Application for Appointment of Contractual Doctors (General/Specialist) in Home Department(Prison)

Pay attention: 1) * Fields are mandatory
                         2) Always use Calendar for entry of Date


Sl No Post Applied For*:-
1. Registration Number with Bihar Medical Council*:-  
2. Name of Candidate*:-  
3. Father's Name*:-  
4. Mother's Name*:-  
5. Data of Birth*:-  
6. Gender*:-
7. Are you a Domicile of Bihar State*:-
8. Reservation Category*:-
9. Marital Status*:-  
10. Present Address*:-  
PIN Code  
11. Permanent Address*:-
 
PIN Code  
12. Mobile Number*:-  
13. E-Mail ID*:-    
14. Identity Details*:- Type Of Identity Card*:
ID Number:
15. Educational Details*:-
Exam Passed Name of Institute* Board/University* % of Marks* Passing Certificate Number* Certificate Issue Date*
Matriculation
Intermediate
MBBS
Post Graduation
Any Other

16. Experience Details (From Latest to Old. Fill all columns but if you are currently working in any Department/Organization then keep End Date blank):-
Sl No Name of Department/Organization Start Date End Date Post Name Permanent/
Temporary
Last Drown Salary
(In Rs/Month)
1
2
3
4
5

17. Health certificate issued by civil surgeon-cum-chief medical officer:-
(Note: Health certificate should be in .pdf / .jpg / .jpeg format)
18. Passport Size Photo of Candidate *:-
(Note: Scan Photo of Candidate should be in .jpg/.jpeg format and file size should be maximum 100 KB)
19. Signature of Candidate*:-
(Note: Scan Signature of Candidate should be in .jpg/.jpeg format and file size should be maximum 20 KB)