WB State Health & Family Welfare Samiti Recruitment 2015 (Technician/Manager Vacancy) Application Form
APPLICATION FORMAT Self attested Photo graph
Application for the post of ………………………………………………………. 1.
Name(Capital Letter):
2. 3.
Father’s/Husband’s Name:
Address :
POST-
PIN-
4.
Date of birth:
5.
Age (as on 01.10.15):
6.
Caste :
7.
Nationality :
8.
Mobile No :
9.
Qualification (Attested photocopy of certificate must be submit with the application).
Sl No A
Educational Qualification Secondary
B
Higher Secondary
C
Graduation
D
Post Graduation
E
Others
10.
Board / University
Total Marks
Obtain Marks
Percentage of Marks (%)
Technical Qualification (Self Attested photocopy of certificate must be submit with the application):-
i) ii) iii) 11. Experience (Self Attested photocopy of experience certificate must be submit with the application):(i) (ii) (iii) DECLARATION:-I do hereby declare that all the information given above is correct and complete in all respect. I understand that my application is liable to rejection if any of the information stated above is found to be incorrect and is not supported by certificate. Place _______________________ Date
Signature of Applicant
Read Full Details About The www.wbhealth.gov.in Recruitment http://www.recruitmentinboxx.com/wb-health-recruitment2016/2713/
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