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

Sl No	Post Applied For*:-	Specialist Doctor General Doctor
1.	Registration Number with Bihar Medical Council*:-	Mandatory Field
2.	Name of Candidate*:-	Mandatory Field
3.	Father's Name*:-	Mandatory Field
4.	Mother's Name*:-	Mandatory Field
5.	Data of Birth*:-	Mandatory Field
6.	Gender*:-	Male Female Other
7.	Are you a Domicile of Bihar State*:-	Yes No
8.	Reservation Category*:-	General BC OBC SC ST EWS EBC PH Freedom fighter succession certificate OBC CREAMY LAYER Any Other
9.	Marital Status*:-	Married Unmarried Divorced Widow Widower Mandatory Field
10.	Present Address*:-	Mandatory Field PIN Code Mandatory Field
11.	Permanent Address*:-	Same as Present Address Mandatory Field PIN Code Mandatory Field
12.	Mobile Number*:-	Mandatory Field
13.	E-Mail ID*:-	Mandatory Field Invalid Email Format
14.	Identity Details*:-	Type Of Identity Card*: Aadhar Card PAN Card Voter ID Driving License Passport COLLEGE ID Residence certificate Any Other 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. All columns are mandatory 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 Permanent Temporary 2 Permanent Temporary 3 Permanent Temporary 4 Permanent Temporary 5 Permanent Temporary
17.	Indemnity Bond on Judicial Stamp Paper (of Value Rs. 100/-) for not Claiming of Regular Appointment:- (Note: Indemnity Bond 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)
20.	Three Preference choices of District Posting (Excluding Home District)	First Choice District Araria Arwal Aurangabad Banka Begusarai Bhagalpur Bhojpur Buxar Darbhanga East Champaran Gaya Gopalganj Jamui Jehanabad Kaimur Katihar Khagaria Kishanganj Lakhisarai Madhepura Madhubani Munger Muzaffarpur Nalanda Nawada Other Patna Purnea Rohtas Saharsa Samastipur Saran Sheikhpura Sheohar Sitamarhi Siwan Supaul Vaishali West Champaran Second Choice District Araria Arwal Aurangabad Banka Begusarai Bhagalpur Bhojpur Buxar Darbhanga East Champaran Gaya Gopalganj Jamui Jehanabad Kaimur Katihar Khagaria Kishanganj Lakhisarai Madhepura Madhubani Munger Muzaffarpur Nalanda Nawada Other Patna Purnea Rohtas Saharsa Samastipur Saran Sheikhpura Sheohar Sitamarhi Siwan Supaul Vaishali West Champaran Third Choice District Araria Arwal Aurangabad Banka Begusarai Bhagalpur Bhojpur Buxar Darbhanga East Champaran Gaya Gopalganj Jamui Jehanabad Kaimur Katihar Khagaria Kishanganj Lakhisarai Madhepura Madhubani Munger Muzaffarpur Nalanda Nawada Other Patna Purnea Rohtas Saharsa Samastipur Saran Sheikhpura Sheohar Sitamarhi Siwan Supaul Vaishali West Champaran