Application for Selection of PHN Tutor, GNM, ANM Trainer at ANMTCs in Dept. of Medical Health and Family Welfare
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Portal will be closed on 30-09-2021 at 11:59 PM.
Title
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Select
Ms.
Mrs.
Dr.
Applicant's Name
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Gender
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Female
Date of Birth
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Age on 12/09/2021
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Father’s Name
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Mother’s Name
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Mobile Number
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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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Reservation Category
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Select
UR
SC
ST
OBC(NCL)
EWS
UP State Nursing Council Registration
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Yes
No
UP State Nursing Council Registration No.
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Special Category
--Select--
Physically disabled
Indian Nursing Council Number
Total years and months of experience
Year:
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--Select--
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Month:
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--Select--
00
01
02
03
04
05
06
07
08
09
10
11
12
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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ANM Diploma Final Marksheet
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District Preferences
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District
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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
10th Marksheet
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12th Mark Sheet
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ANM Diploma final marksheet
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UP State Nursing Council Registration
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Aadhaar
*
Experience Certificate
Caste Certificate
Special Category Certificate -EWS
To be Certified/Issued by an officer Not below the rank of Tehsildar in State
Special Category Certificate -Physical Disability
Upload Photograph
*
(File should be in JPG/PNG format and less than 50KB)
Upload Signature
*
(File should be in JPG/PNG format and less than 50KB)
I hereby declare that the above information is true & best of my knowledge if any mismatch found in the aforesaid information provided by me the organization may take legal action against me and cancel my candidature.
Note:
Please use the same Mobile number and Email Id for any of the form submissions. If Found mismatch or wrong the organization will not be responsible for any further communication not reach to any candidate.
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
12th Mark Sheet
ANM Diploma final marksheet
State Nursing Council Registration/ Application Acknowledgement
Aadhaar
Experience Certificate
Caste Certificate (if applicable)
EWS Certificate (if applicable)
Physical disabled Certificate (if applicable)
* For any queries, contact us at tollfree number 104