District Health & Family Welfare Samiti, Jalpaiguri

APPLICATION FORM

To
The CMOH & Secretary
District Health & Family Welfare Samiti, Jalpaiguri

* Application for the Post of :

Post Code:

* Name of the Applicant :

* Father's/Husband's Name :

* Residential Address :

* Pin Code:

* Sex :

6. * Date of Birth: Age as on 31^st March, 2015 Yrs.

* Caste Status :

8. *Mobile No.

* Email ID :

10.

* Essential: Qualification & Other

EXAMINATION	Board/University/Degree	Total Marks (Excluding Optional)	Marks Obtained (Excluding Optional)	% of Marks
Madhyamik (10th)
HS (10+2)
Graduation or Recognized Sanitary Inspector Course

Ability to drive two wheeler
Valid driving licence no. with expiry date
Computer Course

11.

* Preferential Qualification:

a. Tuberculosis health visitor's recognized course:
b. Govt. recognized degree/diploma in Social Work or Medical Social Work:
c. Successful completion of basic training course (Govt. recognized) for Multi-purpose health workers:

* A. Experience in maintenance of Accounts in double entry system	Govt. Experience
	Private Experience

* B Experience in working with accouting software	Govt. Experience
* B Experience in working with accouting software	Private Experience

C Audit Experience in recognized society or Institution	Govt. Experience
C Audit Experience in recognized society or Institution	Private Experience

12. * Upload Passport Size Photograph
(Size must by wide 120 pixel x Height 160 pixel, 600Kb, jpeg/jpg Image)

13. * Upload Full Signature
(Size must by wide 160x height 60 pixel, 500Kb, jpeg/jpg Image)

14.

* I do hereby decalre that particulars furnished above are correct.

* Enter Verification Code

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