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    Application Proforma For the post of Senior Resident

    To

    Director Principal

    Govt. Medical College,

    Patiala.

    Subject: Application for the Post of Senior Resident at Govt. Medical College, Patiala.

    Recent Photo

    Part-A

    1.

    Choice of speciality (maximum 3)

    2.

    Category (1-7)under which you are applying (For details of each category see Punjab Govt. Notification No. 1/70/2022-2HB3/2268 dated 23.08.2022 )

    3.

    Have you done Senior Residency earlier, if yes, Then Details there of

    Part-B

    1.

    Name

    2.

    Father's Name / Husband's Name

    3.

    Date of Birth

    4.

    Age in years

    5.

    Mobile No

    6.

    Permanent Address

    7.

    Correspondence Address

    8.

    E-mail Address

    9.

    Aadhar No

    10.

    Whether you belongs to SC, BC or Differently abled ( if yes only then attach proof thereof )

    11.

    Present designation and posting(In case of Category 1 to 5)

    12.

    Date of Joining in service

    13.

    Attach Details of Service (Service Certificate from the Controlling Authority) (compulsory for Category 1 to 5)

    14.

    Total Rural Service (Category 1 to 5)

    15.

    Punjab Medical Council Registration Number

    16.

    Do you have serve Bond with Govt. of Punjab Yes/No

    17.

    Whether probation has been cleared Yes/No

    18.

    NOC from Competent authority (compulsory for category 1 to 5) (attach Proof)

    Part C-Details of Qualification

    Details of MBBS

    1

    College
    University
    Date of degree
    Total Marks Marks Obtained %age
    1st Prof
    2nd Prof
    Final Prof Part-1
    Final Prof Part-2
    Total
    No. of Attempts in MBBS(Please Attach Attempt Certificate)
    MBBS Degree

    Details of M.D. / M.S.

    2

    Specialty in which MD/MS
    College
    University
    Date of Degree
    Total Marks Marks Obtained %age
    M.D./M.S.
    No. of Attempt in M.D. / M.S. (please attach attempt certificate)
    M.D. / M.S. Degree

    Details of D.M. / Mch

    3

    Subject in which DM/Mch passed
    Total Marks Marks Obtained %age
    DM/M.Ch

    4

    have you been Convicted by any court in India / Abroad
    Whether any vigilance / Departmental enquiry is pending (If yes details there of )

    Certified that particular given above are true and correct to the best of my knowledge and nothing has been concealed therein

    Place:

    Date:

    Name:

    Note:The Copy of the online submissions will be automatically emailed to your above mentioned email account.