×

Message

SHYAM SHAH MEDICAL COLLEGE, REWA(M.P.)
Fields marked with * are mandatory
Instructions
Documents to be furnished in original at the time of verification of documents along with one set of photocopies should be self attested and a copy of online submitted application form / Receipt
Personal Details
Applying for Post
Examination City Center Name 1 * Examination City Center Name 2* Examination City Center Name 3*
Applicant's Name*
Father's/Husband's Name*
Mother's Name*
Domicile of MP:*
Category:*
Nationality:*
OBC Creamy Layer *
Whether the category of the applicant is under Saharia / Sahariya, Baiga or Bharia primitive tribes as per rule g of rule no.2?* जिला* 
Gender*
Date of Birth(DD/MM/YYYY)* (In DD/MM/YYYY) Age as on 01/07/2019    - -(yy-mm-dd)
Marital Status* Marriage Date* (In DD/MM/YYYY)
No. of Children Last child birth date (In DD/MM/YYYY) Is Your Last Child Born Twins
Are You an Ex Serviceman*
Are You Physically Handicapped?*
Enter % of handicapped
Educational Qualification
Qualification Specialization Passing Year University/Board Institute/College Name Obtained Percent (In 00.00 Format)
10th* 10th
12th*
Qualification obtained*
Master Degree
*
If yes,Registration No.
*
If yes,Registration No.
If any applicant is working currently in any government/semi-government/home-gaurd organization then they have to produce their resignation /no objection certificate while appling for this post and other applicant have to produce their live rojgar office registration no ?*
Year Of Experience In 300 Bed Hospital competent authority?
Communication Address
Address*
State* City/Town* Pin Code.*
Email id* Mobile No.*   Phone No.  
Permanent Address(Same as Communication Address)
Address*
State City/Town* Pin Code*
Mobile No.* Phone No.
Bank Details
Account Number * Bank Name *
Account Holder Name * IFSC Code *
Attachment*
Attach Photo with Signature*
Click here for photo sign format
Declaration *
I HEREBY DECLARE THAT ALL THE INFORMATION GIVEN IN THE AFOREMENTIONED APPLICATION FORMAT IS TRUE TO THE BEST OF MY KNOWLEDGE. I UNDERTAKE AND ACCEPT THAT IF ANY OF THE INFORMATION GIVEN BY ME IS FOUND TO BE INCORRECT, THEN MY APPLICATION WILL BE REJECTED AND IF APPOINTED, THEN MY APPOINTMENT WILL BE TERMINATED & ACTION MAY BE TAKEN ACCORDINGLY.