Tel.: 01639-256232, 256236, E-mail:generalinfo@bfuhs.ac.
in Fax: 01639-256234
Baba Farid University of Health Sciences, Faridkot
Sadiq Road Faridkot – 151203 (Pb) India
Application form
Walk-In-Interview
01 of 2025 Interview Date 14.01.2025
Details of Application fee
DD No. Date and Amount Affix Attested
Passport size
Photograph
Note: 1. Incomplete applications are liable to be rejected.
1. Application for the post of ___________________ Specialty __________________
2. Applicant’s Name (IN BLOCK LETTERS)
3. Father’s Name (IN BLOCK LETTERS)
4. i) Date of Birth of Applicant
(attach proof) DAY MONTH YEAR
ii) Age: (as on 01.01.2025)
YEARS MONTHS DAYS
5. Write in the box ONLY ONE category out of SC/ST/BC/GEN
To which you belong (attach proof if SC/ST/BC ):
6. Nationality:____________7. Religion_____________8. Marital Status;____________
9. Educational/Academic Qualification: (attach attested copies certificates)
Examination Subjects Year of passing No. of attempts University/Institution Status of MCI
Passed recognition
(attach proof)
M.B.B.S.
M.D./M.S/MDS.
DM/M.Ch
Please attach proof of Recognition of degree by National Medical Commission, candidate possessing degree not
recognized by NMC will not be allowed to appear for interview.
10. No. of papers published : National International
(please attach proof)
11. Details of prizes, Medals, Scholarships &
National/ International Awards and Additional
Qualification such as membership of scientific society etc.
12. Chronological details of upto date appointments after obtaining qualification
(attach experience certificate):
Post held From To Total period Employer's address
13. (a) Central/State Medical Council with which the
applicant is registered (attach proof) :_______________________________
(b) Medical/Dental Registration Number :_______________________________
14. Permanent Address 15. Correspondence Address
Pin Code Pin Code
Email: E. Mail
Mobile No Mobile No
.
16. Details of enclosures attached: 1____________________2_________________3_________________
4_______________5_______________6_________________7________________8___________________
I hereby declare that I am Indian National and all statements made in this application are true, complete and correct to
the best of my knowledge and belief. I understand that in the even of any information being found false or incorrect,
my appointment will be liable to be terminated without any reason or prior notice. I also understand that in case of my
final selection, my appointment will be provisional subject to satisfactory police verification.
Date:_________________
Place:_________________ Signature of the applicant
CERTIFICATE BY THE PRESENT EMPLOYER
(In case of candidate who is already in service)
No.________________Date_______________
Forwarded with the remarks that here is no objection to the selection/appointment of
Dr. ______________________________to the post applied for at BFUHS, Faridkot.
Signature of the employer with
Office Stamp & date
