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 Stick here
latest
Photograph,
Recruitment 2024 Sign Across
Application Form
Health and Family Welfare Training Center, Nashik
(All fields in the forms are mandatory to be filled. Incomplete form submitted will be treated as rejected)

Exact Name of Post applied for :

Name:

Father’s/Husband’s Name:

Date of Birth(DD/MM/YYYY) Blood Group: Gender:

Marital status : Existing NHM Employee Nationality:

(Yes/ No)

Address/Contact Details: (Name of the District and Pin code is compulsory)

Address(Present): Address (permanent):(Write same if same as
Present Address)

State
State

Pin:
Pin:

Contact No:
Contact No:

E-Mail Id Correspondence: Alternate E-mail id for Correspondence (if any):

Languages Known: English Hindi Marathi Other (Please Specify below)

(Write “Y” / “N”)

Computer Proficiency:

Academic /Professional Educational all summary: (Starting form most recent)

From TO Degree/Diploma University/Institute Specialization Final Year Total Final Year

/Subjects Marks & Percentag
(MM/YY) (MM/YY)
Obtained Marks e ( %)

Permanent Work Registration No: (Only for MO/Pharmacist /SN) :-

Work/Experience Summary :( Starting form current/most recent)

Experience in ZP / Govt./ UNICEF/ WHO / Similar Organisation

Sr. No Form To Organization Designation Responsibilities

(MM/YY
(MM/YY) (Min.30 & Max.50 Words)

Total Experience (In Years & Months): Relevant Experience to the post applied (In Years &
Months):
Details of Internship /Workshops/Conferences/Trainings Attended (if any):

Declaration:

I hereby declare that all statements made in the application are true, Complete and correct to the best of my
knowledge and belief. I understand that in the event of any information being found untrue/false/incorrect or I
do not satisfy the eligibility criteria my candidature will be cancelled without assigning any reason thereof. I
have read the content of the advertisement and agree to abide by the rules, regulations and procedures for
appointment to the post applied for.

Name:

Place:

Date Signature

Disclaimer:

The applicants are required to submit the full filled application on the day of walk in Interview

Checklist for documents to be submitted during walk in Interview

1) Full filled Application form in the prescribed format.

2) Graduation Final years marksheet.
3) If any post-graduation, Post-graduation certificate &Marksheet
4) Experience – if possesses experience attach Proof of experience.
5) Computer Proficiency - MS - CIT
6) For age Proof – School Leaving Certificate/ 10th or 12 th Passing Certificate
7) Two sets of documents – Self attested & with originals for verification.