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15 views3 pages

SrVacancyUpdate Removed Removed

Uploaded by

s
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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1.

Post Applied
GUJARAT MEDICAL
GMERS Medical

Tutor
:-
for

2. Name of Candidate &

Address

(IN BLOCK LETTERS)

Telephone No. With code :- (Phone) (Mo.)


Local Contact Address

Email-Id

3 . Category: sc - ..... ..... ... ST - ..... ...... SEBC -............ Others - ..... ........

4 Date of Birth: - 19..... Age: - yrs ........month

5 Sex: M/ F

6 Present Job

7 Educational Qualification
Sr. Examination Year of University Total Percentage Attempt
No Passing Marks
.
1 MBBS PART -1
/BDS/MSC
2 MBBS PART -
2/BDS/MSC
3 MBBS PART -
3/BDS/MSC
4 MBBS PART -
4/BDS/MSC
5 MD / MS/MDS/ DNB
6

8 Details of Research papers publications/Presentation :-


National/lntern No. Of Paper Year of Name of Whether Journal Name of
ational Published Publication Journal is an Indexed Article
Journal (Yes/No)
2 3 4 5 6
1

9. Details of Medical / Dental Council Registration:-


Registration No.

Date of Registration

Name of Council

10. Name of two referees (With Phone No.)


1.

2.

1 1 . List of Enclosures (Attested copies — in following order)


(1) ALL MBBS / BDS Mark Sheet. (9) NOC/ Relieving order.
(2) M BBS/BDS Attempt Certificate. (10) Research /
Project/Publication...
(3) P. G/Diploma/DNB [CPS MARK SHEET (11) School-Leaving Certificate
(Will be applicable as per Rules)
(4) P. G/ Diploma/DNB/CPS Attempt Certificate (12) Cast Certificate.
(5) MBBS/BDS: GMC/GDC Registration Cert. (13) Non Creamy Layer
(6) P. G. GMC/GDC Registration Certificate. (14) PAN Card. (Compulsory)
(7) Degree Certificate. (15) Passport Size Photo
(8) Internship Completion Certificate. (16) Aadhaar card (Compulsory)
(17) FMG Marksheet
Undertaking
I declare that information stated above is true to the best of my
Knowledge. If above information found to be False; I am bound to obey the decision of
Selection Committee.

Place: -

Date: - Signature of Applicant

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