5th Floor, Prayaas Building, Sector-38B, Chandigarh
0172-4012011    0172-4012012

Walk-In Specialist (Gen. Surgery, Medicine, Pathology, Ophthalmology, Orthopaedics, ENT, TB & Chest and Skin & VD)

(*) - Star marked fields are essentially to be filled by the candidate.

Note 1:Name as recorded in the Matriculation Examination Certificate.
Note 2: Please do not use any prefix such as Shri/ Mr./ Ms./ Dr./ Mrs. etc.

[Date of Birth as recorded in the Matriculation Examination Certificate]

[Please do not use any prefix such as Shri/ Mr. or Dr. etc.]

[Please do not use any prefix such as Smt/ Mrs. or Dr. etc.]
 Degree Year of Passing University/Board Maximum Marks Marks Obtained %age
 Matric *
 10+2 *
 Graduation *    No. of Attempts:
 Post Graduation
No. of Attempts:
if instead of marks, grade is given in MD/MS/DNB then fill 1 in maximum marks and marks Obt
S.No. Name of Institution Department/ Organization Designation Experience Category From Period To Period Total Period
1 Y M
2 Y M
3 Y M
4 Y M
5 Y M
Total Experience  Years Months
Select Author Type Journal details (Please Mention Journal Name/Subject/Topic/date of Publication)
Marks of MBBS Out of 20 No. of Attempts Marks of MBBS out of 20 After Deduction
Marks of MD/MS/DNB Out of 65 No. of Attempts Marks of MD/MS/DNB out of 65 After Deduction
Marks for Gold Medal out of 5 Marks for Experience out of 5 Marks for Publications out of 5
Final Score out of 100
   I hereby state that the information given above is correct and nothing has been concealed.
   I hereby declare that I don't have any criminal case/conviction/any vigilance enquiry instituted against me.
   I fulfill all the conditions of eligibility as given in the advertisement and other relevant instructions.
   I hereby declare that I have checked the relevant documents and I agree to email these documents to nrc.dhspunjab@gmail.com after the sucessfull submission of this form