Application format Downloaded from www.nrhmchd.gov.
in
Application for the post of ______________________________________
1. Name of the applicant (in Block Letters):_______________________
2. Fathers name (In Block Letters): ____________________________ Affix recent
3. Date of birth (with age in yrs):_______________ passport size
photograph
4. Sex : (Male/ Female) _____________________ (attested)
5. Nationality: ___________________
6. Marital Status: _________________
7. Whether belongs to reserve category (Yes/No) Category details __________
8. Permanent Address:__________________________________________
__________________________________________
9. Correspondence Address with Contact (Mobile) No _________________
__________________________________________
10. Educational Qualifications:
Sr. Educational Year of University/ Maximum Marks %age
No. qualification passing Board Marks obtained
11. Experience if any:
Sr. Name of the Designation Duration Total Period
No. Employer
From To
TOTAL
Declaration
I____________________ hereby declare that the particulars furnished by me in this application form are
true to the best of my knowledge and belief. In case any information is found to be incorrect, my
candidature shall liable to be rejected.
(Signature of the Applicant)
Dated: