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Application For The para Medical Recruitment in The Esi Hospital Sanathnagar Hyderabad - 500038

This document is an application form for a para medical recruitment position at the ESI Hospital in Sanathnagar, Hyderabad. It requests information such as the applicant's name, date of birth, education history, marks obtained, address, and a declaration signing. A checklist is also included asking the applicant to confirm they have included documents like academic qualification proofs, caste certificate, medical certificates, and photos.

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Mudavath Raju
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105 views4 pages

Application For The para Medical Recruitment in The Esi Hospital Sanathnagar Hyderabad - 500038

This document is an application form for a para medical recruitment position at the ESI Hospital in Sanathnagar, Hyderabad. It requests information such as the applicant's name, date of birth, education history, marks obtained, address, and a declaration signing. A checklist is also included asking the applicant to confirm they have included documents like academic qualification proofs, caste certificate, medical certificates, and photos.

Uploaded by

Mudavath Raju
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
You are on page 1/ 4

Page 1 of 4

APPLICATION FOR THE PARA MEDICAL RECRUITMENT IN


THE ESI HOSPITAL SANATHNAGAR HYDERABAD - 500038
Post applied for : ________________________________________

Employment Registration No : ________________________________________


Photo
1. Name of the Applicant : ________________________________________
(Block Letters)

2. Father’s/Husband’s Name :________________________________________

3. Sex. :________________________________________

4. Date of Birth. :________________________________________

5. Religion. :________________________________________

6. Social Status. :________________________________________


(SC/ST/BC with group / OC)

7. Relaxation of age, if any :________________________________________

8.Whether Physically Challenged / Compromised : ____________________________


(Latest certificate issued by the Medical
Board to be enclosed)

9. Details of Education Qualifications :

Sl. Year of School & Place / College &


Class District
No Passing Board / University
1 4th Class

2 5th Class

3 6th Class

4 7th Class

5 8th Class

6 9th Class

7 10th Class

8 Intermediate
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10. Marks obtained in academic / Technical Qualification Examination

Please specify Qualify


Month &
Type of Examination Maximum Marks Percentage of
Qualification Year of
(SSC/Intermediate/Techn Marks obtained Marks
passing
ical Certificate courses)

Academic

Technical

11. Number of completed years as : __________________________________


contract employee in
A.P. Insurance Medical Services

12. Address for communication along with pin code:

Name. :

House No. :

Village/Town :

District :

Phone No (if any) :

DECLARATION
I hereby declare that the above facts are true and correct. I further declare
that if any thing found incorrect, I shall be liable for termination from service with
immediate effect without any notice and also liable for legal action.

SIGNATURE OF THE CANDIDATE


Page 3 of 4

CHECK LIST
Candidates are requested to arrange the documents in the following order :

1 Filled in Application form YES/NO

2 Attested copy of age proof (SSC marks memo) YES/NO

3 Attested copies of Academic Qualification Marks YES/NO

Attested copies of marks Memos of Technical Qualification


4 YES/NO
examination (for all the years)

Attested copy of Registration certificate for


5 YES/NO
(ANM & Lab Assistant /Lab Assistant for Blood Bank)

Attested copy of latest caste certificate


6 YES/NO
(in case SC/ST/BC including group)

Attested copy of study certificate from class – IV to X.


7 YES/NO
Where the candidate has studied./ Local Status

Attested copy of Medical Certificate for Physically.


8 YES/NO
Challenged Persons

In case working on contract basis in Andhra Pradesh Insurance


9 YES/NO
Medical Services Department a certificate in prescribed proforma.

(3) passport size photographs (colour) with name on the back of


10 YES/NO
the photo one pasted on application

Two self addressed and stamped envelope with acknowledgment


11 YES/NO
card (Postal stamp of Rs.25/-) of 10.5 X 4.5 inches size.
Page 4 of 4

SERVICE CERTIFICATE (CONTRACT)


[CERTIFICATE TO BE ISSUED BY THE CONTROLLING OFFICER
JOINT DIRECTOR / MEDICAL SUPERINTENENT]

This is to certify that Kum / Smt /Sri ___________________________________________________

S/o, D/o, W/o ______________________________________________________________ has been working

as _______________________________________in ESI Dispensary / Hospital on contract basis.

The details of service are as follows:

Reasons for
Nature and address of Period of service
Rural / Urban breaking in service,
institution tenure From – To
if any

I here by certify that:


1. His/Her services as _________________________on contract basis are satisfactory.

2. He/She has the following adverse remarks from his/her superiors and the
public during his/her period of contract service as___________________________.

a)

b)

c)

Date:
Place: Signature of Controlling Officer
with stamp

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