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DHFWS Panipat ANM Posts Notification and Application Form PDF

This document is an application form for a position with the National Rural Health Mission in Haryana. It requests information such as the applicant's name, contact details, address, education history, work experience, and a declaration signed by the applicant stating that the information provided is true. The form collects details necessary to evaluate the applicant's qualifications for the open position.

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chirag Narang
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153 views9 pages

DHFWS Panipat ANM Posts Notification and Application Form PDF

This document is an application form for a position with the National Rural Health Mission in Haryana. It requests information such as the applicant's name, contact details, address, education history, work experience, and a declaration signed by the applicant stating that the information provided is true. The form collects details necessary to evaluate the applicant's qualifications for the open position.

Uploaded by

chirag Narang
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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NATIONAL RURAL HEALTH MISSION, HARYANA

Application for the post of ________________________

1. Name of the candidate : ______________________________

2. Father’s/Husband Name : ______________________________ Paste Passport Size


Photo Here
3. Sex : Male / Female
4. Date of Birth : __________________________________________
(DD/MM/YYYY)

5. Category to which belong : __________________________________________

6. Telephone / Mobile No. : __________________________________________

7. E-mail : __________________________________________

8. Permanent Address : ____________________________________________________

____________________________________________________

__________________________PIN CODE ________________

9. Correspondence Address : ____________________________________________________

____________________________________________________

__________________________PIN CODE ________________

10. Educational / Professional Qualifications :


Examination Board/ Year of Maximum Marks %age Division Subject
Passed University Passing Marks Obtained of
marks
10th

10+2 /
Vocational /
Intermediate

Graduation

Post
Graduation

Any other
Course /
Diploma etc
11. Internship / Training (if any): Year(s)______ Month(s) _______ Day(s) ________
Name of Institution / Designation From To Total period
Organization

12. Total Experience: Year(s)______ Month(s) _______ Day(s) ________


Name of Institution / Designation From To Pay/Salary / Total
Organization Honorarium period
p.m.

13 Detail of document : _____________________________________________________


attached
14. Declaration : I hereby declare that
1. All statements made in this application form are true, complete and correct to the best of my knowledge and belief. In the event
of any information being found false or incorrect, or ineligibility being defected before or after the
interview/selection/appointment, my candidature may be cancelled and action can be taken against me by the commission.
2. I have read the provisions in advertisement of the omission carefully and I hereby undertake to abide by them. I fulfill all the
conditions of eligibility regarding age limits, educational qualifications etc. prescribed in the advertisement and other relevant
rules and instructions.
3. I have never been convicted by criminal court.
Date : ______________
Place : _____________ Signatures of the Candidate

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