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
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Mr.
Ms.
Mrs.
Dr.
Applicant's Name
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Gender
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Select
Male
Female
Date of Birth
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Age on 01/01/2021
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Father’s Name
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Mother’s Name
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Mobile Number
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Marital Status
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Select
Married
Unmarried
Others
PAN Number
Aadhaar Number
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Email ID
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State
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Select
Andaman and Nicobar Islands
Andra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadar and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadeep
Madya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telagana
Tripura
Uttaranchal
Uttar Pradesh
West Bengal
Permanent Address
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Tick if current address is same
Current Address
Reservation Category
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Select
UR
SC
ST
OBC(NCL)
EWS
Home District
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-Select-
AGRA
ALIGARH
AMBEDKAR NAGAR
AMETHI
AMROHA
AURAIYA
AYODHYA
AZAMGARH
BAGHPAT
BALARAMPUR
BALLIA
BANDA
BARABANKI
BAREILLY
BASTI
BEHRAICH
BIJNOR
BUDAUN
BULANDSHAHAR
CHANDAULI
CHITRAKOOT
DEORIA
ETAH
ETAWAH
FARRUKHABAD
FATEHPUR
FIROZABAD
GAUTAM BUDDHA NAGAR
GHAZIABAD
GHAZIPUR
GONDA
GORAKHPUR
HAMIRPUR
HAPUR
HARDOI
HATHRAS
JALAUN
JAUNPUR
JHANSI
KANNAUJ
KANPUR DEHAT
KANPUR NAGAR
KASGANJ
KAUSHAMBI
KUSHINAGAR
LAKHIMPUR KHIRI
LALITPUR
LUCKNOW
MAHARAJGANJ
MAHOBA
MAINPURI
MATHURA
MAU
MEERUT
MIRZAPUR
MORADABAD
MUZAFFARNAGAR
PILIBHIT
PRATAPGARH
PRAYAGRAJ
RAEBARELI
RAMPUR
SAHARANPUR
SAMBHAL
SANT KABIR NAGAR
SANT RAVIDAS NAGAR
SHAHJAHANPUR
SHAMLI
SHRAVASTI
SIDDHARTHNAGAR
SITAPUR
SONBHADRA
SULTANPUR
UNNAO
VARANASI
Other
Other Home State
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Select
Andaman and Nicobar Islands
Andra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadar and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadeep
Madya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telagana
Tripura
Uttaranchal
West Bengal
Other Home District
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State Nursing Council Registration
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Yes
No
State Nursing Council Registration No.
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State Nursing Council Applied
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Yes
No
State Nursing Council Application No.
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Special Category
--Select--
Physically disabled
Indian Nursing Council Number
Other Achievements
Educational Qualification/ Details
Examination Passed
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Institution/College
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Board/ University
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Year of Passing
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Final obtained Marks
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Maximum Marks
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% Marks
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10
th
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12
th
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Integrated B.Sc.(N)/ PB.B.Sc.(N)
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District Preferences
(CHO position is not transferable, please choose district preferences accordingly)
Distric Preference 1
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-Select-
Agra
Aligarh
Ambedkarnagar
Amethi
Amroha
Auraiya
Ayodhya
Azamgarh
Baghpat
Bahraich
Ballia
Balrampur
Banda
Barabanki
Bareilly
Basti
Bijnor
Budaun
Bulandshahr
Chandauli
Chitrakoot
Deoria
Etah
Etawah
Farukhabad
Fatehpur
Firozabad
Gautam Budh Nagar
Ghaziabad
Ghazipur
Gonda
Gorakhpur
Hamirpur
Hapur
Hardoi
Hathras
Jalaun
Jaunpur
Jhansi
Kannauj
Kanpur Dehat
Kanpur Nagar
Kasganj
Kaushambi
Kushinagar
Lakhimpur Kheri
Lalitpur
Lucknow
Maharajganj
Mahoba
Mainpuri
Mathura
Mau
Meerut
Mirzapur
Moradabad
Muzaffar Nagar
Pilibhit
Pratapgarh
Prayagraj
Raibareli
Rampur
Saharanpur
Sambhal
Sant Kabir Nagar
Sant Ravidas Nagar (Bhadohi)
Shahjahanpur
Shamli
Shravasti
Siddharth Nagar
Sitapur
Sonbhadra
Sultanpur
Unnao
Varanasi
Distric Preference 2
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Distric Preference 3
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Distric Preference 4
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Distric Preference 5
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Distric Preference 74
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10th Marksheet/ Provision
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B.Sc.(N)/PB.B.Sc.(N) Final Marksheet/ Degree/ Provision
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State Nursing Council Registration/ Application acknowledgement
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College Principal Format
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PAN/ Aadhaar
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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)
* For any queries, contact us at tollfree number 104