test 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 ) ---1234567 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 ) ---yesno 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 ---YesNo 17. Whether probation has been cleared Yes/No ---YesNo 18. NOC from Competent authority (compulsory for category 1 to 5) (attach Proof) ---YesNo 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.