CENTRAL MEDICAL SERVICES SOCIETY

(An Autonomous Body under Ministry of Health & Family Welfare, Govt. of India)
2nd Floor, Vishwa Yuvak Kendra, Teen Murti Marg, Chanakyapuri, New Delhi-110021
Phone: 011-21410905/6 Website: www.cmss.gov.in
Advt. No.: CMSS/AN/015/ dated 03-07-2024
Application for the post of: ______________________________________________
[Please read General Terms & conditions before filling up the application.]
Application No.:
(For office use only) Affix A Recent
Passport Size
Bank details for Application Fee of Rs.100.00 Photograph Duly
i. Bank Draft No: _______________________ Date:_____________________ Signed by
ii. Payable at :______________________________________________________ the Candidate
iii. In case Application Fee remitted online, please provide Transaction
Reference No.:____________________________Date:___________________

Name of the post applied for (As in advertisement) :

01. Full Name (in capital letters)
[as stated in 10th standard marks sheet]
02. Father’s Name

03. Marital Status

(Spouse Name)
04. Date of birth (DD/MM/YYYY)
[As stated in 10th standard marks sheet]
Age as on 16.08.2024
05. Address for correspondence with PIN code, E-mail &
Contact no.
(Email ID and Mobile Nos. are mandatory)

Email ID:
Alternate Email ID:
Mobile No:
Alternate Mobile No:
06. Permanent address
[Candidates to mention Email ID, Mobile/landline
number]
[If permanent address is the same as correspondence write
‘Same as Correspondence Address’] Email ID:
Mobile No:
07. Religion
08. Nationality
09. Gender (Male/Female/TG)

10. Category (SC /ST/OBC/Gen/ Ex-Serviceman/PwD)

11. Whether any criminal case/ disciplinary/ vigilance case

pending against you? If YES please give details in separate
sheets.
12. Whether you were convicted by any court at any time in
your life? If YES please give details in separate sheets.
13. Have you ever filed any case against any Government
body/ Autonomous Bodies/ PSU’s & Private Sector. If
YES please give details in separate sheets.

6
14. Whether any financial liabilities / any other obligations are
pending with previous / present employer? If YES please
give details in separate sheets.
15. Whether you have any conflict of interest with or
pecuniary interest that you could derive by working in this
assignment with Government of India. If YES please give
details in separate sheets.

16. Educational & Professional Qualification

Examination Name of the Board/ Duration Year of % of Division/ Subjects / Stream
Passed University of Degree/ Passing Marks / Class
Diploma CGPA

10th Standard
/ Equivalent

12th Standard
/ Equivalent

Graduation

Post-
Graduation

Any Others

17. Details of Employment and Experience in reverse chronological order (Attach self-attested copies of
Certificates with details of job description/TOR/ Appointment letter mentioning the job profile meeting the Column
-7 of Recruitment Rules of the post.)
Department/ Post held Government Regular/ Period of Duration Gross
Institute/ Office / Private Permanent employment (Years, Salary per
Sector / Contract From To Months & Month
Days)
dd/mm/yy dd/mm/yy

7
 18. Name and Address of Reference
(References should be familiar with your academic / professional / work and should not be relatives)
I. Name
Designation
Postal address
Phone Number & Email ID
II. Name
Designation
Postal address
Phone Number & Email ID
III. Name
Designation
Postal address
Phone Number & Email ID

19. Details of Enclosures: Candidate should attach proof of application fee DD/NEFT details, self-attested copies of
qualification & experience. If space is not sufficient, attach separate sheet in the format given below):
Sl. Description/ Details of enclosures Page No.

20. I hereby declare that I fully meet the eligibility requirement mentioned at Sr. Nos. 6 & 7 of the Recruitment
Rule of the Post & attached all the documents above at (Sr. No. 19: Details of Enclosures) in support of
meeting the minimum eligibility of the applied post (i.e., Age, Educational qualification & Past Experience
requirement).
DECLARATION

1) I hereby declare that I have carefully read and understood the ‘General Terms & Conditions’ and that all the entries
in this form are true to the best of my knowledge and belief.
2) I have enclosed the demand draft No:………………………………. Dated.……./……./……..
of ……………………………………………. bank in favour of “CENTRAL MEDICAL SERVICES SOCIETY”
payable at NEW DELHI / Enclosed the UTR./NEFT Transaction ref. details
……………………………………dated……./……./……..of ..……………………………………………. bank.
3) I undertake to submit the original documentary proof in respect of educational qualifications, working experience,
date of birth, address and all other documents submitted by me as and when asked.
4) If detained, convicted, debarred etc. subsequent to the completion and submission of the form, the details will be
communicated immediately to CMSS, H.Q, failing which it will be deemed to be suppression of factual
information.
5) I also declare that I have not concealed any material information that may debar my candidature for the post applied
for and I am fulfilling the eligibility conditions. I have also gone through the recruitment rules for the post and as
per RR I am eligible for the post. In the event of suppression or distortion of any fact in my application form, I
understand that I will be denied any employment in the organization and if already employed on any of the posts in
the organization; my services will be terminated forthwith.

Place:
Date:

Name and
Signature of the Applicant
8
 GENERAL TERMS & CONDITIONS

Instruction for filling of application

1.1 All the columns are compulsory. If any column is not applicable or no information is there to be
furnished write ‘Not applicable’ or ‘N/A’. Any other answers will render the application invalid.

1.2 Incomplete/invalid application: If any column is left unfilled, such an application will be treated as
incomplete/invalid and will be rejected summarily.

1.3 Instructions are provided below for each column in the application. Please read the instructions before
filling the application.

1.4 TA/DA:- Outstation Applicants will g e t reimbursement of rail fare (upto a maximum of AC 3 Tier
Class rail fare, by shortest route, from the railway station nearest to their address as cited in the
application to New Delhi Railway Station/ Delhi Division and back) on submission of the tickets. The
payment shall be made through RTGS in due course of time. For the purpose, the candidate(s) are
required to submit duly filled TA form which will be made available on the day of selection test.

1.5 Application Fee: Applicants shall be required to pay application fee of Rs. 100.00 (Rupees One
Hundred Only) by demand draft in favour of “CENTRAL MEDICAL SERVICES SOCIETY”
Payable at New Delhi OR by online payment / NEFT as per below mentioned accounts details: -

[ Female, SC/ST, PwD & Ex-serviceman category applicants need not pay any application fee.]

Note: The fees once paid shall not be refunded or re-adjusted under any circumstances.

NAME OF ACCOUNT CENTRAL MEDICAL SERVICES SOCIETY

BANK NAME STATE BANK OF INDIA
BRANCH NAME WITH ADDRESS NIRMAN BHAWAN, MAULANA AZAD ROAD,
NEW DELHI-110011
BANK ACCOUNT NUMBER 32719062216
IFSC CODE SBIN0000583
MICR CODE 110002092

Column Description Instructions

No.
--- Photo Affix a self-attested recent passport size photograph
--- Name of the post applied Should be exactly as stated in the Advertisement.
Do not write Post No. or anything else.
01. Full Name Name As stated in SSLC/10th standard certificate. If the name has
been changed, enclose a self-attested copy of document of name
change without fail.
02. Father’s Name Father’s Name as stated in 10th standard certificate.
03. Marital Status State whether married/ unmarried. If yes, mention the spouse’s
(Spouse Name) name.
04. Date of birth As mentioned in SSLC/10th standard certificate.
05. Address for correspondence Please write complete postal address with PIN Code.
Please note that the CMSS will not accept change of address, even if
communicated, after tendering the application. In case you change
the address after tendering the application, please make your own
arrangements with concerned person/authorities for
redirecting/receiving the communication to your new address.
Please mention E-mail Id & Mobile No.
06. Permanent address Please write complete postal address with PIN Code.
If this address is the same as that of correspondence address for
communication, you may state ‘Same as correspondence address.
07. Religion Please state the religion.
08. Nationality Please state Nationality.
09. Gender Please Mention
9
10. Category Please write the category.
11. Whether any criminal case/ If YES please give details in separate sheets.
disciplinary/ vigilance case
pending against you?
12. Whether you were convicted If YES please give details in separate sheets
by any court at any time in
your life?
13. Have you ever filed any case If YES please give details in separate sheets.
against any Government body/
Autonomous Bodies/ PSU’s &
Private Sector.
14. Whether any financial If YES please give details in separate sheets.
liabilities / any other
obligations are pending with
previous / present employer?
15. Whether you have any conflict If YES please give details in separate sheets.
of interest with or pecuniary
interest that you could derive
by working in this assignment
with Government of India.
16. Essential educational, Essential qualification: Please note that holding the essential
professional, and technical qualification is a must.
qualifications The application of a candidate not having essential qualification will
be summarily rejected even if such a candidate possesses one or
more higher qualifications
17. Details of employment and If the advertisement prescribes possession of employment or
experience experience, details should be furnished in this column.
Please provide complete information and attach self-attested copies
of certificates.
Essential Educational Qualification and Experience.
Please note that post qualification experience certificate/terms of
reference/appointment letter/ published RR/ job description for
the post held to see if applicant meets the requirement. Any of
these must be attached as a proof.
Please attach self-attested copy of relieving certificate of the past
employer with your application form.
18. Reference References should be familiar with your academic / professional /
work and should not be relatives.
19. Details of enclosure Please write the details of enclosures in the order in which they are
attached. Serially number the enclosures.
20 Declaration Candidate to sign the declaration with date and fill up all the details
as mentioned in declaration. If any candidate did not sign the
declaration, then the application will be summarily rejected.
21. Address for forwarding Candidates are advised to submit their application along with all
application supporting documents pertaining to age, educational qualification,
experience etc. and envelop should be superscribed on
the top as “APPLICATION FOR THE POST OF
……………………………………………………………………….
AGAINST ADVT. No. CMSS/AN/015/ dated 03.07.2024” to the
address: -
Administrative Officer, Central Medical Services Society, 2nd
Floor, Vishwa Yuvak Kendra, Teen Murti Marg, Chanakyapuri,
New Delhi-110021.
The last date of receipt of application is 16.08.2024. No application
will be received after 5.30 PM. on closing date.

10
 2. GENERAL TERMS & CONDITIONS
i) It shall be the responsibility of the candidate to ascertain his/her own eligibility for the post for which
he/she is applying in accordance with the prescribed qualifications, experience, etc., and submit his/her
application duly filled-in, along with the desired information and documents as per the advertisement.
ii) Suppression of factual information, supply of fake documents, providing false or misleading
information or canvassing in any manner on the part of the candidates shall lead to his/her
disqualification. In case, it is detected at any point of time in future, even after appointment, that the
candidate was not eligible, his/her appointment shall be liable to termination forthwith.
iii) The date of birth is acceptable only as mentioned in the SSC/ Matriculation certificate issued by the
concerned educational board / university
iv) The date for determining the age of applicants shall be the closing date of receipt of applications.
v) Candidate who is already in Central / State Government / PSU/ Autonomous Institution services shall
submit a "No Objection Certificate” at the time of selection test.
vi) Certificates in support of experience should be in proper format ie., it should be on the organization's
letter head mentioning date of issue, period of experience, gross salary and the name and designation of
the issuing authority along with signature and date.
vii) CMSS shall verify the antecedents submitted by the applicant at any time of appointment or during the
service. If it is detected at any stage that the information given in the application is incorrect / false then
the candidature / appointment shall be summarily cancelled / terminated.
viii) In case of any ambiguity pertaining to the eligibility criteria for the post, or during the entire process of
recruitment, the decision of the Competent Authority of the CMSS shall be final. No correspondence
will be entertained in this connection from any individual (s) representatives.
ix) The selection will be based on selection test as prescribed by CMSS.
x) Any information related to the advertisement shall be displayed in the CMSS Website
(www.cmss.gov.in) only. Applicants are advised to visit the website regularly.
xi) CMSS reserves the right to rectify any discrepancy in the advertisement, if found later, as well as to
modify / cancel any communication made to the candidate.
xii) CMSS also reserves the right to withdraw the advertisement, either partly or wholly, at any time
without assigning any reason.
xiii) Any issue not covered in the instruction shall be decided by the Competent Authority of the CMSS and
the decision shall be final and binding on all applicants.
xiv) Application Form is available in the website www.cmss.gov.in for download and use.
xv) Candidates are advised to submit their application along with all supporting documents pertaining to
age, educational qualifications, experience etc. to Administrative Officer, Central Medical Services
Society, 2nd Floor, Vishwa Yuvak Kendra, Teen Murti Marg, Chanakyapuri, New Delhi-110021
by Speed Post/ Registered Post only.
xvi) The last date of receipt of application is 16-08-2024.
xvii) The application along with all serially page-numbered enclosures/documents in support of the
candidature must be sent in an envelope of suitable size and quality. The envelop should be
superscribed on the top as APPLICATION FOR THE POST OF ----------------------------------------
AGAINST ADVT. No. CMSS/AN/015/ dated 03.07.2024.
xviii) Application received after the last date (16.08.2024) will not be entertained. CMSS shall not be
responsible for any postal delay.
xix) Canvassing in any form by the candidate or on behalf of the candidate shall be treated as
disqualification of candidature.
xx) Any dispute arising out of this advertisement including the recruitment process / during employment
shall be subject to the sole jurisdiction of the Court(s) at Delhi.

11