Application for Selection of PHN Tutor, GNM, ANM Trainer at ANMTCs in Dept. of Medical Health and Family Welfare

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Format of Principal

Portal has been closed till further notice.

Portal will be closed on 19-03-2021 at 11:59 PM.

Title *

Applicant's Name *

Gender *

Date of Birth *

Age on 01/01/2021 *

Father’s Name *

Mother’s Name *

Mobile Number *

Marital Status *

PAN Number

Aadhaar Number *

Email ID *

State*

Permanent Address*

Tick if current address is same

Current Address

Reservation Category *

Home District *

Other Home State *

Other Home District *

State Nursing Council Registration *

Yes No

State Nursing Council Registration No. *

State Nursing Council Applied *

Yes No

State Nursing Council Application No. *

Special Category

Indian Nursing Council Number

Other Achievements

Educational Qualification/ Details

Examination Passed *	Institution/College *	Board/ University *	Year of Passing *	Final obtained Marks *	Maximum Marks *	% Marks *
10^th*
12^th*
Integrated B.Sc.(N)/ PB.B.Sc.(N) *

District Preferences (CHO position is not transferable, please choose district preferences accordingly)

Distric Preference 1 *

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10th Marksheet/ Provision*

B.Sc.(N)/PB.B.Sc.(N) Final Marksheet/ Degree/ Provision*

State Nursing Council Registration/ Application acknowledgement*

College Principal Format *

PAN/ Aadhaar *

INC Certificate

Caste Certificate

Special Category Certificate -Physical Disability

Special Category Certificate -EWS
To be Certified/Issued by an officer Not below the rank of Tehsildar in State

Upload Photograph *
(File should be in JPG/PNG format and less than 100KB)

I hereby declare that the above information is true & best of my knowledge and I take sole responsibility that the organization may take legal action against me and cancel my candidature if any mismatch found in the aforesaid information provided by me.

Note: District Allocation to the candidate is based on multiple criteria such as merit/marks under the category, availability of vacancy under reservation category in the respective district. Allocation of the districts to the candidate shortlisted under the category and as the information provided by the candidate for district preference. However, it is to notify that district preference is taken only as one of the parameter for district allocation and any claim regarding the same is not the right of the candidate. No claim regarding district allocation will be entertained.

If called for document verification, the candidate is required to bring copies of the following documents:

10th Marksheet/ Provision
B.Sc.(N)/PB.B.Sc.(N) Final Marksheet/ Degree/ Provision
State Nursing Council Registration/ Application Acknowledgement
College Principal Format
PAN/ Aadhaar
INC Certificate
Caste Certificate (if applicable)
EWS Certificate (if applicable)
Physical disabled Certificate (if applicable)