Nhm Application Format (1).doc 101170

NATIONAL HEALTH MISSION APPLICATION FORM Applied For ……………………………………………………………………………

port Size Photo /

State / District / Panchayat………………………………………….. Candidate …………….

Name

:

Block

:…………………………………………………….. Signature

Father/Husband Name ……………………………………………………………

:

Date of Birth………………………………. Religion:……………………………….Caste……………………….Gen OBC SC ST Gender ……………………Marital No…………………………

Status……………………..

Email ID…………………………………………………………………………………… ………………………. Present Address…………………………………………………………………………… ………………….. …………………………………………………………………………………… PIN-…………………………….. Permanent Address ……………………………………………………………………………………… ….. …………………………………………………………………………………… PIN………………………………. Educational Qualification Sl.No Exam .

Board/Uni ing v. Year

% of Sub Marks

Extra Qualification :……………………………………………………………………………………… … Experience:……………………………………………………………………………………… ………………. Demand Draft Details: ………………………………………………………………………………………. . I, do hereby declare that all the above statements are true and best of my knowledge. Date : Place: Signature : For all categories

(For Male/Female)

NATIONAL HEALTH MISSION REQUIREMENT,S 1.District Program Manager, 2. Staff Nurse(for Female), 3.Health Coordinator, 4.Hospital Boy. Eligibility: 10th , 10+2, Graduation. S.no

Name Of Post

No. of Post

Age

Salary

Qualification

1.

District Program Manager

200

25 to 40

15600 to 39100+5400

Graduate(any)

2.

Staff Nurse( for female )

560

18 to 40

9300 to 34800+4800

10+2 (PCB)

3.

Health Co-ordinator

820

18 to 40

5200 to 20200+2400

12th (any stream)

4.

Hospital Boy

1160

18 to 40

4440 to 7440+2100

10th

Age Limit- 18-40 years, How To Apply: 1. Application form can be ed From official website, www.nhmind.org or

candidates can apply with their Biodata with one port Size Photograph. 2.

One Self Address envelope with No. And Address.

Instruction:

1. Candidate will be enclose their educational certificate photo copy with the application form. 2. Send application form by the Indian (speed post or registry) only. 3. All applicants send demand draft with application form according to the rule and regulations only. (Application fee- Gen Rs. 380/-, Ladies, SC ST, Rs.280/- ) 4. Make a Demand Draft in favour of “NATIONAL HEALTH MISSION” payable at “KOLKATA” 5. Reservation will be given by rule. Apply within Last Date- through your ment by ed/Speed Post in the following Address: C-21/4-A-2, Maldahiya, Varanasi (U.P) -221002 Help line : 033-65000267/ 9230700692