Online Recruitment Management System
 
 
APPLICATION FORM
PERSONAL DETAILS
1. Post Applying For * :  
3. Applicant Name (As in 10th Certificate) * :  
4. Father's Name(As in 10th Certificate) * :  
5. Date Of Birth * :  
6. District of Domicile :
7. Gender * :  
8. Age as on :
9. Category * :  
10. Physically Challenged :  
11. Present Contact Address * :  
12. Permanent Contact Address * :
 
13. Mobile No. :
14. Email Address :  
15. Language Spoken/Written * :  
16. QUALIFICATION DETAILS
Exam Passed Name of Board/University Year Of Passing Month of Passing
Marks(excluding 4th optional)
Full Mark Marks
Secured
Percentage
Duration Of Course Full/Part Time
       
 
17. Regd. No & Name of Board / Council  Registration No. Name of Board / Council
18. Experience Details
Name of the Employer Post Held From Date To Date
Total
Year Month
Job Description Salary
Total Experience
DECLARATION
I do hereby declare that the information furnished above are true to the best of my knowledge and belief and that, if at any stage, it is found that any of the above material information is false / incorrect or is suppressed by me, my candidature / appointment under Odisha State Health & Family Welfare Society (OSH&FWS), Odisha is liable to be rejected/terminated.I also declare that I have never been disengaged from service under the OSH&FWS,Odisha on administrative ground such as disobedience/poor performances/misbehavior/criminal activity etc.

Further, I undertake that I shall produce all original certificates/documents in support of the above information at the time of interview/certificate verification.
 

List of District Preferences

 
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