Application form for Senior Resident (Non Academic) - 3 years tenure post - at AIIMS Kalyani
Please submit this form with scanned certificates and a payment receipt of Rs 1000/- if applicable (only candidates belonging to the SC/ST category are exempt) within 13.05.2023 by 1 pm after which application portal will be closed.
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Email *
Advertisement Number *
1. Full Name *
2. Upload your recent passport size photograph in jpeg format. *
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3. Father`s / Husband`s Name *
4. Email *
5. Phone number *
6. Full postal address *
7. Which position you are applying? *
8. Date of birth (DD/MM/YYYY) *
9. Please upload proof of date of birth in pdf format (board examination certificate/ admit card/ birth certificate) *
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10. Nationality *
11. Name of the state to which you belong *
12. Gender *
13. Reservation Category *
14. Please upload reservation category certificate in pdf format if applicable.
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15. Physically challenged *
16. If physically challenged type and percentage of disability. Write NA if not applicable. *
17. Please upload the physically challenged certificate in pdf format if applicable.
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18. Please provide the following information regarding passing 10th Standard (1. University/ board/ council of examination; 2. Month and year of passing; 3. Number of extra attempts. *
19. Upload certificate of 10th standard in pdf format. *
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20. Please provide the following information regarding passing 12th Standard (1. University/ board/ council of examination; 2. Month and year of passing; 3. Number of extra attempts. *
21. Upload certificate of 12th standard in pdf format. *
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22. Please provide the following information regarding passing MBBS / BDS course (1. University/ board/ council of examination; 2. Month and year of passing; 3. Number of extra attempts. *
23. Upload MBBS / BDS pass certificate in pdf format. *
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24. Please provide the following information regarding passing MD/ MS/ MDS/ DNB course (1. University/ board/ council of examination; 2. Month and year of passing; 3. Number of extra attempts. *
25. Upload  MD/ MS/ MDS/ DNB pass certificate in pdf format. *
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26. Please provide the following information regarding passing DM/ MCH/ DNB SS course (1. University/ board/ council of examination; 2. Month and year of passing; 3. Number of extra attempts.
27. Upload  DM/ MCH/ DNB SS pass certificate if applicable in pdf format.
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28. Please upload your updated medical / dental registration certificate in pdf format. *
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29. Please provide the following information regarding passing any other NMC / Dental Council recognized course (1. University/ board/ council of examination; 2. Month and year of passing; 3. Number of extra attempts.)
30. Upload pass certificate of any other NMC / Dental Council recognized degree course if applicable in pdf format.
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31. Please provide the details of your work experience after obtaining MD/MS/MDS/ DNB degree, starting from recent most job containing the following details. 1. Name of the organization, 2. Period of service from DD/MM/YYYY to DD/MM/YYYY, 3. Designation, 4. Nature of duties performed, 5. Reasons for leaving service
32. Upload your scanned experience certificates if applicable in a single pdf file. Merge pdf files if necessary.
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33. Are you currently employed in a Government job? *
34. Have you obtained a no objection certificate from your employer? *
35. Upload no objection certificate from present employer if applicable.
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36. Details of application fee submitted (bank NEFT transaction ID). Write NA if not applicable. *
37. Upload scanned copy of the payment receipt if applicable.
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38. Choice of interview mode. *
39. I hereby declare that entries made in this form as above are true and correct to the best of my knowledge and belief. In the event of any information being found false/incorrect my candidature/ services are liable to be terminated without any notice. I agree to abide by the terms and conditions of contractual appointment. *
40. Place *
41. Date (DD/MM/YYYY) *
42. Upload your scanned full signature in jpeg format. *
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A copy of your responses will be emailed to the address you provided.
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