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SR Application Form 2025

This document is an application form for the Compulsory Government Service for Senior Residents in 2025, requiring candidates to provide personal and educational details. It includes sections for contact information, community status, date of birth, and bank account details. Candidates must join their assigned medical college or hospital between April 1st and 4th, 2025, or after completing 36 months of their PG course.

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ali baridi
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429 views1 page

SR Application Form 2025

This document is an application form for the Compulsory Government Service for Senior Residents in 2025, requiring candidates to provide personal and educational details. It includes sections for contact information, community status, date of birth, and bank account details. Candidates must join their assigned medical college or hospital between April 1st and 4th, 2025, or after completing 36 months of their PG course.

Uploaded by

ali baridi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FORM

COMPULSORY GOVERNMENT SERVICE - SENIOR RESIDENTS - 2025


(Please download two copies and submit at the time of counselling)
Degree: MD/MS: Speciality: ______________________________________
AFFIX PHOTO
Name of College completed PG: ___________________________________

1.Name of the Candidate :_________________________________________


(Full Name in block letter including surname)

2.Email-id :__________________________________________

3.Phone / Mobile No. :__________________________________________

4.Address for communication :__________________________________________

____________________________________________

_______________________Pincode:____________

5. Sex:Male/Female 6. Community: OC/BC-A/B/C/D/ SC/ST

7.Date of Birth (DD/MM/YY) :

8.Permanent Address _______________________________________

_______________________________________

Pincode:_______________________________

Contact No :______________________________________

10. Total Marks obtained in the Degree :____________(out of _______)

11. Details of Bank Account

1) Name of the Bank and Branch :______________________________________

2) Account No :______________________________________

3) IFSC code :______________________________________


12. PAN Number:
13. Aadhar Number: __________________________________

Signature of Candidate

(For office use only)


Allotted for posting as Senior Resident for a period of one year from _________________ at

_________________________________________________Medical College / Hospital in the

department of _____________________________.

Candidate should join between 1st and 4th April 2025, or after the completion of 36 months of the
PG course.

DIRECTOR OF MEDICAL EDUCATION

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