Government of Telangana
Notification No. 5512/E1/DMHO/2025, Dated:17.06.2025
                        Recruitment for the post of Medical Officer in UPHCs under NUHM on contract
                                              basis for a period of one year
                                                         Application Form
Registration No
Post for which
Application made
District for which
applied
1           Name of the Candidate
2.a         Father’s Name
2.b         Mother’s Name
2.c         Husband Name (If married)
3           Sex (Please tick)                          Male                      Female
4           Date of Birth
5           Social Status ( OC / BC-A / BC-B /
            BC-C / BC-D /BC-E /SC-Gr I,II,III / ST )
5.a         Local Status                               Local                     Non-local
6           Whether Physically Handicapped              Yes               /               No
            (Please Tick)
6.a         If yes, please mention category (Please    HH       /       OH          /      VH
            tick)
7           Whether Ex-Service man/woman               Yes          /                     No
Details of school education
      Class                         Year of passing                     District in which studied
       IV
       V
       VI
       VII
      VIII
       IX
       X
District to which candidate belongs as per presidential order
Educational Qualification
Qualification          Year of passing                         Name of the College /University
                            Marks obtained in the qualifying examination
Qualifying               Max.Marks                  Marks Obtained            % of marks obtained
examination
                                         Address Particulars
Name
Father/Mother/Husband’s Name
House No.
Street
Village / Town
District
Pin
Mobile / Contact No.
                                            Declaration
      I, ____________________________________________________________________ W/o ,
D/o Sri________________________________________________________ Certify that , the
above particulars funirshed by me are correct to the best of my knowledge. I also agree that, in
the event of any of the particulars furnished in my application being found to be incorrect or false
at a later date my candidature will be cancelled summarily.
NOTE : If any candidate fail to submit the required certificates Xerox copies as per the notification
guidelines their application shall be rejected. No further representation will be entertained.
                                                        Name and Signature of the Candidate
                     ACKNOWLEDGEMENT
01    SSC/Dated of Birth Certificate issued by the competent authority of the
      Government, for proof of Age
02    Intermediate or 10+2 examination
03    Qualifying examination pass certificate
04    Marks Memos of all the years (qualifying examination)
05    Registration Certificates of respective Councils
06    Latest Community Certificate/EWS Certificate/Ex-Service
      Men/NCC/Physically handicapped, whichever is applicable issued by the
      competent authority( SC aspirants should produce latest caste certificate
      as per the recent SC categorization & Subclassification)
07    Study Certificates for the years from 1st to 10th & incase of private study
      residence certificate from the Tahsildar by MRO concerned to be
      submitted
08.   PH Certificate in respect of candidates claiming reservation under PH
      quota
09    Relevant Certificates in respect of candidates claiming Ex-Service Men
      quota
10    Registration Certificate from the concerned Medical Council/Nursing
      Council/Paramedical Board/Other relevant authority
                                                         Signature of the Clerk