SWAMI VIVEKANANDA YOUTH MOVEMENT
Application Form
CA 2, KIADB Industrial Housing Area, Hebbal, Mysore – 570016, Karnataka
Tel/Fax: 91 0821 2415412; Email: info@[Link] website: [Link]
Source:
Date: Full Legal Name
Ref/Ads/ Website/
[Link].S.Y Social Media
Age Gender Date of Birth Caste* Category* Married
66 yrs Male 15/02/1959 Hindu (Ambiga) OBC Yes YesNo
Family Details
Name Relationship Age Occupation
Dr. Sudha K.V Wife 63 Doctor
[Link].V Daughter 32 Doctor
Present Address Contact No. (Landline/Mobile)
B4-0003 L&T South city apartments,Near Arekere Mico Layout,
Bannerghatta Road BENGALURU-560076 9482278382
Permanent Address Contact No. (Landline/Mobile)
B4-0003 L&T South city apartments,Near Arekere Mico Layout,
9482278382
Bannerghatta Road BENGALURU-560076
Email Address: Blood Group
B+ve
doctorvk@[Link]
Emergency Contact (Family / Immediate relation contacts only)
Sl. No. Name Address Contact No. Relation
1 2nd Cross Vivekanand Nagar
[Link] K.V Behind Idhga Hoskote Banglore 9972888435 Wife
Rural district -562114
2 Anugrah Nilaya chowdeshwari
[Link] Colony Brahmpur Gulbarga - 9845832734 Nephew
585103
Post Applied for Senior Consultant Pediatrics Available joining date: 1st May 2025
Current/Previous drawn Rs 3 lakhs per Salary Expected
salary Rs 3 lakhs per month
Month
Are you an Ex-employee of SVYM? If Yes, please mention details
ESI No.
Yes / No
No PF No.
Aadhaar No. PAN No. UAN NO.
5284 5395 0680 ACSPV1012B
Hobbies and Interests:
Do you have a Driving License? Date of issue Date of expiry If Yes, please mention details
Yes / No 12/12/2008 23/07/2029
Yes
*Required as per govt. norms. Confidentiality will be maintained.
Education
School Class/ Course Name of the Institution / Year Graduated
University Yes/ No
High School
Govt junior college Bijapur 1972-1975 Yes
P.U.C/12th
Govt junior college Bijapur 1975-1977 Yes
Graduation 1978-Jan
MBBS Karnataka Medical college Hubballi Yes
1984
Post-Graduation Jan 1985-
MD paediatrics JN medical college Belagavi Yes
Feb 1988
Others
Training
Course Name of the Institution Location Year Period/
Duration
Details of Present & Previous Employment
Years of Period Names and address of Title or Duties and Reason for leaving
Employment organization position responsibilities
20 yrs Narayana Hrudayalaya Senior Emergency critical care
2002-2022
Banglore consultant Ped. Critical care
Nov 2022- Jan 2yrs 3 Kmc hospital Ambedkar Senior
Ped. Critical care
2025 Months Circle Mangaluru Consultant
Reference (Previous Employer)
Name Address & E-Mail Id Contact Number
I certify that information contained in this application is true and complete. I understand that false information
may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am
hired, I authorize the verification of any or all information listed above.
Signature of Applicant
Date of Interview:
Note: Application should be filled by applicant’s own handwriting either in Kannada or English. Receiving the
application from the applicant does not purport to be commitment on the organization to invite the candidate for
interview.
For office use only
Interview assessment remarks
Shortlisted - Yes No On Hold Offered CTC - Designation -
Remarks (if any) Signature of Interviewer
