Walk in Interview
THE GUJARAT CANCER & RESEARCH INSTITUTE
NEW CIVIL HOSPITAL CAMPUS, ASARWA, AHMEDABAD-380 016
Phone No: 079-2268 8012 Fax No. 079-2268 5490
----------------------------------------------------------------------------------------------------------------------------------
APPLICATION FORM Affix Photograph
here
Post Applied for:
Full Name of the Candidate as per Adhar Card:______________________________________
Postal Address as per Adhar Card : _______________________________________________
__________________________________________________________
_________________________________________________________
City:_________________Pincode:__________State:_______________
E-mail Address : __________________________________________________________
Mobile No : _______________________ Residence : _____________________
Date of Birth : _______________Age : _____ years (As on 21-01-2025)
Marital Status : Single / Married Nationality : ___________________
Gender : Male Female *Handicap
Caste : General SC ST OBC EWS
Non-Creamy Layer : Certificates Date:
Certificate No.
Academic Details (from SSC or Equivalent onwards)
Examination
% of Year of
SSC/HSC/Diploma/Deg Main
Faculty Board / University marks/Class/ Passing Attempt
ree/ Subjects
Grade / Rank
Computer/ Others
S.S.C.
H.S.C.
Diploma
Degree
Post Graduate
Degree
Super Speciality
Any Other
1
Computer Literacy (Description of Computer Knowledge):
__________________________________________________________________________
__________________________________________________________________________
Council Registration Number with State: (If Applicable)
BAMS / BHMS / MBBS / MD / MS / D.M / M.Ch / Dental / Nursing / Pharmacy & Other (Name:____________)
Registration No. Under Graduate: ____________ Post Graduate:_____________ State._____________________
Work Experience (start with your recent employment):
Monthly Reason
Government Period Salary for
Name of the Organization / Designation / Rs. Change
Sector/
Institute & Place Nature of work
Private Total
From To
Years
Language Proficiency (Tick Mark the Appropriate Column):
Sr. No. Language Satisfactory Good Excellent
1 English
2 Hindi
3 Gujarati
4
5
Any Other Details/ Remark/ Course/ Speciality/ Achievement &
Present Job Description (Role & Responsibilities):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2
Details of Research Paper Publication / Acceptance (Start with Recent) for Teaching Post:
State/ National / Name of Verify by
Published Name of Indexed
International No. of Paper Article ( attach concern HOD
year Journal (Yes/No)
Journal list separately ) use
1 2 3 4 5 6 7
Present & Expected Salary Package
Present(Rs.) Expected (Rs.)
Gross Net Gross Net
Salary & Allowances
(p.m.)
Provide Names, Designations and Phone Nos. of Two References who you know and / or
your work and whom we can contact directly for reference.
1. __________________________________________________________________________
2. __________________________________________________________________________
Undertaking
I declare that information stated above are true to the best of my knowledge. If above
information is found to be false, I am bound to obey the decision of selection committee.
Place: ____________________
Date: _____________________ Signature: ______________________
3
Application Form should be submitted along with documents mention 1 to 12 below
otherwise Application Form will be rejected.
1. Application Form
2. Detailed Bio-data
3. Adhar Card
4. PAN Card
5. School Leaving Certificate / Birth Certificate
6. S.S.C, H.S.C Passing Certificate & Mark sheet
7. Caste Certificate as per Govt. of Gujarat rules (certificate is mandatory if applicable for OBC, ST, SC)
8. Income Certificate for EWS (Economically Weaker Section) Quota (if applicable)
9. All educational qualifications with Photocopies of Mark Sheets
a. NMC Registration of Graduation / Post Graduation.
b. Gujarat State Medical Council Registration / or other State’s Medical Council Registration.
c. Attempt Certificate of Graduation, Post-Graduation.
10. Degree Certificate
11. All Experience Certificates (If experience certificate mention in Recruitment Rules then certificate is
mandatory)
12. NOC from Present Employer
* If you want to apply for two or more posts than you have to fill separate application
forms for each posts
