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Vrdlappldec 1

This document is an application form for a contract post at the SRI Venkateswara Institute of Medical Sciences, specifically within the Department of Clinical Virology. It collects personal information, educational qualifications, work experience, and other relevant details from the applicant. The form also includes a declaration statement and sections for office use regarding document verification.

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Ashok G
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49 views3 pages

Vrdlappldec 1

This document is an application form for a contract post at the SRI Venkateswara Institute of Medical Sciences, specifically within the Department of Clinical Virology. It collects personal information, educational qualifications, work experience, and other relevant details from the applicant. The form also includes a declaration statement and sections for office use regarding document verification.

Uploaded by

Ashok G
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

SRI VENKATESWARA INSTITUTE OF MEDICAL SCIENCES: TIRUPATI SVIMS

(A University established by an Act of A.P. State Legislature)


TIRUMALA TIRUPATI DEVASTHANAMS
DHR-ICMR-SVRDL

Department of Clinical Virology


Latest PP
Application form Photograph

1. Name of the contract post applied for :


2. Name of the Project : _______________ ___________

3. Name in full (IN BLOCK LETTERS) :

4. Title (Ms, Mr, MRs, Dr, etc.,) :


5. Mother’s Name :
Father’s Name :
Husband’s Name :

6. Address for Correspondence :

Mobile No: E-mail ID:

7. Permanent Address :

8. Date of Birth :
DD / MM / YYYY
Age as on 20/12/2021: Years Months
9. Whether SC/ST/OBC/General : Caste:

10. Whether Physically Handicapped : Yes/No If Yes percentage of disability


Type of disability

11. Marital Status : Married / Single

12. Educational Qualifications (SSC Onwards) (attach additional sheet if required):

SR. EXAM PASSED GRADE YEAR OF BOARD/


SPECIALIZATION
NO. PASSING UNIVERSITY
1

5
6
13. Work Experience starting from latest (Total Experience Years Mont

PERIOD
SR. POST HELD & NAME OF THE REASON FOR
NO. SCALE OF PAY EMPLOYER LEAVING
FROM TO
1

14. Employment Exchange Registration details, [if available]: No.: Exchange:


15. If selected what period would you require joining the post: _
16. Have you ever been declared unfit by a Medical Board/Court for appointment in any Govt.
service?
Yes / No (If yes, details)
I hereby declare that the particulars furnished in this form by me are true to the best
of my knowledge and belief. If any of the above information is found to be incorrect or
misleading, I am liable to be disqualified for the recruitment process.

Date:

Place:

Signature of the Candidate

--------------------------------------------------------------------------------------------------------------------

Office Use only

All the original documents that support the details mentioned in the application are verified:

Remarks:………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………

Name and signature of the person verifying the documents:…………………………………….


……………………………………..

Date …………..……………
Time………………………..

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