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Application Form: Affix Photograph Here

The document is an application form for The Gujarat Cancer & Research Institute. It requests information such as the applicant's name, address, education history, work experience, language skills, and references. The applicant is asked to provide personal details including their photo, contact information, age, marital status, nationality, caste, and computer literacy. Employment history including organization names, dates, designations, salaries, and reasons for leaving are solicited. The expected and present salary packages in gross and net amounts are also requested.

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Jeshi
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72 views3 pages

Application Form: Affix Photograph Here

The document is an application form for The Gujarat Cancer & Research Institute. It requests information such as the applicant's name, address, education history, work experience, language skills, and references. The applicant is asked to provide personal details including their photo, contact information, age, marital status, nationality, caste, and computer literacy. Employment history including organization names, dates, designations, salaries, and reasons for leaving are solicited. The expected and present salary packages in gross and net amounts are also requested.

Uploaded by

Jeshi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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THE GUJARAT CANCER & RESEARCH INSTITUTE

NEW CIVIL HOSPITAL CAMPUS, ASARWA, AHMEDABAD-380 016

Phone No: 079-2268 8008

Fax No. 079-2268 5490

----------------------------------------------------------------------------------------------------------------------------------

APPLICATION FORM

Affix Photograph
here

Post Applied for: ________________________________________________


Full Name of the Candidate : ____________________________________________________
Postal Address

: __________________________________________________________
__________________________________________________________
_________________________________________________________
City:_________________Pincode:__________State:_______________

E-mail Address

: __________________________________________________________

Mobile No

: _______________________

Residence : _____________________

Age : _____ years


Marital Status :

Single / Married

Nationality : ___________________

Gender :

Male

Female

Caste :

General

SC

*Handicap
ST

OBC

Academic Details (from SSC or Equivalent onwards)


Examination
SSC/HSC/Diploma/Degree/
Computer/ Others

Year of
Passing

Board / University

% of marks/Class/
Grade / Rank

Main Subjects

Computer Literacy (Description of Computer Knowledge) :


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Council Registration Number with State: (If Applicable)
BAMS / BHMS / MBBS / MD / MS / D.M / M.Ch / Dental / Nursing / Pharmacy & Other
Registration No.________________________________ State._________________________

Work Experience (start with your recent employment):


Name of the Organization /
Institute & Place

Monthly
Salary Rs.

Period

Designation /
Nature of work
From

To

Reason for Change

Total
Years

Job Description (Role & Responsibilities of the Present Job):


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Language Proficiency (Tick Mark the Appropriate Column):


Sr. No.
1
2
3
4
5

Language
English
Hindi
Gujarati

Satisfactory

Good

Excellent

Any Other Details / Remark / Course / Speciality / Achievement


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Present & Expected Salary Package


Present(Rs.)
Gross
Net

Expected (Rs.)
Gross
Net

Salary & Allowances


(p.m.)

Provide Names, Designations and Phone Nos. of Two References who you know and / or
your work and whom we can contact directly for reference.
1.

___________________________________________________________________________

2.

___________________________________________________________________________

Declaration: I hereby declare that all the details furnished in this form are true in every respect
and I take full responsibility for the contents and consequences of this declaration.

Place : ____________________

Signature : ______________________

Date : ____________________

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