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Fields marked with * are mandatory
Documents to be furnished in original at the time of verification of documents along with one set of self attested photocopies and a copy of online submitted application form / Receipt.
व्यक्तिगत विवरण (Personal Details)
आवेदित पदवर्ग का नाम,जिस हेतु आवेदन कर रहे है(Post Applied) *
आवेदक/आवेदिका का पूरा नाम (Applicant's Name)*
पिता/पति का नाम (Father's / Husband's Name)*
माता का नाम (Mother's Name) *
क्या म.प्र. के मूल निवासी है? (M.P. Domicile)*
जाति वर्ग/श्रेणी (Category)*
लिंग (Gender)*
वैवाहिक स्थिति (Marital Status )* क्या आप भूतपूर्व सैनिक हैं? (Are You Ex-service Man?)*
बच्चो कि संख्या (No. of Children)
यदि बच्चे नहीं हैं तो कृपया 0 भरें|
अंतिम बच्चे की जन्मतिथि (Last child birth date) (In DD/MM/YYYY) क्या अंतिम बच्चे जुड़वाँ पैदा हुए हैं? (Is Your Last Child Born Twins)
नागरिकता (Nationality) *
जन्म तिथि (DD/MM/YYYY)(DOB) * (In DD/MM/YYYY) Age as on 01/08/2019    - -(yy-mm-dd)
क्या आप शारिरिक विकलांग है? (Are you Physically handicapped?)*
विकलांगता का प्रकार (Type Of Physically Handicapped)
Permanent two wheeler driving license and should be able to drive two wheeler*
Tuberculosis health visitors recognized course*
Govt. recognized degree/diploma in social work or Medical social work*
Successful completion of basic training course Govt. recognized for Multi-Purpose health workers*
परीक्षा केंद्र वरीयता विवरण (Exam Center Preference Details)
Examination City Center Name 1 Examination City Center Name 2 Examination City Center Name 3
शैक्षणिक योग्यता विवरण(Educational Qualification Details)
योग्यता (Qualification) परीक्षा का नाम (Exam Name) Stream उत्तीर्ण वर्ष (Passing Year) विश्वविद्यालय / बोर्ड (University/Board) संस्थान / कॉलेज का नाम (Institute/College Name) प्राप्तांकों का प्रतिशत(Percentage) (In 00.00 Format)
10th* 10th  
Diploma/12th* Diploma/Higher Secondary
संचार पता (Communication Address)
पता (Address)*
राज्य (State)* शहर (City)* पिन नंबर (Pin No.)*
ईमेल आईडी (Email id)* मोबाइल नम्बर (Mobile No.)*   फोन नंबर (Phone No.)  
स्थायी पता (संचार पते के समान) (Permanent Address(Same as Communication Address))
पता (Address)*
राज्य (State)* शहर (City)* पिन नंबर (Pin No.)*
मोबाइल नम्बर (Mobile No.)* फोन नंबर (Phone No.)
संलग्नक (Attachment)*
हस्ताक्षर के साथ फोटो संलग्न करें (Attach Photo with Signature)*
Click here for photo sign format

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