APPLICATION FORM Reg. No.

To be Filled by NTS

Health Department, Khyber Pakhtunkhwa Picture 1

NTS Independent Monitoring Unit Paste your recent
passport size color
photograph not older than
Government of Khyber Pakhtunkhwa 6 Months having
blue background with gum
Project ID: N-20-4518 Screening Test for the Post of
Monitoring & Data Collection Assistant (M/F)
Eligibility Criteria:
A. Is your age according to the desired post at the date of 08-11-2019 as mentioned in the advertisement? Yes No

B. Do you possess required Qualification / Experience as asked in Advertisement? Yes No

C. Do you possess relevant area Domicile as advertised? Yes No

If your reply is “Yes” to A, B & C above, only then please proceed further. Otherwise you are not eligible to apply.

Bank Online Deposit of Rs: 460/- from Designated Bank Branches. Exemption of fee for Disabled Person only

Bank Code Are you a Disabled Person? Yes No

Deposit Date
*Note: Application Form will not be entertained without Original Deposit Slip (NTS Copy)

01. District / Area of Domicile Applying For: Fill Only One Box for District / Area of Domicile Applying For. (Mandatory)

Relevant District / Area Positions (Candidates must be domiciled of the District / Area applying for)

Newly Merged Tribal Area (Former FATA)

i. Khyber ii. Bajaur iii. Mohmand

iv. North Waziristan v. South Waziristan vi. Upper Kurram

Monitoring &
Data Collection Assistant vii. Central / Lower Kurram viii. Orakzai
(Male / Female) (BS-16)
Former FR Regions

i. Tank ii. D.I. Khan iii. Lakki

iv. Bannu v. Kohat vi. Peshawar

Personal Information: Use CAPITAL letters and leave spaces between words.
02. Name in Full:

03. Father’s Name:

04. Candidate CNIC #:

Write your own CNIC No.

06. Date of Birth: D D M M Y Y Y Y

05. Gender: Male Female Write your Correct Date of Birth
otherwise you will be rejected

07. Postal Address:

Only for Information: NTS will not issue Roll No Slips through courier/postal services. Candidate must required to take electronic print out of Roll No. (having picture of candidate) from NTS website for appearing in tests.

City: District:

08. Phone No: (OFF) (RES.) Mobile:

City Code - Phone No DO NOT give your portable mobile number (which is converted
from one network to another) so that SMS delivery is ensured.
09. Are you a Government Servant and applying through proper channel?
In case of Yes, NOC will be required. Yes No

10. Are you a Disabled Person? 11. Religion:

If yes, please attach Disability Certificate Yes No Muslim Non Muslim

12. Do you possess valid LTV Driving License?

Will be required for seletion Yes No

13. Academic Information: (Please attach attested copies of your academic certificates.)
Note: 1. NTS will not issue Roll No Slips to those who have not filled in their academic record properly.
2. Candidate should convert their grades / CGPA into marks.
3. Write exact degree name & major subject mention in certificate / transcript.
4. Result awaiting candidates are not eligible.

Certificate / Specialization /
Degree Title Year Passing Obtained Marks Total Marks Board / University / Institute
Degree Name Major Subject

Matric Matric Science Arts

(10 Years)
Other: _______________ Other: __________

F.A F.Sc
Intermediate /
D.A.E D.A.E
(12 / 13 Years)
Other: _______________

B.A B.Sc
Bachelor
(14 Years)
Other: _______________

Bachelor (Hons) M.A M.Sc

/ Master
(16 Years) Other: _______________

MS M.Phil
MS / M.Phil
(18 Years)
Other: _______________

Ph.D

14. Relevant Employment Record: (Please attach copies of your experience certificates)
Job Duration
Sr # Organization / Employer Name Job Title Write only Month & Year
From To

01

02

03

Years Months
15. Total Job Experience as on closing date of application:

16. Desired Test City: Fill Only One Box for Desired Domicile District (Mandatory)
(Subject to a minimum of 200 candidates, otherwise the candidates will be assigned next nearest test city).

01. Peshawar 02. D. I. Khan

17. Age Relaxation Claim: Proof to be provided before selection. (Only 1 will be admissible)
A. Are you Govt. Employee and have completed 2 years continuous service on the closing
date for receipt of applications? (10 years) Yes No

B. Are you a disabled person / **Divorced Woman / Widow? Yes No

(10 years)

Undertaking By The Applicant:

I_____________________________ d/s/w of _________________________do hereby solemnly
declare and affirm that I have read and understood the instructions and conditions for appearing in Picture 2
the NTS Test, and I have filled-up the application form as per criteria according. In case of any Affix your recent
information contained herein is found at any stage to be missing, untrue, false or forged, my passport size color
candidature can be cancelled at any stage (even after employment, if so revealed later), and I shall photograph not older than
6 Months having
be liable to legal action.
blue background with Stapler

Date: _________ Thumb Impression ____________ Candidate’s Signature ________________

GENERAL INSTRUCTIONS / INFORMATION:

Ø Please fill the Application Form properly with complete and correct information / answers.
Ø Please DO NOT leave any field blank, otherwise your application may not be considered.
Ø Incorrect, false or forged information may result in cancellation of your candidature at any stage, even after employment,
and also proceeding of a legal action.
Ø Attach your Two recent Passport Size Photographs, Attested copies of CNIC, Domicile Certificate, Experience Certificates
(If Any) and Original Bank Deposit Slip (NTS Copy)
Ø By Hand submission of Application Form is not allowed.
Ø Mobile Phones or any Electronic Gadgets are not allowed in Test Center premises.
Ø Use separate envelop and separate application form for each post you are applying for.
Ø Last date for submission of application form is Friday 8th November, 2019.

HELP LINE: Please Send Application Forms to:

UAN : +92-51-844-444-1 NATIONAL TESTING SERVICE (HQ)
Website : www.nts.org.pk IMU KP (Project)
Plot 96, Street # 4 H-8/1, Islamabad.

Only for Information: NTS will not issue Roll No Slips through courier/postal services. Candidate must required to take
electronic print out of Roll No. (having picture of candidate) from NTS website for appearing in tests.
 NTS COPY BANK COPY
Health Department, Khyber Pakhtunkhwa Health Department, Khyber Pakhtunkhwa
Independent Monitoring Unit Independent Monitoring Unit
Branch Code: Date: Branch Code: Date:

Branch Name: Branch Name:

(* Please deposit fee in only one bank & tick the relevant bank) (* Please deposit fee in only one bank & tick the relevant bank)

Muslim Commercial Bank Muslim Commercial Bank

A/C Title: NTS Pakistan A/C Title: NTS-Pakistan A/C Title: NTS Pakistan A/C Title: NTS-Pakistan
A/C No: 00427991771403 A/C No: 0647943831005734 A/C No: 00427991771403 A/C No: 0647943831005734
Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost

*Note: Desired Bank Stamp is required on the Deposit Slip & Send Original Deposit *Note:
Slip (NTS Copy) along Application Form to NTS Office 1. Please Stamp both copies of deposit Slip.
a 2. The Bank Must Return “NTS Copy” to the Candidate.
Application Form will not be entertained without Original Deposit Slip (NTS Copy)
3. Deposit Slip will not accepted without Candidate CNIC/ B Form No.

th th
Last date for fee submission: Friday 8 Nov, 2019 Last date for fee submission: Friday 8 Nov, 2019

N-20-4518 N-20-4518
Applicant’s Applicant’s
Name: Name:
Father Father
Name: Name:
CNIC No/ CNIC No/
B Form No: B Form No:

Post Name: Post Name:

GST INVOICE GST INVOICE

NTN # 2680612-6 NTN # 2680612-6
GST # 3277876121192 GST # 3277876121192
NTS fee: 400/- NTS fee: 400/-
Amount in Four Hundred & Sixty Rupees Only Amount in Four Hundred & Sixty Rupees Only
GST@ 15%: 60/- word: Rs. Non Refundable/ Non Transferable
GST@ 15%: 60/- word: Rs. Non Refundable/ Non Transferable
Total: 460/- Total: 460/-

Applicant Signature Cashier Officer Applicant Signature Cashier Officer

CANDIDATE COPY
Health Department, Khyber Pakhtunkhwa Independent Monitoring Unit

Branch Code: Branch Name: Date:

(* Please deposit fee in only one bank & tick the relevant bank)

Muslim Commercial Bank

A/C Title: NTS Pakistan A/C Title: NTS-Pakistan
A/C No: 00427991771403 A/C No: 0647943831005734
Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost

*Note: Desired Bank Stamp is required on the Deposit Slip & Send Original Deposit Slip (NTS Copy) along Application Form to NTS Office. Application Form will not be entertained
without Original Deposit Slip (NTS Copy)

th
Last date for fee submission: Friday 8 Nov, 2019

N-20-4518
Applicant’s Father
Name: Name:
CNIC No/
Post Name:
B Form No:

GST INVOICE NTS fee: 400/-

Amount in Four Hundred & Sixty Rupees Only
NTN # 2680612-6 GST@ 15%: 60/- word: Rs. Non Refundable/ Non Transferable
GST # 3277876121192 Total: 460/-

Applicant Signature Cashier Officer