-Division, in pursuance of the Memo
No.HFW/NRHM-652/t2llL62 dated 19lO3l2O18 of the Mission Director, National
Health Mission, fkalth & Family Welfare Department, Government of West Bengal.

Date of submission of application from 29-S-2OLA 6 l2'7'2O18.

Time of submission of application from 11:OO a.m. to 3:OO p.m. on all working
days except Saturday, Sunday and other holidays.
Venue of submission of application form - Oflice of the Block Development
Oflicer, Kurseong.
Eligibility criteria for engagement to the post of ASHA:-
I Should be a married/ divorced / widowed woman'
r Should be a permanent resident of the sarne area under the health sub-centre
for which she is aPPlylng.
r As on O1.01.2O18 should be within the age group 30-40 yeal's. In case of SC/ST
candidates, the lower age limit may be relaxed to 22 years. (For all candidates,
born not before 1-1-1978 and not after 2-1.-L987; for SC/ST candidates born
not before 1-1-1978 and not after 2-1-1995)
! Should be Madhyamik or equivalent examination appeared, (either passed or
failed). Candidates possessing frigh.r qualilication are also eligible. However, in
all cases (appeared and faiied or passed or possessing higher qualifrcation) only
the mart<s obtained in Madhyamik or equivalent examination will be
considered.
. Areas where the majority of the population belongs to SC/ST, preference will be
given to candidates from that category, keeping the selection criteria fixed, by
the Sub-Divisional level ASHA Selection Committee'
r preference will be given to Grade I & Grade II SHG Members/trained Dais/Link
workers, keeping the selection criteria fixed'

How to aPPIY:-
prospectivi and interested candidates should frll up prescribed application form
(Annexuie A) in her own hand-writing with blue/black pen and enclose the following
document:-
r Birth Certificate or Admit Card of Madhyamik or equivalent Examination (self
attested photocopy) as proof of age'
Contd.. ..page(2)
 z'. 2 zi

Voters Identity card (EPIC) and Ration Card ( Self attested photocopy) as proof
of local residence.
Marksheet of Madhyamik or equivalent Examination (Self attested photocopy),
even in case of failure in exam.
Self Attested copy of Marriage Registration Certificate in case of married women
or self attested copy of Decree of Divorce in case of Divorced women or self
attested copy of Death Certificate of Husband in case of widow.
In case of above mentioned Certificates are not available, Self Declaration
regarding marital status certified by E.A./Secretar5r and Health Supervisor of
concerned G.P. in Annexure-C.
r Self Attested copy of Death Certificate of Husband for Widowed applicant.
T
If applicable, SC/ST Certificate from competent authority (Self attested
photocopy)
If applicable, in case of Grade I & Grade II SHG Members, certificate from BDO,
Kurseong and in case of trained Dais/Link -workers, certificate from BMOH,
Kurseong at Sukna BPHC has to be submitted alongwith application form.
Two (02) copies of identical Passport size coloured photo, one for application
form and aqpther for Admit Card.
An envelope (Size: 23cm X locm) with postal stamp of Rs 5/- affrxed and the
full postal address of the candidate written on.
The envelope containing the Application Form and enclosures should be
superscripted as "APPLICATION FOR ENGAGEMENT AS ASHA, name of
sub-centre applied for and narne of area-" and should be
addressed to and to be submitted at, preferably by hand or via Speed Post or
Registered Post to:
The Block Development Officer,
Kurseong Development Block.
At Kurseong BDO oflice.
Pankhabari Road, P.O. + P.S. Kurseong
Dist. - DarJeeling, Pin-7 342o,3
I Application by Whatsapp/e-mail/BDO Offrce drop box shall not be entertained.
I Incomplete/erroneous application/un-signed application/application without
any or all of the required documents shall be summarily rejected, and no
consideration in this regard shall be allowed.
I Application received after 3:00 pm on l2-7-2O18 will not be entertained.
T Applications received after due date and time due to postal delay or any other
reason will not be considered.
Interview will be held for the applicants fulfilling all criteria. The notice of date,
time and venue of the interview will be sent to the applicant via post. The
details will also be available at Kurseong Block Office, Sukuna BPHC, all Gram
Panchayat Offices and Health Centres under Kurseong Block.
While applying the applicant should ensure that she fulfills the eligibility &
norrns and that the particulars furnished by her are correct in all respects. In
case it is detected at any stage of selection that applicant does not fulfill any
eligibility norrns and/or that she has furnished any incorrect/fa-lse information
or has suppressed any material fact(s), her candidature will stand cancelled
with no further communication. If any of these shortcomings is/are detected
even after selecLion her engagement is liable to be terminated without assigning
any reason thereof.

Contd. ..page(3)
,i

.. 4D ..
..u..

r The ASHA Selection Committee, Kurseong Sub-Division will draft panel list sub-
centre wise on the composite number of Marks in Madhyamik Examination and
Interview.
r If any candidate fails to appear before the Interview board, her candidature
will be summarily rejected even if she is otherwise eligible and has secured
highest marks.
I Engagement of ASHA is purely on contractual basis and this does not confer
any right/privilege for regular appointment or continuity of service.
r Misconduct on the part of the candidate at any stage of the engagement process
is strictly prohibited & shall render disqualification.
t The applicant shall not possess adverse Crimina-l Record which may render her
unsuitable for the post.
r The original documents (except Self Declaration vrith Certificate by
EA/Secretary and Health Supervisor of concerned Gram Panchayat regarding
marriage and Certificate regarding Grade-I/Grade-II/Trainned Dias/Link
Workers) need not to be submitted.
r The self attested copy of the certificates will be checked/verified during the
interview.
Hence the {ualifred/short listed applicants will be asked to bring the original
documents during interview or consequently for verification of self attested
documents.
General Conditions:

i. Carefully read the instructions mentioned above before applylng. Fill up

Application Form with due care.
2. Help Desk has been set up at the Kurseong BDO Office. Apart from this, the
Gram Panchayats/BPHCs/PHCs/Health Sub Centres under Kurseong
Development Block have been briefed, too. They may be approached.
3. Submission of the application does not guarantee an appointment.
4. In case of any misrepresentation of facts and documents, the applicant shall be
disqualified at any time and at any stage during the process of selection.
Appropriate legal action may be taken against the candidate.
5. The Sub-Divisional Level ASHA Selection Committee reserves the right to alter
the mode of examinations or to conduct re-interview or to cancel part or whole
of any process of engagement including provisions/clauses of this notice or
application at any stage, if required.
6. Biware of touts & job racketeers tryrng to deceive you by false promise(s) of
securing job as "ASHA" either through influence or by use of unfair means.
Please beware of unscrupulous elements and do not fall in their trap. Any
attempt on the part of candidate to be selected by unfair means, request
through persons, officia-ls or agencies etc. will disqualify her candidature.
7. The decision of ASHA Selection Committee, Kurseong will stand frnal.
Enclosed: Annentre A: Application Form.
Annentre B: Area taise ASHA uacancg under different health sub-centres of Sukna BPHC'
Kurseong DeueloPment Block.
Annentre C: Self declaration bg tlrc applicant for ter marital slatus (Married/ Diuorced/Wdout) dulA

Member-
ASHA Selection Cbmmittee
Kurseong Sub-Division
&
Sub-Divisional Officer
Kurseong, Darjeeling
Contd..........Page (4)
 .. 4..

Memo No. 313( 161/GEN/H/ 18 Date:29-O5-2O18

Copy forwarded for information, necessa.ry action to:

l.Smt.ShantaChettri,Hon'bleMemberofParliament(RajyaSabha)and
Chairoerson of the ASHA Selection Committee, Kurseong'
2. The District Magistrate, Darjeeting.
-. ftre envlc), Da-"rjeeling with ieques-l to cause wide publicity at her good office'
4. The ADM(D), oarieeling with request to cause wide publicity at his good off,rce.
5. The ADM( (t-n) & Oistrict Land & Land Reforms Officer, Darjeeling with request to
cause wide publicity at his good ofllce.
6. The Chief Medica.l Officer of Health, Darjeeling.
7. The DIO (NlC), Darjeeling with a request to upload this in district website of Darjeeling
immediately.
S. The DPHNO, Darjeeling with request to cause wide publicity.
9. The DPO(ICDS),-Darjeeling with a request to brief the CDPO (Kurseong Rural) under
his jurisdiction to display same in the office and all the AWCs under his jurisdiction and
to send a certificate to that effect to the undersigned within two days of receiving this
notice.
10.The SDPO, Kurseong with request to cause wide publicity through local P.S. / Out
Post.
11.The Block Development Officer, Kurseong with a request to.briefthe Cram Panchayat
staff accordingly, to advertise the above Notice in Block & Cram Panchayat Office, to set
up a Help Desk for ASHA at the Block Office, to receive applications of ASHA with
proper receipt, to maintain a register for applicants, etc. and to send a certificate to that
effect to the undersigned within two days of receiving this notice.
12.The BMOH, Kurseong at Sukuna BPHC with a request to brief the BPHC/PHC/Health
Sub-centre staff accordingly and to display same in all BPHC/pHC/Health Sub-centre
within his jurisdiction and to send a ceitificate to that effect to the undersigned within
two days of receiving this notice.
13.The-lr Co-ordinator, IT Cell, Swasthya Bhawan, GN-29, sector-v, Salt Lake, Kolkata -
700091 with a request to upload this notification in the website immediatelv.
14.The Sub- Divisional Information & cultural officer, Kurseong ,tiith requesl to
cause wide publicity.
15.The Station Director, Arl India Radio, Kurseong Station with request to cause
wide
publicity.
16. Oflice Notice Board.

Kurseong Sub-Division
&
Sub-Divisional Officer
Kurseon& Darieeling
 'ci

Annexure-A
APPLICATION FORM fOT ASHA-2018
[Please fill the application form in CAPITAL LETTERS in own handwriting
with Black/ Blue ball point pen)
To Paste self attested
For Office Use only
The Member Secretary,ASHA Selection Committee,Kurseong
Received on ....../ ...../201.8 recent colour
& Sub-Divisional Offi cer,Kurseong passport size
Index No:
Darjeeling, West Bengal p hotograph of the
applicant
Roll No: Sub: Application for engagement as ASHA
Ref: Notice Vide Memo No. 313/Gen/H/1'B dated 29.5'201

Name in full:

Date of Birth I I I I Age as on 01.01.2018: ............. Years months

DDMMYYYY
Name of the Sub-Centre applied for:......... ..'...... Area applied for: '..'.......-.

MaritalStatus:(Pleasewrite,.YES,,intheappropriatebox)Married:l_-lDivorced:|---tiaowed:

Husband's name: .................:{

Address: Village .... G.P. """"' P'O'

Distance of house from the Sub-Centre (in metres)

category: sc l--l sr [-l General
f_J
SC/ ST Certificate No [if applicable) Ration Card No......
Details of Madhyamik o uivalent examination:
o/o
of Marks
Name of Year of Board/Council Total Marks Total Marks
Examination Appearance/ ofthe Exam Obtained obtained)
Passing
Iexcluding Iexcluding
additional additional subjecti
subiectl
Madhyamik or
equivalent
Examination

-or
Enclosures: 1-Birth Certificate Admit Card of Madhyamik or equivalent Examination (Self attested photocopy)
2. Voters Identity card (EPIC) and Ration Card (selfattested photocopy)
3. Marksheet and Admii card of Madhyamik or equivalent Examination (Self attested photocopy)
4. Marriage Certificate / Decree of Divorce / Self-Declaration on Marital status (in Annexure-C)
certified by EA/Secretary and
Health Supervisor of concerned Gram Panchayat.
5. If applicable, SC/ST Certificate (Self attested photocopy)
o. tf applicaule, Certificate from appropriate auihority, ln iase of Grade I & Grade Il SHG
Members and trained Dais/Link -workers.
Declaration: I have read carefullythe notice and understood it fully. I do declare that all the statement made on this application are
true, complete and correct to th; best of my knowledge and belief. In the event of being the above information found
false/incorrect at any stage, my candidature is liable io be cancelled forthwith. This is also to certify that I have no criminal record
get for the post'
anywhere and if any criminal iecord is found my candidature will be summarily rejected even I selected
I shall not claim for permanent engagement by
I am fully aware that the engagement is purely iontractual and Temporary and
virtue ofthis in future.

Place :

Date : Full Signature of the APPlicant

 VACANCY OF ASHA IN KURSEONG DEVELOPMENT BLOCK

ANNEXURE. B
SL, NAME OF SUB.
No_
CENTRE
NAME OF VILLAGE/AREA NAME OF G P Vacancy for ASHA

SUKNA
CHOTA ADALPL]R '|

2
KOKLONG F V
1 SUKNA ANAMSH BUSTY 1
SUKNA
CHAMPTA F,V
KHAIRENI F,V
1
PUNOING F V
SIMULBARI T E 3
1

CHUNABHATTI 1
KOTHIDARA
1
KOPCHEY GAON
GHAYABARI .II
2 2, NO, SABIRTI BUSTY
CHUNABHATTI 1
RONGTONG
1

SEPOYDHURA T E 2
SHIVAKHOLA
JTE 2

KOTI.,lIDARA
DURPIN 1

IHALIPAKHA
BIMITAR
1
CHILAUNEY DHUM
PANKHA BARI
CENTRE LINE
SCHOOL
-DARA 1
NAYA GAON
RAMHATTI
NEW LINE
PANKHABARI ST, MARY'S -III

1
MUNSHI GAON
GURDUNG
VELLACOOP 1
5NO 1
HOAPITAL LINE 1
PLAIN LINE
1
GODAMDHURA
34 NO.
'|
KALIKHOLA
 SANKER NIWAS 1

GOLAI PAKHA 1

GAIRY GAON
17th MtLE 1
4 SANKER NIWAS GHAYABARI .II
BHANU GRAM
OLD HOSPITAL & BARAKHOTI 1

RAMGARH
TINDHAREY T.E 1

LAPCHEYKHETI 1

-APCHEYTAR
]HISOPANI 1

THAROGAON
3AIRIGAON 1
GHAYABARI -III
ALEYTOP
N4ANEYKHOP
1

RATNEYDYANG
I\4ARCHEYBONG
JABARHATT 1

PAILADHURA 1

KOTHIDARA GHAYABARI.I
LOWER SIRUBARI(Below poultry
1

LOWER SIRUBARI

rARUA & DAMPHEYTAR 1

RAI GAON 1

DUDHIA 2
MARIONBARI T.E. ST, MARY'S.1II 3
6 DUDHAI
AMRIT BUSTY 1

BAMON POKHARI 1

3ARIDHURA 1

SIPTIGURI SUKNA 1
 TRIVENI CHOWK
GUMBADARA 1

GAIRIGAON
CHETTRI GAON
BOOGTHING DARA
1
12.No.
BIRTALEY TAR
SHIVATAR
SHIVAKHOLA
7 MAHANADI GODAMTAR MAHANADI 1

TERES GAON
5. No
MUNSHI GAON
KOTHIDARA 1

10. No.
KHANI
GHOOMTI T.E. 3
MAHANADI 1

63. LINE 1

RAJBARI
SCHOOL DARA 1

HOTEL GAIRI
GHAYABARI .II
8 RAJBARI CRICKET BAZAR 1

BHANJYANG
1
MITHAIDARA
NAYAKAMAN GHAYABARI -II 1

.b.

3HAYABARI 3
14th MtLE
)AGLAJHORA
GHAYABARI .III 1

I GHAYABARI (ALIMATI 1

SELIM HILL 1

JOGMAYA I
3AGMARA MAHANADI 1

,q
 BORBONG
1
UHANDU BUSTY
1
UIUUHAPAHAR
2
JHUbIKHULA
1

10 GIDDHAPAHAR GOURI SHANKER

GHAYABARI - 2
I
GWALA BUSTY
SAMSHER BUSTY
MANDIR BUATY 1

NAYA BUSTY 1
SIRUBARI BUSTY 1

CHIMNEY
6th MILE 1

SIMANATAR
DEORALI
1
SHAITAYPANI
l1 CHIMNEY CHIMNEY-DEORALI
3rd MILE
KHUNDRUKAY
1
CHITRAY
MAJUA
1
TITENEE
JANGPANA T E MAHANAOI 2

DHAREN GAONG
SUSIL GAONG 1

SIRI GAONG
ST. MARY'S.II
R.VILLA TP CHURCH RD.
BEECH GAONG 1

12 ST. MARY'S LOOP.4

I
i

I
I

I
 KOTHIDHURA
MALIDHURA 1

SULEEKHOLA
NAYADHURA
8Th No. 1

7Th No.
5 DHURAY .II
13 SINGELL ST. MARY'S
4 DHURAY 1

SARKEEDHURA
2No
3 No.
t No. 1

]RECHE PAKHA
(ILLKHAN

LOWER KHAHARAY 1

IVIIDDLE KHAHARAY ST. MARY'S - II 1

GOETHALS 1

SEPOYDHURA 1

14 KHAHARAY LOWER CHAITAYPANI

BHOTE BUSTY ST. MARY'S - I
1

EDEN VELL 1

t.T.l.
'l
TUNG

DARA DHURA
SIMANA DHURA
'l
.AP$ BOTAY
SOOAT.,T DHURA
NAYA DHURA ST. MARY'S.II
KHAMARAY 1
15 RINCHINGTONG
KAIBARI 1

BHATTI KALITAR 1

GAIRI GAONG
PANCHGHARAY AMEOTIA 1

KOTHIPAKHA AMBOTIA PANOU

1

KALIDHURA AMBOTIA
 ,i
SPRING SIDE 1

IHULOPATHLAY 1

SANUPATHLAY
PHUSDHURA 1

H. KOTHI
16 MAKAIBARI THAPATHALI 1
PANOU
CHEPTAY
KAILAPANI 1

SAAT GHOOMTI
KODOBARI
1
PHULBARI
MAKAIBARI 1

]HATTAKPUR
1
JPPER DILARAM
-OWER DILARAM
1
3EECH GAONG
-APCHEY GAONG
BHOTAY GAONG 1

LOCATION
17 DILARAM ARINGALAY ST. MARY'S.I
1
GAIRI GAONG
M1AHARANI T.E, 1

BELOW ARINGALAY
BELOW GAIRI GAONG 1

SELOW TUNG
BELITAR
1
FAZI

BASSURI I
,l

BASSURII 1

GODAM DHURA
SCHOOL DARA 1

DHOBIKHOLA GAON
HASPOKHARI
DABAIKHETI 1
18 AMBOTIA PANDU
KUMALTAR GAON
IAR GAON
1
JAGSING GAON
U/ SIRISEY
1
U SIRISEY
SIGN BOARD 1

.ALMATI 1

\
SITTONG - II
 KARMAT F.V 1

45/3 DHURA
GANDHI GRAM
1
RASIK/ MEROJ
PRAVAT TOLE
]HOBI DHURA
(OTHI DHURA 1

SITTONG F. V
22 LATPANCHAR srTToNG - ill
JHOLEY F.V 1

1
48 DHURA
GANESH DHURAJs ACRE 1

72 DHUM
MILAN DHUM
1
12 DHURA
SUMBA DHURA
in n,trre r v 'l

GODOWN DHURA 1

GAIRI GAON
)ANGRAY KHOLA 1

1
DAKBUNGLOW SHIVAKHOLA
1
FAGUTAR
23 MALOOTAR
UPPER SIMRING 1

SIMRING BUSTY
1
SHIVAKHOLA 5 NO.

GITANGEY MAHANADI 1

MAHALDIRAM T.E SITTONG.II 1

t
zOTh MILE 1

1
KANDUNG
UPPER LANKU 1

24 LANKU LOWER LANKU SITTONG.III

,|
JPPER ROLAK
TOWER ROLAK 1

I\iIIDDLE ROLAK 1

nU \t
 Annexure-C

Self {eclar.ation by the applicanI tor her marital statusf Married/Divorced/Witlow).

I Smt D/O, W/O

presently residing at

(area) under (sub centre).

have applied myself for the post of Asha for

I hereby declare that:-

l. I am aresident of

2. I am married to Shri S/o

resident of
,,'

for the last vears.

oR.

3. I am widow of late S/o

resident of who expired on

OR

4. I am separated frorn my husband Shri

for the last years.

S/o

giving the above declaration'

This is true to the best of my knowledge and belief and I have not suppressed any facts while

Date:-

Place:-
Full Signature of the aPPlicant.

true to the best of my

This is to certify that the above mentioned information has been verified and it is
knowledge.

Signature of the Health Supervisor

Signature of Executive Assistant / Secretary
Gram PanchaYat Gram Panchayat

Seal Seal of the Gram PanchaYat