EMPLOYEES’ STATE INSURANCE CORPORATION
PANCHDEEP BHAWAN, C.I.G. MARG, NEW DELHI‐110002. www.esic.nic.in (Tel./Fax.011‐23230963) e‐mail: jd‐rectthq@esic.in, jd‐rectt@esic.nic.in
RECRUITMENT OF SPECIALISTS GRADE-II (JR. SCALE) IN ESI CORPORATION
Employees’ State Insurance Corporation is a statutory body constituted under an Act of Parliament (ESI Act, 1948) and works under the administrative control of Ministry of Labour and Employment, Government of India. Employees’ State Insurance Corporation proposes to recruit Specialist Gr. II (Jr. Scale) on direct recruitment basis. The Region wise detail of vacancies is as under:
NAME OF THE STATE & ESIC HOSPITALS
| |||||||||||||||||||||||||||||||||||
Kerala
| |||||||||||||||||||||||||||||||||||
Assam
|
Bihar
|
Chandigarh
|
Haryana
|
Himachal
|
Jammu &
|
Jharkhand
|
(ESICHs,
|
Orissa
|
Punjab
|
Rajasthan
| |||||||||||||||||||||||||
Specialty
|
(ESICH,
|
UT
|
(ESICHs,
|
Pradesh
|
Kashmir
|
(ESICH,
|
Ashramam
|
(ESICHs,
| |||||||||||||||||||||||||||
(ESICH,
|
(ESICH,
|
(ESICH,
| |||||||||||||||||||||||||||||||||
Beltola)
|
(ESICH,
|
Gurgaon &
|
(ESICH,
|
(ESICH,
|
Adityapur,
|
, Ezukone
|
Jaipur &
| ||||||||||||||||||||||||||||
Patna)
|
Rourkela)
|
Ludhiana)
| |||||||||||||||||||||||||||||||||
Chandigarh)
|
Manesar)
|
Baddi)
|
Jammu)
|
Ranchi)
|
& Udyog ‐
|
Bhiwadi)
| |||||||||||||||||||||||||||||
mandal
| |||||||||||||||||||||||||||||||||||
1.
|
2.
|
3.
|
4.
|
5.
|
6.
|
7.
|
8.
|
9.
|
10.
|
11.
| |||||||||||||||||||||||||
ST‐01 &
|
SC‐01,
|
SC‐01,
|
SC‐01 &
| ||||||||||||||||||||||||||||||||
Anesthesia
|
‐‐
|
UR‐01
|
SC‐01
|
OBC‐01
|
‐‐
|
‐‐
|
OBC‐01 &
|
UR‐01
|
OBC‐01
| ||||||||||||||||||||||||||
OBC‐02
|
OBC‐01
| ||||||||||||||||||||||||||||||||||
UR‐04
|
& UR‐01
| ||||||||||||||||||||||||||||||||||
Pulmonary
|
SC‐01,
| ||||||||||||||||||||||||||||||||||
OBC‐01
|
UR‐01
|
OBC‐01
|
‐‐
|
OBC‐01
|
UR‐01
|
UR‐02
|
ST‐01 &
|
UR‐01
|
‐‐
|
OBC‐01
| |||||||||||||||||||||||||
Medicine
| |||||||||||||||||||||||||||||||||||
UR‐01
| |||||||||||||||||||||||||||||||||||
SC‐01 &
|
SC‐01,
| ||||||||||||||||||||||||||||||||||
Obst. & Gynae.
|
‐‐
|
‐‐
|
SC‐01
|
UR‐01
|
‐‐
|
SC‐01
|
OBC‐01 &
|
‐‐
|
UR‐01
|
‐‐
| |||||||||||||||||||||||||
ST‐01
| |||||||||||||||||||||||||||||||||||
UR‐01
| |||||||||||||||||||||||||||||||||||
Pathology
|
‐‐
|
‐‐
|
‐‐
|
OBC‐01 &
|
‐‐
|
UR‐01
|
UR‐01
|
OBC‐01 &
|
UR‐01
|
UR‐02
|
SC‐01
| ||||||||||||||||||||||||
UR‐01
|
UR‐01
| ||||||||||||||||||||||||||||||||||
Radio‐Diagnosis
|
‐‐
|
‐‐
|
ST‐01
|
OBC‐01 &
|
UR‐02
|
OBC‐01
|
SC‐01 &
|
SC‐01 &
|
OBC‐01
|
UR‐02
|
UR‐02
| ||||||||||||||||||||||||
UR‐02
|
OBC‐01
|
UR‐03
| |||||||||||||||||||||||||||||||||
Microbiology
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
ST‐01
|
‐‐
|
OBC‐01
|
‐‐
| ||||||||||||||||||||||||
Biochemistry
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
UR‐01
|
‐‐
|
OBC‐01
|
SC‐01
| ||||||||||||||||||||||||
Dermatology &
|
‐‐
|
UR‐01
|
‐‐
|
OBC‐01
|
ST‐01
|
OBC‐01
|
OBC‐01 &
|
SC‐01 &
|
SC‐01
|
OBC‐01
|
OBC‐01
| ||||||||||||||||||||||||
STD
|
UR‐01
|
ST‐01
| |||||||||||||||||||||||||||||||||
Oto‐Rhino –
|
SC‐01 &
| ||||||||||||||||||||||||||||||||||
Laryngology
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
OBC‐01
|
OBC‐01
|
‐‐
|
‐‐
|
UR‐01
| |||||||||||||||||||||||||
UR‐01
| |||||||||||||||||||||||||||||||||||
(ENT)
| |||||||||||||||||||||||||||||||||||
SC‐01,
| |||||||||||||||||||||||||||||||||||
Ophthalmology
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
UR‐01
|
‐‐
|
UR‐01
|
OBC‐01 &
|
‐‐
|
‐‐
|
UR‐01
| ||||||||||||||||||||||||
UR‐01
| |||||||||||||||||||||||||||||||||||
SC‐01,
| |||||||||||||||||||||||||||||||||||
Pediatrics
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
UR‐01
|
UR‐01
|
UR‐01
|
OBC‐01 &
|
UR‐01
|
UR‐02
|
OBC‐01
| ||||||||||||||||||||||||
UR‐02
| |||||||||||||||||||||||||||||||||||
General Surgery
|
‐‐
|
‐‐
|
‐‐
|
OBC‐01
|
OBC‐01
|
UR‐01
|
‐‐
|
OBC‐01 &
|
‐‐
|
OBC‐01
|
‐‐
| ||||||||||||||||||||||||
UR‐04
| |||||||||||||||||||||||||||||||||||
General
|
‐‐
|
‐‐
|
‐‐
|
OBC‐01
|
OBC‐01
|
UR‐01
|
‐‐
|
OBC‐01 &
|
‐‐
|
OBC‐01
|
OBC‐01
| ||||||||||||||||||||||||
Medicine
|
UR‐03
|
& UR‐01
| |||||||||||||||||||||||||||||||||
Orthopedics
|
‐‐
|
‐‐
|
‐‐
|
SC‐01 &
|
‐‐
|
‐‐
|
‐‐
|
OBC‐01
|
‐‐
|
UR‐01
|
OBC‐01
| ||||||||||||||||||||||||
UR‐01
| |||||||||||||||||||||||||||||||||||
Psychiatry
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
‐‐
|
UR‐01
|
‐‐
|
UR‐01
|
‐‐
| ||||||||||||||||||||||||
Total
|
01
|
03
|
04
|
15
|
10
|
08
|
12
|
41
|
06
|
18
|
13
| ||||||||||||||||||||||||
No. of Posts
| |||||||||||||||||||||||||||||||||||
reserved for
| |||||||||||||||||||||||||||||||||||
Persons with
|
01
|
01
|
01
|
02
|
01
|
01
|
01
|
02
|
01
|
01
|
02
| ||||||||||||||||||||||||
Disabilities
| |||||||||||||||||||||||||||||||||||
(PWDs)
| |||||||||||||||||||||||||||||||||||
Note 1: The candidates appointed under PWD quota will be adjusted against the vacancy of respective categories of SC/ST/OBC/General.
Note 2: Above vacancies may increase or decrease depending upon the actual requirement.
Name of Specialty identified
|
Categories
|
of
|
disable,
|
Name of Specialty identified
|
Categories of disable,
| |
as suitable for PWDs
|
suitable for job
|
as suitable for PWDs
|
suitable for job
| |||
Anesthesia
|
OL
|
Dermatology & STD
|
OL
| |||
Pulmonary Medicine
|
OL
|
Oto‐Rhino – Laryngology
|
OL
| |||
(ENT)
| ||||||
Pathology
|
OL, OA
|
Pediatrics
|
OL
| |||
Radio‐Diagnosis
|
OL
|
General Medicine
|
OL
| |||
Microbiology
|
OL, OA
|
Psychiatry
|
OL
| |||
Biochemistry
|
OL
| |||||
Abbreviations Used:
1. OL – One Leg,
2. OA – One Arm.
Scale of Pay: PB‐3 Rs‐15600‐39100/‐ with Grade Pay of Rs.6600/‐ plus Non ‐ Practicing Allowance (NPA) as admissible to analogous posts in the Central Health Service.
Age Limit: Not exceeding 45 years as on 14.10.2013. (Relaxable up to 5 years for employees of the Employees’ State Insurance Corporation and Government Servants Upper age limit is also relaxable for SC/ST/OBC/PWD/Ex‐Servicemen candidates as per Govt. of India instructions.
Relaxation in age ‐ SC / ST / OBC candidates shall be eligible for age relaxation to the extent of the posts reserved for these categories. In case vacancies are not reserved for these categories of applicants in any of the above speciality, the candidates shall not be eligible for any age relaxation.
Essential Qualifications:
1. A recognized medical qualification included in the first or second Schedule of Part‐II of third Schedule (other than licentiate qualifications) to the Indian Medical Council Act, 1956. Holders of educational qualification included in Part‐II of the Third Schedule should also fulfill the conditions stipulated in Sub‐Section (3) of Section 13 of the Indian Medical Council Act, 1956.
2. Post Graduate Qualification in the requisite speciality as mentioned in Table A or equivalent.
3. Work experience in a responsible position connected with the speciality for a period of:
a) 3 years in case of Post Graduate Degree Holder.
b) 5 years in case of Post Graduate Diploma Holder.
4. Language Test: The candidate shall have passed middle level examination in official language of the State concerned where the vacancies are notified or if no candidate is available who fulfills the required conditions, Selection Board will have powers to recommend candidates who have working knowledge of local language.
NOTE I: Work experience after obtaining the P.G. degree/ diploma will be reckoned as on 14.10.2013. Experience certificates duly signed by the Head of Department indicating clearly the period and nature of work, should be submitted along with the application form.
NOTE II: The qualifications regarding experience in respect of Scheduled Castes and the Scheduled Tribes candidates is relaxable based on the guidelines issued by the Government of India from time to time.
Recognized Post Graduate Qualification for recruitment to Group‐“A” posts in E.S.I. Corporation.
S. No.
|
Subject
|
Requisite Post Graduate Degree Qualification.
|
Requisite Post Graduate Diploma
|
Qualification.
| |||
NON CLINICAL
| |||
01
|
General Medicine
|
M.D. (General)
| |
M.D. (General Medicine)
| |||
M.D. (Medicine & Therapectics)
| |||
M.R.C.P.
| |||
Speciality Board of Internal Medicine (USA)
| |||
02
|
Pediatrics
|
M.D. (Paediatrics)
|
Diploma Paed. D.C.H.
|
03
|
Tuberclosis
|
M.D. (Tuberclosis)
|
T.D.D.
|
M.D./M.R.C.P. in Medicine with T.D.D., D.T.D. or D.T.D.C.
|
D.T.D.
| ||
D.T.D.C.
| |||
04
|
Dermatology
|
M.D. (Dermatology)
|
D.D.
|
M.D. (Dermatology & Venereology)
| |||
Speciality Board of Dermatology (USA)
| |||
05
|
Psychiatry
|
M.D. (Psychiatry)
| |
M.D. (Psychological Medicine)
| |||
Speciality Board of Psychiatry and Neurology (USA)
| |||
D.P.M. of two years course, Diploma in Psychiatry (Edin) of two
| |||
years course.
| |||
Diploma in Psychiatry (Mc.Gill) University, Montreal, Canada of
| |||
two years course.
| |||
06
|
General Surgery
|
M.D. (Surgery)
| |
M.S. (General Surgery)
| |||
Speciality Board of Surgery (USA)FRCS
| |||
07
|
Orthopaedics
|
M.S. (Ortho)
|
D. Ortho.
|
M.Ch. (Ortho)
| |||
Speciality Board of Ortho Surgery (USA)
| |||
08
|
Ophthalmology
|
M.S. (Ophthalmology)
|
D.O.
|
M.D. (Ophthalmology)
|
D.O.M.S.
| ||
Speciality Board of Ophthalmology (USA)
| |||
09
|
Oto‐Rhino‐Laryngology
|
M.S. (Oto‐Rhino‐Laryngology)
|
D.I.O.
|
ENT
|
Speciality Board of Laryngology (USA)
|
D.O.R.L.
| |
10
|
Obst. & Gynae
|
M.D. (Obstetrics and Gynaecology)
|
D.G.O.
|
M.S. (Obstetrics and Gynaecology)
| |||
M.D. (Mid & Gyane)
| |||
M.S. (Gynae)
| |||
M.O.
| |||
M.R..C.O.G.
| |||
Speciality Board of Obstetrics and Gynaecology (USA)
| |||
11
|
Radio‐diagnosis
|
M.D. (Radio‐diagnosis)
|
D.M.R.D. or equivalent Diploma of
|
D.M.R.D. or equivalent Diploma of two years duration.
|
one year duration.
| ||
Note: The persons who have done their M.D. in Radiology or
| |||
Diploma in Radiology before 1985 will also be eligible to apply
| |||
to the post of Radio‐diagnosis and Radio – Therapy.
| |||
12
|
Anesthesiology
|
M.D. (Anesthesiology)
|
D.A.
|
D.A. (Two years’ course)
| |||
FFARCS (by examination)
| |||
Speciality Board of Anesthesiology (USA)
| |||
13
|
Chest/Respiratory Diseases
|
M.D. Respiratory Diseases and T.B.O. or Diploma National
|
T.D.D.
|
Board (Respiratory Diseases)
|
D.T.D.
| ||
M.D. (Medicine) with Diploma National Board (Respiratory
|
D.T.C.D.
| ||
Diseases).
| |||
CLINICAL
| |||
14
|
Pathology
|
M.D. (Pathology)
| |
M.D. (Pathology & Bacteriology) D.C.P.
| |||
M.D. (Pathology & Bacteriology) D.P.B.
| |||
M. Sc. (Pathology)
| |||
M. Sc. (Medical Pathology)
| |||
Ph. D. (Pathology)
| |||
D. Sc. (Pathology)
| |||
Speciality Board of Pathology (USA)
| |||
15
|
Bacteriology/Microbiology
|
M.D. (Bacteriology)
|
D. (Bact.)
|
M.D. (Microbiology)
|
D.P.B.
| ||
M.D. (Bact. With Pathology)
| |||
M. Sc. (Microbiology)
| |||
M. Sc. (Bacteriology)
| |||
16
|
Bio‐chemistry
|
M.D. (Bio‐Chemistry)
| |
M. Sc. (Medical Bio‐Chemistry)
| |||
Ph. D (Bio‐Chemistry)
| |||
D. Sc. (Bio. Chemistry)
|
HOW TO APPLY:
The duly filled Application Form along with enclosures shall also be submitted at the office of the concerned SSMC/SMC as under:
TABLE ‐ B
Name of the State in
|
Address of the SSMC/SMC of the
|
Name of
|
the city
| |||||
where
|
the
| |||||||
Sl. No.
|
which the candidate
|
concerned State where Application
|
Demand
|
Draft is
| ||||
wants to apply
|
Form is to be submitted
|
payable
| ||||||
Senior
|
State
|
Medical
| ||||||
1.
|
Assam
|
Commissioner,
|
ESI
|
Corporation,
|
Kolkata
| |||
Panchdeep
|
Bhawan,
|
5/1, Grant
| ||||||
Lane, Kolkata – 700012.
| ||||||||
Senior
|
State
|
Medical
| ||||||
2.
|
Bihar
|
Commissioner,
|
ESI
|
Corporation,
|
Patna
| |||
Panchdeep
|
Bhawan,
|
Belly Road,
| ||||||
Opp.C.R. Building, Patna‐800001
| ||||||||
State Medical Commissioner,
| ||||||||
3.
|
Haryana
|
Regional Office,
|
Faridabad
| |||||
ESI Corporation, N.I.T.
| ||||||||
Sector – 16, Faridabad‐121002.
| ||||||||
State Medical Commissioner,
| ||||||||
ESI Corporation,
| ||||||||
4.
|
Himachal and Jammu
|
Regional Office,
|
Baddi
| |||||
& Kashmir
|
Housing Board, Phase – 1,
| |||||||
Sai Road, Baddi – 173205.
| ||||||||
Himachal Pradesh.
| ||||||||
Senior
|
State
|
Medical
| ||||||
Punjab & Chandigarh
|
Commissioner,
|
ESI
|
Corporation,
|
Chandigarh
| ||||
5.
|
Panchdeep
|
Bhawan, Block No.3,
| ||||||
UT
| ||||||||
Sector ‐ 19‐A, Madhya Marg,
| ||||||||
Chandigarh‐160020
| ||||||||
State Medical Commissioner,
| ||||||||
6.
|
Jharkhand
|
Regional Office, ESI Corporation,
| ||||||
ESI Hospital Campus,
|
Ranchi
| |||||||
Namkum, Ranchi‐834010.
| ||||||||
State Medical Commissioner,
| ||||||||
Regional Office, ESI Corporation,
| ||||||||
7.
|
Kerala
|
Panchdeep Bhawan,
|
Trissur
| |||||
North Swaraj Round,
| ||||||||
Thrissur‐680020.
| ||||||||
State Medical Commissioner,
| ||||||||
Regional Office, ESI Corporation,
|
Bhubaneswar
| |||||||
8.
|
Orissa
|
Panchdeep Bhawan,
| ||||||
Plot C, Janpath Unit No. IX
| ||||||||
Bhubaneswar‐751007.
| ||||||||
State Medical Commissioner,
| ||||||||
9.
|
Rajasthan
|
Regional Office, ESI Corporation
| ||||||
Regional Office, Udyog Bhawan,
|
Jaipur
| |||||||
Tilak Marg, Jaipur.
| ||||||||
S. No.
|
Category
|
Fee Amount
|
01
|
SC/ST/PWD/ Departmental Candidates,
|
NIL
|
Female Candidates & Ex Servicemen
| ||
02
|
All other categories
|
225/‐
|
Mode of payment: ‐
A Demand Draft of Rs.225/‐(as applicable) in favour of ‘ESI Fund Account No. I’, drawn on any scheduled bank payable at the respective city of the State for which the candidate wants to apply as mentioned in the Table – B has to be submitted alongwith the Application Form.
Note: ‐ i. Fee once paid will not be refunded under any circumstances.
ii. Only Demand Draft drawn on any Scheduled Bank valid for three months will be accepted. Application Fee paid by any other mode will not be accepted.
iii. The Demand Draft must be issued after the issuing date of this advertisement.
How to Apply: ‐
Duly filled and signed Application Form in the Performa appended below along with attested copies of certificates are to be sent in a cover super scribed “Application for the post of Specialist Gr. II (Jr. Scale)”, State Applied For _____________”, Specialty Applied For ____________________” by Registered Post/Speed Post so as to reach the office of the concerned SSMC/SMC of the concerned State at the above mentioned addresses.
The following testimonials should be attached with application form:
(a) One copy of recent self‐attested passport size photograph firmly pasted on the application form.
(b) Self‐attested copies of certificates and testimonials in support of proof of age (Date of Birth), Educational Qualification and Experience etc.
(c) Self‐attested copy of Community Status Certificate in the prescribed form in case of candidates belonging to SC/ST/OBC category. Candidates claiming reservation/age relaxation on grounds of belonging to OBC should submit the Community Certificate in Annexure ‐”A” prescribed vide Govt. of India, Department of Personal and Training OM No. 36012/22/93‐Estt.(SCT) dated 15.11.93 along with self‐declaration given in Annexure – ‘B’ failing which the benefit of reservation and age relaxation will not be given.
Those candidates who are employed in Govt./Semi Govt. /Autonomous bodies etc. should send their applications “Through Proper Channel”. However, they may send an advance copy of their application along‐with demand draft and other certificates and testimonials before the last date.
Note 1 :‐ The application and the other documents should be arranged in the following order one below the other and tightly tagged or stapled on the left hand side top corner:
1. Application Form.
2. Attested copies of certificates.
Note 2:‐The Demand Draft should not be tagged or stapled, but should be pinned or clipped at the top of the application form. The name and address of the candidates should be written on the reverse side of the Demand Draft.
The E.S.I. Corporation reserves the right not to call candidate for the interview.
(i) All eligible candidates should apply in the application format appended below on or before the last date for receipt of applications. Applications received after the last date will not be considered.
(ii) Selection will be made on the basis of interview which will be conducted by the Selection Board. The interview for the above posts will be held at a suitable place in the respective State preferably State capital which will be notified at the time of calling for interviews. The Corporation, however, reserves its right not to conduct interview in any of the venues and to call candidates in a State other than his/her choice, in the event of inadequate number of candidates available for interview in a particular venue. The results of the interview will be published on the website of the Corporation and no inquiry or correspondence in this regard will be entertained.
General Conditions:‐
(i) Mere submission of application does not confer any right to the candidate for being called for interview.
(ii) A candidate should submit only one application for one state. If a candidate wants to apply for more than one state he should submit separate Application Forms for different States.
(iii) Application should be submitted in the prescribed form appended below. It should be filled up in block/capital letters in the candidates own handwriting.
(iv) Incomplete or Unsigned applications or the applications received without the self‐attested copies of mark sheets/certificates in support of educational qualification, proof of age (Date of Birth), examination fee, caste certificate, experience certificates, photographs and those received after the last date of receipt of applications are liable to be rejected without any communication to the candidate.
(v) Wrong declarations/submission of false information or any other action contrary to law shall lead to cancellation of the candidature at any stage.
(vi) ESIC will not be responsible for postal delays.
Note 1 : The selected candidates will be kept posted in the State chosen, upto the promotional post in the respective cadre, as far as possible, but they are liable to be posted anywhere in India.
Note 2: The candidates must mention the state applied for in the application form and send it to the concerned ESIC Office as mentioned in the Table ‐ B.
Note 3: The crucial date for determining the age limit, work experience and other criteria regarding eligibility for the post shall be the closing date of receipt of applications from candidates in India i.e. 14.10.2013 (and not the closing date prescribed for those in Assam, Meghalaya, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim, Ladakh Division of Jammu and Kashmir State, Lahaul and Spiti District and Pangi Sub‐Division of Chamba District of Himachal Pradesh, Andaman and Nicobar Islands and Lakshadweep).
Caution: ‐ Canvassing in any form will be a disqualification.
Last date of receipt of application is 14.10.2013. (Last date for receipt of application from candidates residing in Assam, Meghalaya, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim, Ladakh Division of Jammu and Kashmir State, Lahaul and Spiti District and Pangi Sub‐Division of Chamba District of Himachal Pradesh, Andaman and Nicobar Islands and Lakshadweep will be 21.10.2013)
Dated: 30th August, 2013
Jt. Director (Recruitment)
1. (a) State Applied For ______________________
(b)
|
Speciality__________________________
|
Affix self‐attested
| ||
recent passport size
| ||||
2.
|
Particulars of the draft:
|
photograph here
| ||
(photograph should be
| ||||
(a)
|
Amount Rs.___________________________
|
firmly pasted on this
| ||
space and not stapled)
| ||||
(b) Name of issuing bank branch _____________
(c) D.D. No. ______________ dated___________
3.
|
Name in full (in block letters)
|
_____________________________________________
| |||||||
4.
|
Father’s / Husband's Name
|
____________________________________________
| |||||||
5.
|
(a) Date of Birth (in figures)
|
____________________________________________
| |||||||
(in words)
|
_________________________________________
| ||||||||
(b) Age as on closing date (i.e. 14.10.2013)
|
______ ___________________________________
| ||||||||
6.
|
(a) Religion
|
_________________________________________
| |||||||
(b) Nationality
|
_________________________________________
| ||||||||
7.
|
Mailing address
|
__________________________________________
| |||||||
(with e‐mail address
|
__________________________________________
| ||||||||
and telephone number)
|
__________________________________________
| ||||||||
8.
|
Permanent Address
|
__________________________________________
| |||||||
(with e‐mail address
|
__________________________________________
| ||||||||
and telephone number)
|
__________________________________________
| ||||||||
10.
|
Sex (write 1 for Male, 2 for Female)
| ||||||||
11.
|
(i)
|
(a)
|
If Person With Disability (PWD)
|
Yes / No
| |||||
(b)
|
Percentage of Disability
|
____________
| |||||||
(ii)
|
Whether Ex‐Serviceman
|
Yes / No
| |||||||
(iii) Whether ESIC / Govt. Employees
|
Yes / No
| ||||||||
12. Community to which applicant belongs (Write 1 for SC
2 for ST and
3 for OBC
4 for General
Contd…02/‐
‐‐ 02 –
13. ESSENTIAL EDUCATIONAL AND PROFESSIONAL QUALIFICATIONS
(Attach annexure, if necessary).
Name & Address of College
|
University
|
Duration
|
Degree/
|
Subjects
|
Percentage of marks
| |
Examination
|
obtained
| |||||
From
|
to
|
Passed
| ||||
Contd. …3/‐
‐3‐
14. DETAILS OF EMPLOYMENT (IN CHRONOLOGICAL ORDER) (Attach annexure, if necessary).
Name of the Organization (please
|
Position(s) held
|
Period of service
|
Nature of Work
|
Scale of
|
Basic Pay
| |
specify whether Central Govt./State
| ||||||
Govt./Public Sector /Autonomous
|
Pay
| |||||
Body/Private Sector
| ||||||
From
|
to
| |||||
16. Whether the post graduate qualification is recognized YES/NO
by Medical Council of India.
17. Training.
Institution
|
Period
|
Field of Training
|
18. Academic attainments and activities ______________ (Attach annexure, if necessary).
19. Details of Publications:
20. List of enclosures :
(i) (ii)
(iii) (iv)
(v) (vi)
(vii) (viii)
(ix) (x)
I hereby declare that all the statements made in this 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 false or incorrect at any stage, my candidature/appointment shall be liable to be cancelled / terminated summarily without notice or any compensation in lieu thereof.
I also affirm that No Objection Certificate from the present employer for applying this post has been applied for/taken.
If selected, I am willing to serve anywhere in India.
Place ___________
Date ___________
Signature of the Candidate
The form of certificate to be produced by Other Backward Classes candidates applying for appointment to posts under the Government of India.
This is
|
to certify
|
that Shri/Shrimati/Kumari*...........................................
|
son/daughter*
|
of
| ||
Shri...............................
|
of village/town* ...........................
|
in
|
District/Division*...............
|
of
|
the
| |
State/Union
|
Territory*..................................
|
belongs
|
to the
|
....................Community
|
which
|
is
|
recognised as a backward class under:
@ Government of India, Ministry of Welfare Resolution No. 12011/68/93-BCC (C) dated 10th September, 1993 published in the Gazette of India Extraordinary Part-I, Section-1, No. 186 dated 13th September, 1993.
@ Government of India, Ministry of Welfare Resolution No. 12011/9/94-BCC dated 19-10-94, published in the Gazette of India Extraordinary Part-I, Section-1, No. 163 dated 20-10-1994.
@ Government of India, Ministry of Welfare Resolution No. 12011/7/95-BCC dated 24-5-95, published in the Gazette of India Extraordinary Part-I, Section-1, No. 88 dated 25-5-1995.
@ Government of India, Ministry of Welfare Resolution No. 12011/96/94-BCC dated 9th March, 1996 published in the Gazette of India Extraordinary Part-I, Section-1, No. 60 dated 11th March, 1996.
@ Government of India, Ministry of Welfare Resolution No. 12011/44/96-BCC dated 6th December, 1996 published in the Gazette of India Extraordinary Part-I, Section-1, No. 210 dated 11th December, 1996.
@ Government of India, Ministry of Welfare Resolution No. 12011/99/94-BCC dated 11th December, 1997 published in the Gazette of India Extraordinary Part-I, Section-1, No. 236 dated 12th December, 1997.
@ Government of India, Ministry of Welfare Resolution No. 12011/13/97-BCC dated 3rd December, 1997 published in the Gazette of India Extraordinary Part-I, Section-1, No. 239 dated 17th December, 1997.
@ Government of India, Ministry of Social Justice and Empowerment Resolution No. 12011/68/98-BCC dated the 27th October, 1999 published in the Gazette of India Extraordinary Part-I, Section-1, No. 241 dated the 27th October, 1999.
@ Government of India, Ministry of Social Justice and Empowerment Resolution No. 12011/88/98-BCC dated 6th December, 1999 published in the Gazette of India Extraordinary Part-I, Section-1, No. 270 dated 6th December, 1999.
@ Government of India, Ministry of Social Justice and Empowerment Resolution No. 12011/36/99-BCC dated 4th April, 2000 published in the Gazette of India Extraordinary Part-I, Section-1, No. 71 dated 4th April, 2000.
@ Government of India, Ministry of Social Justice and Empowerment Resolution No. 12011/44/99-BCC dated the 21st September, 2000 published in the Gazette of India Extraordinary Part-I, Section-1, No. 210 dated the 21st September, 2000.
@ Government of India, Ministry of Social Justice and Empowerment Resolution No. 12015/9/2000-BCC dated 6th September, 2001 published in the Gazette of India Extraordinary Part-I, Section-1, No. 246 dated 6th September, 2001.
@ Government of India, Ministry of Social Justice and Empowerment Resolution No. 12011/1/2001-BCC dated 19th June, 2003 published in the Gazette of India Extraordinary Part-I, Section, 1 No. 151 dated 20th June, 2003.
@ Government of India, Ministry of Social Justice and Empowerment Resolution No. 12011/4/2002-BCC dated 13th January, 2004 published in the Gazette of India Extraordinary, Part-I Section-1, No. 9 dated 13th January, 2004.
@ Government of India, Ministry of Social Justice and Empowerment Resolution No. 12011/14/2004-BCC dated 12th March, 2007 published in the Gazette of India Extraordinary, Part-I, Section-1, No. 67 dated 12th March, 2007.
Shri/Shrimati/Kumari*................................
|
and/or* his/her* family ordinarily
|
resides in village/town*................................
| |
of......................
|
District/Division* of the State/ Union Territory* of.............................
|
This is also to certify that he/she* does
| |
not belong to the persons/sections* (Creamy Layer) mentioned in column 3 of the Schedule to the Government of India, Department of Personnel & Training O.M. No. 36012/22/93-Estt. (SCT) dated 8-9-1993, O.M. No. 36033/3/2004-Estt. (Res.) dated 9th March, 2004, O.M. No. 36033/3/2004-Estt. (Res.) dated 14th October, 2008 and OM No. 36033/1/2013-Estt. (Res.), dated: 27th May, 2013.
Signature................................
**Designation............................
(With seal of Office)
State/Union Territory
Place....................................................
Date.....................................................
*Please delete the words which are not applicable. @ Strike out whichever is not applicable.
NOTE: The term “ordinarily reside (s)” used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950.
(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Deputy Collector/1st Class Stipendiary Magistrate/† Sub-Divisional Magistrate/Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner.
†(not below of the rank of 1st Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officers not below the rank of Tehsildar.
(iv) Sub Divisional Officer of the area where the candidate and/or his/her family normally resides.
(v) Administrator/Secretary to Administrator/Development Officer (Lakshadweep)
Note 1: Candidates claiming to belong to OBCs should note that the name of their caste (including its spellings) as indicated in their certificates, should be exactly the same as published in the lists notified by the Central Government from time to time. A certificate containing any variation in the caste name will not be accepted.
Note 2: The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which his/her father originally belongs. A candidate who has migrated from one State (or part of the State) to another should, therefore, produce an OBC certificate which should have been issued to him/her based on his/her father’s OBC certificate from the State to which he (father) originally belongs.
Note 3: No change in the community status already indicated by a candidate in his/her simplified application form for this examination will ordinarily be allowed by the Commission.
Form of declaration to be submitted by the OBC candidate (in addition to the community certificate)
I ………………. Son/daughter of Shri…………………….resident of village/town/city…………………. district…………………. state………………hereby declare that I belong to the………………..community which is recognized as a backward class by the Government of India for the purpose of reservation in services as per orders contained in Department of Personnel and Training Office Memorandum No 36102/22/93-Estt. (SCT) dated 8-9-1993. It is also declared that I do not belong to persons/ sections/sections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred Office Memorandum dated 8-9-1993, O.M. No. 36033/3/2004-Estt. (Res.) dated 9th March, 200, O.M. No. 36033/3/2004-Estt. (Res.) dated 14th October, 2008 and OM No. 36033/1/2013-Estt. (Res.), dated: 27th May, 2013.
Signature:………………………..
Full Name:………………………
Address
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