Scribd
Upload
11 views2 pages

Application Form

Uploaded by

Swagat kumar Singh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
Download as pdf or txt
11 views2 pages

Application Form

Uploaded by

Swagat kumar Singh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
Download as pdf or txt
Download as pdf or txt
You are on page 1/ 2

APPLICATION FORM

Advertisement No. : 25-24


Application no. : NRHM_PTD_76631
Applied Date : 17/10/2024
Name of the Post : Physiotherapist-DEIC
Applied for State/District : Odisha
PERSONAL DETAILS :
1. Applicant Name : SWAGAT KUMAR SINGH
2. Father's Name : SORAJ KUMAR SINGH
3. Date Of Birth : 01/11/1996
4. Mobile No. : 7653913020 5. Email Address : swagat2584@gmail.com
6. Gender : Male 7. Age as on : 27 Years 11 Months 0 Days
8. Category : SEBC 9. Physically Challenged : No
10. District of Domicile : Kandhamal
: Sai guest house, damana : Bank colony,g.udayagiri,dist-
11. Present Contact Address 12. Permanent Contact Address
square ,near Bollywood hotel kandhamal,pin-762100

13. QUALIFICATION DETAILS (STARTING FROM HIGHER QUALIFICATION) :

Name of
Name of the Year Of Month Of Duration Of
Board/Universit Full Mark Marks Secured Percentage Full/Part Time
Examination Passing Passing Course
y
UTKAL
Degree 2020 September 3550 2222 62.59 4year6month Full Time
UNIVERSITY

14. EXPERIENCE DETAILS (STARTING FROM PRESENT / LAST EMPLOYMENT) :

Name of the Employer Post Held From Date To Date Total Year Total Month
SWAGAT KUMAR CONSULTANT
16/02/2022 10/03/2024 2 0
SINGH PHYSIOTHERAPIST

15. PAR DETAILS OF LAST THREE CONTRACT PERIOD (FOR OSH&FW EMPLOYEE ONLY) :

Designation From Date To Date Remarks in PAR

16. Experience details under OSH&FW Society (Only for employees working under OSH&FW Society):

Name of the Post and Place


From Date To Date Total Year Total Month
of Posting

DECLARATION :
I do hereby declare that the information furnished above are true to the best of my knowledge and belief and that, if at any stage, it is found that
any of the above material information is false / incorrect or is suppressed by me, my candidature / appointment under Odisha State Health &
Family Welfare Society (OSH&FWS), Odisha is liable to be rejected/terminated.I also declare that I have never been disengaged from service
under the OSH&FWS,Odisha on administrative ground such as disobedience/poor performances/misbehavior/criminal activity etc.

Further, I undertake that I shall produce all original certificates/documents in support of the above information at the time of
interview/certificate verification.

Date :
Place :
Full Signature of the Applicant

Enclosure (Self attested copies):-


1. 10th Mark Sheet and Certificate
2. +2 Mark Sheet and Certificate
3. Diploma Mark Sheet and Certificate (if applicable)
4. Degree Mark Sheet and Certificate
5. P.G. Degree Mark Sheet and Certificate
6. No Objection Certificate from candidates working under Health Dept.
7. One Recent Passport size colour photograph
8. Experience Certificate
9. Any Identity Proof
10. PGDCA/DCA/any other Certificate (if applicable)
11. Registration Certificate (if applicable)

You might also like