All India Institute of Medical Sciences
Ansari Nagar, New Delhi - 110608
APPLICATION FORM - Nursing Officer Recruitment Common Eligibility Test (NORCET-5)
Candidate Profile Candidate ID: 6151387135 Registration No: 52021808 Registration Date: 11/08/2023
Candidate Name: SAYANI BISWAS Date of Birth: 04 Dec 1996
Gender: Female Category: SC
Father's Name: SADHAN BISWAS Mother's Name:
SANTI RANI BISWAS ROY
Persons with Benchmark Disability Status: No PWBD Category: NA
Nationality: INDIAN State of Domicile: WEST BENGAL
Applied for :
Nursing Officer Recruitment Common Eligibility Test (NORCET-5)
Are you a Government Employee : Yes
Name of Institution / Organisation: Type of Job Present Position Date of Date Of Type of orgination : Total No of
R g kar medical college and hospital Status: held: Staff nurse Appointment: Relieving : State Government Days :
Regular 15/10/2020 25/08/2023 1044
Are you a Ex-Service men : No
Contact Details
Address for Permanent: Correspondence Address:
VILL+PO- ANGRAIL, P.S- GAIGHATA, , , Angrail , WEST BENGAL, India, VILL+PO- ANGRAIL, P.S-GAIGHATA, , , Angrail , WEST BENGAL, India,
743235 743235
Mobile No: 1. 9547849771 , 2. Alternate-MobileNo 7363806348 E-Mail ID: [email protected]
Qualification Details
Qualifying Exam University Name Collage Name Admission Passing
Date Date
B.Sc (Hons.) Nursing / B.Sc Nursing from an Indian Nursing West Bengal university College of nursing, R G Kar 08/08/2015 10/12/2019
Council recognized Institute or University of health sciences medical college and hospital
Registration Number with Nursing Council of India/State Nursing Council
Registered as Registration No:(Nurse) Registration No.: (Midwife) State Name of Nursing Council: Issuing Date of Registration:
Nurse and Midwife 53525-NM 53525-NM WEST BENGAL 17/03/2020
Valid Photo Identity (To be presented in original at the Examination Center along with Admit Card)
ID Proof: Adhar Card ID No: 426782941523 Place of Issue: INDIA Issue Date: NA Valid Till: NA
Payment Details
Mode: Online Date: 11/08/2023 Transaction ID: 13871355299 Amount: 2400
Do you have experience : Yes
Organisation Name Designation Job Type Start Date End Date Total Day's
Other / Basirhat super speciality hospital Staff nurse Regular 15 Oct 2020 23 Mar 2023 889
:
Examination City Opted:
State: Exam City (Preference 1): State : Exam City (Preference 2): State : Exam City (Preference 3):
WEST BENGAL KOLKATA WEST BENGAL KALYANI WEST BENGAL ASANSOL
UNDERTAKING/DECLARATION: I hereby declare that the information furnished by me in the Registration/Application Form is correct and nothing has been
concealed. In case any information furnished by me is found to be false/incorrect/untrue than i shall be liable to civil/criminal prosecution and my claim to
admission/appointment/registration/ service in the Institute may be cancelled/terminated.
Signature of Candidate
Thumb of Candidate
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