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 attested by a Gazetted officer and a copy of online submitted application form / Receipt For Application Submission OTP is Required which will be send to Your Registered Email ID and Mobile Number.Kindly Fill the Valid Email ID and Mobile Number.

Required Details
Do You Have Passed Degree/Diploma/Certificate From Govt. Nursing School/Govt. College? *

Personal Details
Applying for Post *
Applicant's Name*
Father's/Husband's Name*
Mother's Name*
Category:*		Nationality:*
Gender*		Date of Birth(DD/MM/YYYY)*		Age as on 01/01/2022	- -(yy-mm-dd)
Are you Domicile of MP? *		Are You an Ex Serviceman?*
Are You Physically Handicapped?(Only Orthopedic Handicapped (45% to 50%) Lower Body Disability is Valid.)*
*
Employment Registration Number
Type of Handicap?*

Marital Status
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?				Is Your Second Marriage

Educational Qualification
Do you posses Diploma in Computer Application from Govt. recognized Institute/ Knowledge of Computer*
Pass Hindi and English Typing from Govt. recognized Institute*
Qualification Name of the Degree/Diploma Stream Passing Year(YYYY) University/Board Institute/College Name Obtained Percentage (00.00) Details of Degree/Diploma in Civil Engineering * 8th* 8th   10th * 10th   12th * Higher Secondary Diploma in Computer from recognized University/Institute by U.G.C. M.Phil*
* In case your University/Institute does not award marks, please convert grades(CGPA) to Percentage marks and fill.
* Write % of marks with two digits after the decimal. The second digit after the decimal should be rounded off. e.g., if Marks is 60%, then write 60.00%. If marks are 68.938% then write 68.94%.

Typing Qualification Details
Name Of Certification *		Passing Year *		Name Of Institute *

CPCT exam information*
Total Marks	Obtained Marks	Hindi Typing(Words per minute)		English Typing(Words per minute)
Result	QualifyDisqualify	Result	QualifyDisqualify	Result	QualifyDisqualify

Other Information
Are You Serving in Government/Corporation/Board/Autonomous Organizations/Nagar Sainik? (If Yes so, the applicant NOC is compulsory to attach)*
Do You Have Certificate Course in Computer Operations (Minimum Two Months)?*
Have you Worked as Samvida Employee on the Same Post? *

Communication Address
Address*
State*		City*		Pin No.*
Email id*		Mobile No.*		Phone No.

Permanent Address(Same as Communication Address)
Address*
State*		City*		Pin No.*
Mobile No.*		Phone No.

Bank Details
Account Number		Bank Name
Account Holder Name		IFSC Code

Read form carefully before submission. I, HEREBY DECLARE THAT ALL THE INFORMATION GIVEN IN THE AFOREMENTIONED ACCORDING TO POST OF 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.