Phone: 0413- 2272380 to 2272390 Fax: 0413- 2272067
Website: www.jipmer.edu
JAWAHARLAL INSTITUTE OF POSTGRADUATE
MEDICAL EDUCATION AND RESEARCH,
PUDUCHERRY - 605 006.
Institute of National Importance
(Under the Ministry of Health & Family Welfare, Government of India)
======================================================
No. Admn-I/SR/1(1)/2013 Dated: 23.11.2013
RECRUITMENT TO THE POST OF SENIOR RESIDENT
ON REGULAR BASIS BY WALK-IN- INTERVIEW
It is informed that there are 375 posts of Senior Resident in various departments
of the Institute. The post of SR is a tenure post for three years. At any given point of time,
there used to be vacancies in the grade. Hence in order to fill up as many vacancies as
possible to render optimal patient care services, it is proposed to conduct walk-in-interview
for every two months. Accordingly the walk-in-interview for the month of December
2013 will be held from 10.12.13 to 11.12.13. At present there are 145 vacancies in
the grade of SR as detailed below and it is proposed to fill up the vacancies on regular
basis.
Senior Resident 145 Posts (04 Posts reserved for PH candidates)
S.No Department
Vacan
cies
Earmarked for
UR OBC SC ST
1 Anesthesiology 24 9 9 4 2
2 Anatomy 7 4 2 1 0
3 Biochemistry 4 2 1 1 0
4 EMSD (Casualty) 12 7 3 1 1
5 Forensic Medicine 1 1 0 0 0
6 Medicine 8 6 0 1 1
7 Microbiology 1 1 0 0 0
8 Obst & Gynaec 10 5 3 2 0
9 Ophthalmology 1 0 0 1 0
10 Orthopaedics 5 2 2 0 1
11 Paediatrics 6 2 1 2 1
12 Pathology 4 2 1 0 1
13 Pharmacology 2 1 1 0 0
14 Physiology 4 2 0 2 0
15 P & S.M 4 2 1 1 0
16 Psychiatry 2 1 0 1 0
17 Radio-Diagnosis 8 3 2 2 1
18 Radiotherapy 3 2 0 0 1
19 Dermatology 2 0 1 1 0
20 Surgery 13 6 3 2 2
21 TB & CD 7 4 2 1 0
22 CTVS 2 2 0 0 0
23 Gastro-Medicine 6 5 1 0 0
24 Nuclear Medicine 6 5 1 0 0
25 Blood Transfusion
Medicine
1 1 0 0 0
26 Geriatric Medicine 2 2 0 0 0
Total 145 77 34 23 11
Vacancies may increase or decrease and appointment is subject to the
rules of reservation.
ESSENTIAL QUALIFICATIONS:-
A Postgraduate Medical Degree/Diploma in respective discipline from
recognized university/Institute.
For the post of Senior Resident in Cardio Thoracic Vascular Surgery, the candidate
should possess M.S (General Surgery). M.Ch. (CTVS) will be preferred.
For the Post of Senior Resident in Gastroenterology (Medical Department), the
candidate should possess MD (General Medicine). DM (Gastroenterology) will be
preferred.
For the Post of Senior Resident in Nuclear Medical Department, the candidate
should possess MD in Radiotherapy / Radio diagnosis with diploma in Radiation Medicine
or MD in Nuclear Medicine / MBBS with Diploma in Radiation Medicine.
For the Post of Senior Resident in Geriatric Medicine, the candidate should
possess MD in Geriatric Medicine or MD in Medicine
For the Post of Senior Resident in Emergency Medical Services Department
(Casualty) the candidate should possess M.D/DNB in Medicine / M.S/DNB in General
Surgery.
Age: - Below 33 years, with usual relaxation of 5 years for SC/ST and 3 years for OBC
as per rules. Upper age limit for Differently Abled persons shall be relaxable by 10
years. (15 years for SCs/STs and 13 years for OBCs.)
For differently abled persons the posts in Non-Surgical departments are identified
suitable. Categories of Differently Abled persons suitable for the job and age relaxation
are as below:-
OL- One leg affected (R and/or L),
OA- One arm affected(R or L)
a) Impaired reach, b) Weakness of grip, c) Ataxia
Persons suffering from not less than 40% of relevant disability shall alone be eligible for
reservation and age relaxation.
Indian Nationals only need apply.
PAY SCALES:-
The candidates with Postgraduate Medical Degree/Diploma recognized by
the Medical Council of India will be paid B/Pay Rs.18750/-Plus Grade Pay of
Rs. 6600/- (Revised) and other usual allowances per month in the first year of
his/her residency.
Selection of candidates will be based on a written test followed by Personal
Interview on the same day. The schedule of Written test/Interview for the above
mentioned departments are as below:-
D
Interested and eligible candidates may attend the Written test/Interview
to be held at 08.30.A.M from 10.12.13 to 11.12.13 at Bernard Theatre, I
st
Floor, Institute Block, JIPMER, Puducherry-06, along with i) filled in
application & Bio-Data in the prescribed format (appended) ii) the following
certificates in original and an attested copy thereof and iii) a Demand Draft
for Rs.500/ for General and OBC candidates and Rs.250/- for SC/ST candidates
drawn in favour of Accounts Officer, JIPMER, Puducherry-06. No fee is payable
by Differently Abled candidates.
Sl/No NAME OF THE DEPARTMENT
Date of written test &
Interview
1 Anaesthesiology
2 Anatomy
3 Biochemistry
4 EMSD (Casualty)
5 Forensic Medicine
6 Medicine
7 Microbiology
8 Ophthalmology
9 Orthopaedics
10 Pathology
11 Obst & Gynaec
10.12.2013
12 Pharmacology
13 Paediatrics
14 Physiology
15 P & SM
16 Psychiatry
17 Radio-Diagnosis
18 Radiotherapy
19 Dermatology
20 Surgery
21 Pulmonary Medicine
22 CTVS
23 Gastro-Medicine
24 Nuclear Medicine
25 Blood Transfusion Medicine
26 Geriatric Medicine
11.12.2013
01. Age proof certificate
02. MBBS Degree with no. of attempts certificate
03. MD/MS /DNB Degree/Provisional Certificate
04. Medical Council Registration Certificate
05. Internship Completion Certificate
06. Latest SC/ST/OBC (Creamy Layer) Certificate (format appended), if he/she
belongs to SC/ST/OBC, issued by the Revenue Officer not below the rank of
Thasildar. In case the certificate is in regional language, the English version of
the certificate duly attested by a Gazetted Officer is also to be furnished.
07. The candidates who are in service in any Govt. Hospital /Institutions are
required to submit “No objection Certificate” from the present employer.
Selection Procedure: -
A written Examination based on MCQs in the subject concerned will be
conducted for eligible Candidate followed by personal interview. 85% of total
marks will be for written test and 15% for Personal interview.
Note:-
1. The number of posts to be filled up will be decided by the
competent authority.
2. The Non M.Ch/Non.D.M Senior Residents will be posted in the
EMSD (Casualty) from parent departments on rotation basis.
No correspondence will be entertained through e-mail.
DIRECTOR
Phone: 0413- 2272380 To 2272390 Fax: 0413- 2272067 Website: www.jipmer.edu
JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION
AND RESEARCH, PUDUCHERRY- 605 006.
Institute of National Importance
(Under the Ministry of Health & Family Welfare, Government of India)
------------------------------------------------------------------------------------------------------
Application form for the post of Senior Resident
Application form No.______________
(for Office use only)
Details of Application fee:
Demand Draft No., and Amount, Name of the Bank& Place
Note: In-complete application is liable to be rejected.
1. Application for the post of Senior Resident in ________________________
(Subject/Speciality)
2. Applicant’s Name (IN BLOCK LETTERS)
3. Father’s/Husband’s Name (IN BLOCK LETTERS)
4. i) Date of Birth of Applicant
(Attach proof) DAY MONTH YEAR
ii) Age: (as on the last date
of receipt of application) YEARS MONTHS DAYS
5. Write in the box ONLY ONE category out of SC/ST/OBC/GEN
to which you belong (Attach proof of SC/ST/OBC)
6. Nationality:__________ 7.Religion:____________ 8. Marital Status: _____________
9. Educational/Academic/Technical/Professional Qualifications (Attach proof):
Examination
Passed
Subject Name of
College/Institution
Name of
University
Year of
Passing
with %of
Marks
No. of
attem
pts
Matric
*M.B.B.S./BDS
Affix recent
passport size
photograph
duly attested
: 2:
*M.D./M.S/MDS
*DNB/M.Ch./D.M
* Please attach proof of Recognition of MBBS/MD/MS degree by Medical Council of
India. Candidates possessing Degree/PG degree not recognized by MCI will not be
allowed to appear for interview.
10. No. of papers published: National International
11. Details of prizes, Medals, Scholarships & National/ International Awards and
Additional Qualification such as members of scientific society etc.
12. Chronological details of up to date appointment after obtaining postgraduate
qualification (attach experience certificate)
Post held From To Organisation/Employer’s
Name & Address
13. (a) Central/State Medical Council with which the
applicant is registered (attach proof) : _________________________________
(b) Medical Registration Number : _________________________________
14. Permanent Address 15. Correspondence Address:
Pin Code: Pin Code
Mobile No: Mobile No:
E. Mail I.D.: E. Mail I.D.:
16. Details of enclosures attached: As per list.
DECLARATION to be signed by the candidate
I hereby declare that I am an Indian National and all statements made in this
application are true, complete and correct to the best of my knowledge and belief. I
understand that in the even of any information being found false or incorrect, my appointment
will be liable to be terminated without any reason or prior notice. I also understand that in
case of my final selection, my appointment will be provisional subject to satisfactory police
verification.
Date: __________________
Place: __________________ (Signature of the applicant)
____________________________________________________________
: 3:
*DECLARATION TO BE SIGNED BY OBC CANDIDATES ONLY
I_______________________________ son/daughter Shri ___________________
resident of Village/ Town/ City/ District _____________State _________Community
_________________(certificate enclosed) hereby declare that I belong to
the___________________ community which is recognized as a backward class by the Govt.
of India for the purpose of reservation in services as per orders contained in Department of
Personnel and Training Office Memorandum No.36012/22/93-Estt(SCT) dated 8.9.1993. It is
also declared that I do not belong to the persons/sections (creamy layer) mentioned in
Column 3 of OM No. 36012/22/93-Estt(SCT) dated 08.09.1993 and modified vide Govt. of
India, Department of Personnel and Training OM No.36033/3/2004-Estt(Res) dated
09.03.2004.
Place:
(Signature of applicant)
Date: (in running handwriting)
*Note: The closing date for receipt of application will be treated as the date of reckoning for
OBC status of the candidate and also, for assuming that the candidate does not fall in the
creamy layer.
CERTIFICATE / NO OBJECTION BY THE PRESENT EMPLOYER
(In case candidate is in Govt. / Semi Govt. / PSU/ Autonomous Body service etc.)
No… … … … … … … … … Date… … … … … … … … … …
Forwarded with the remarks that there is no objection to the selection/appointment of
Dr. ____________________________________________to the post applied for at JIPMER,
Puducherry.
Date:-__________________ Signature of the employer with
Office Stamp
: 4:
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES
APPLYING FOR APPOINTMENT TO POST UNDER THE GOVERNMENT OF INDIA
This is to certify that Shri / Smt. / Kum*. ………………………….............………………………son /
daughter of shri ……………………………………………………of village / town………………………
…in District …………… in ………………...............…...… state belongs to ……………….community
which is recognised as a backward class under :-
(1) Resolution No.12011/68/93-BCC© dated 10th September 1993, published in the Gazette of
India - Extraordinary - part 1, Section 1, No.186 dated 13th September 1993.
(2) Resolution No.12011/9/94-BCC dated 19th October 1994, published in the Gazette of India -
Extraordinary - part 1, Section 1, No.163, dated 20th October 1994.
(3) Resolution No.12011/7/95-BCC, dated 24th May, 1995, published in Gazette of India -
Extraordinary - part 1, Section 1, No.88, dated 25th May 1995.
(4) Resolution No.12011/44/96-BCC, dated 6th December 1996, published in Gazette of India -
Extraordinary - part 1, Section 1, No.210, dated 11th December 1996.
(5) Resolution No.12011/68/93-BCC, published in Gazette of India - Extraordinary - No.129,
dated the 8th July 1997.
(6) Resolution No.12011/12/96-BCC, published in Gazette of India - Extraordinary - No.164,
dated the 1st Sept 1997.
(7) Resolution No.12011/99/94-BCC, published in Gazette of India - Extraordinary - No.236,
dated the 11th Dec 1997.
(8) Resolution No.12011/13/97-BCC, published in Gazette of India - Extraordinary - No.239,
dated the 3rd Dec 1997.
(9) Resolution No.12011/12/96-BCC, published in Gazette of India - Extraordinary - No.166,
dated the 3rd Aug 1998.
(10) Resolution No.12011/68/93-BCC, published in Gazette of India - Extraordinary - No.171,
dated the 6th Aug 1998.
(11) Resolution No.12011/68/98-BCC, published in Gazette of India - Extraordinary - No.241,
dated the 27th Oct 1999.
(12) Resolution No.12011/88/98-BCC, published in Gazette of India - Extraordinary - No.270,
dated the 6th Dec 1999.
(13) Resolution No.12011/36/99-BCC, published in Gazette of India - Extraordinary - No.71,
dated the 4th April 2000.
Shri/Smt./Kum*. ………………….and/or his/her family ordinarily reside(s) in the….……………….
District of the …………………… State. 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 OM NO.36012/22/93 - Estt (SCT), dated 08.09.1993)
and modified vide Government of India, Department of Personnel and training O.M No.36033/3/
2004-Estt.(Res) dated 09.03.2004.
Place :....................... Signature_____________________________
Dated : ..................... District Magistrate/Dy. Commissioner etc.
*Strike out whichever is not applicable (With seal of office)
NB: (a) The term 'ordinarily' used here will have the same meaning as in section 20 of the
Representation of People’s Act., 1950.
-----------------------------------------------------------------------------------------------------------------------------------
The Authorities competent to issue OBC caste certificates are indicated below :-
(i) District Magistrate / Additional Magistrate / Collector / Deputy Commissioner /Additional Deputy
Commissioner / Deputy Collector / 1st class Stipendiary Magistrate / Sub - Divisional Magistrate
/ Taluk Magistrate / Executive Magistrate / Extra Assistant Commissioner (not below the rank of
1st class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate/ Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tahasildar, and
(iv) Sub-Divisional Officer of the area where the Candidate and or his family resides.
: 5:
CHECK LIST FOR THE POST OF SENIOR RESIDENT ON REGULAR BASIS
IN THE DISCIPLINE/DEPARTMENT OF________________
(Put a cross (X) wherever applicable)
1. Certificate of Date of Birth Attached :
2. Passport size photograph affixed and :
attested by a Gazetted Officer
3 Degree Certificate for MBBS
Internship completion Certificate,
Medical Registration Certificate attached. :
4. Mark Sheets, Attempt Certificate
for M.B.B.S :
5. Character Certificate attached :
6. No Objection Certificate from the present :
Employer (if employed)
7. Degree Certificate for MD/MS/PG. Dip. :
8. Bank Draft attached :
9. Application duly signed :
10. Community certificate attached (if applicable):
Signature of the Candidate: ________________________
Date : ________________________
: 6:
BIO-DATA
Name of the department:
1. Applicant’s Name (in BLOCK LETTERS):-
2. Father’s Name :-
3. Date of Birth of Applicant :-
4. Educational/Academic/Technical/Professional Qualifications:-
Examination
Passed
Subject Name of College/
Institution
Name of
University
Year of
Passing
with %
of Marks
No.of
attempts
M.B.B.S.
M.D./M.S
DNB/M.Ch/D.M
05. No. of papers published:-
National International
06. Details of prizes,
1. Medals :
2. Scholarships :
3. National/ International Awards and
additional qualification such as membership of scientific societies etc.
07. Any other information of meritorious nature.
Date: __________________
Place: __________________ (Signature of the applicant)
Website: www.jipmer.edu
JAWAHARLAL INSTITUTE OF POSTGRADUATE
MEDICAL EDUCATION AND RESEARCH,
PUDUCHERRY - 605 006.
Institute of National Importance
(Under the Ministry of Health & Family Welfare, Government of India)
======================================================
No. Admn-I/SR/1(1)/2013 Dated: 23.11.2013
RECRUITMENT TO THE POST OF SENIOR RESIDENT
ON REGULAR BASIS BY WALK-IN- INTERVIEW
It is informed that there are 375 posts of Senior Resident in various departments
of the Institute. The post of SR is a tenure post for three years. At any given point of time,
there used to be vacancies in the grade. Hence in order to fill up as many vacancies as
possible to render optimal patient care services, it is proposed to conduct walk-in-interview
for every two months. Accordingly the walk-in-interview for the month of December
2013 will be held from 10.12.13 to 11.12.13. At present there are 145 vacancies in
the grade of SR as detailed below and it is proposed to fill up the vacancies on regular
basis.
Senior Resident 145 Posts (04 Posts reserved for PH candidates)
S.No Department
Vacan
cies
Earmarked for
UR OBC SC ST
1 Anesthesiology 24 9 9 4 2
2 Anatomy 7 4 2 1 0
3 Biochemistry 4 2 1 1 0
4 EMSD (Casualty) 12 7 3 1 1
5 Forensic Medicine 1 1 0 0 0
6 Medicine 8 6 0 1 1
7 Microbiology 1 1 0 0 0
8 Obst & Gynaec 10 5 3 2 0
9 Ophthalmology 1 0 0 1 0
10 Orthopaedics 5 2 2 0 1
11 Paediatrics 6 2 1 2 1
12 Pathology 4 2 1 0 1
13 Pharmacology 2 1 1 0 0
14 Physiology 4 2 0 2 0
15 P & S.M 4 2 1 1 0
16 Psychiatry 2 1 0 1 0
17 Radio-Diagnosis 8 3 2 2 1
18 Radiotherapy 3 2 0 0 1
19 Dermatology 2 0 1 1 0
20 Surgery 13 6 3 2 2
21 TB & CD 7 4 2 1 0
22 CTVS 2 2 0 0 0
23 Gastro-Medicine 6 5 1 0 0
24 Nuclear Medicine 6 5 1 0 0
25 Blood Transfusion
Medicine
1 1 0 0 0
26 Geriatric Medicine 2 2 0 0 0
Total 145 77 34 23 11
Vacancies may increase or decrease and appointment is subject to the
rules of reservation.
ESSENTIAL QUALIFICATIONS:-
A Postgraduate Medical Degree/Diploma in respective discipline from
recognized university/Institute.
For the post of Senior Resident in Cardio Thoracic Vascular Surgery, the candidate
should possess M.S (General Surgery). M.Ch. (CTVS) will be preferred.
For the Post of Senior Resident in Gastroenterology (Medical Department), the
candidate should possess MD (General Medicine). DM (Gastroenterology) will be
preferred.
For the Post of Senior Resident in Nuclear Medical Department, the candidate
should possess MD in Radiotherapy / Radio diagnosis with diploma in Radiation Medicine
or MD in Nuclear Medicine / MBBS with Diploma in Radiation Medicine.
For the Post of Senior Resident in Geriatric Medicine, the candidate should
possess MD in Geriatric Medicine or MD in Medicine
For the Post of Senior Resident in Emergency Medical Services Department
(Casualty) the candidate should possess M.D/DNB in Medicine / M.S/DNB in General
Surgery.
Age: - Below 33 years, with usual relaxation of 5 years for SC/ST and 3 years for OBC
as per rules. Upper age limit for Differently Abled persons shall be relaxable by 10
years. (15 years for SCs/STs and 13 years for OBCs.)
For differently abled persons the posts in Non-Surgical departments are identified
suitable. Categories of Differently Abled persons suitable for the job and age relaxation
are as below:-
OL- One leg affected (R and/or L),
OA- One arm affected(R or L)
a) Impaired reach, b) Weakness of grip, c) Ataxia
Persons suffering from not less than 40% of relevant disability shall alone be eligible for
reservation and age relaxation.
Indian Nationals only need apply.
PAY SCALES:-
The candidates with Postgraduate Medical Degree/Diploma recognized by
the Medical Council of India will be paid B/Pay Rs.18750/-Plus Grade Pay of
Rs. 6600/- (Revised) and other usual allowances per month in the first year of
his/her residency.
Selection of candidates will be based on a written test followed by Personal
Interview on the same day. The schedule of Written test/Interview for the above
mentioned departments are as below:-
D
Interested and eligible candidates may attend the Written test/Interview
to be held at 08.30.A.M from 10.12.13 to 11.12.13 at Bernard Theatre, I
st
Floor, Institute Block, JIPMER, Puducherry-06, along with i) filled in
application & Bio-Data in the prescribed format (appended) ii) the following
certificates in original and an attested copy thereof and iii) a Demand Draft
for Rs.500/ for General and OBC candidates and Rs.250/- for SC/ST candidates
drawn in favour of Accounts Officer, JIPMER, Puducherry-06. No fee is payable
by Differently Abled candidates.
Sl/No NAME OF THE DEPARTMENT
Date of written test &
Interview
1 Anaesthesiology
2 Anatomy
3 Biochemistry
4 EMSD (Casualty)
5 Forensic Medicine
6 Medicine
7 Microbiology
8 Ophthalmology
9 Orthopaedics
10 Pathology
11 Obst & Gynaec
10.12.2013
12 Pharmacology
13 Paediatrics
14 Physiology
15 P & SM
16 Psychiatry
17 Radio-Diagnosis
18 Radiotherapy
19 Dermatology
20 Surgery
21 Pulmonary Medicine
22 CTVS
23 Gastro-Medicine
24 Nuclear Medicine
25 Blood Transfusion Medicine
26 Geriatric Medicine
11.12.2013
01. Age proof certificate
02. MBBS Degree with no. of attempts certificate
03. MD/MS /DNB Degree/Provisional Certificate
04. Medical Council Registration Certificate
05. Internship Completion Certificate
06. Latest SC/ST/OBC (Creamy Layer) Certificate (format appended), if he/she
belongs to SC/ST/OBC, issued by the Revenue Officer not below the rank of
Thasildar. In case the certificate is in regional language, the English version of
the certificate duly attested by a Gazetted Officer is also to be furnished.
07. The candidates who are in service in any Govt. Hospital /Institutions are
required to submit “No objection Certificate” from the present employer.
Selection Procedure: -
A written Examination based on MCQs in the subject concerned will be
conducted for eligible Candidate followed by personal interview. 85% of total
marks will be for written test and 15% for Personal interview.
Note:-
1. The number of posts to be filled up will be decided by the
competent authority.
2. The Non M.Ch/Non.D.M Senior Residents will be posted in the
EMSD (Casualty) from parent departments on rotation basis.
No correspondence will be entertained through e-mail.
DIRECTOR
Phone: 0413- 2272380 To 2272390 Fax: 0413- 2272067 Website: www.jipmer.edu
JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION
AND RESEARCH, PUDUCHERRY- 605 006.
Institute of National Importance
(Under the Ministry of Health & Family Welfare, Government of India)
------------------------------------------------------------------------------------------------------
Application form for the post of Senior Resident
Application form No.______________
(for Office use only)
Details of Application fee:
Demand Draft No., and Amount, Name of the Bank& Place
Note: In-complete application is liable to be rejected.
1. Application for the post of Senior Resident in ________________________
(Subject/Speciality)
2. Applicant’s Name (IN BLOCK LETTERS)
3. Father’s/Husband’s Name (IN BLOCK LETTERS)
4. i) Date of Birth of Applicant
(Attach proof) DAY MONTH YEAR
ii) Age: (as on the last date
of receipt of application) YEARS MONTHS DAYS
5. Write in the box ONLY ONE category out of SC/ST/OBC/GEN
to which you belong (Attach proof of SC/ST/OBC)
6. Nationality:__________ 7.Religion:____________ 8. Marital Status: _____________
9. Educational/Academic/Technical/Professional Qualifications (Attach proof):
Examination
Passed
Subject Name of
College/Institution
Name of
University
Year of
Passing
with %of
Marks
No. of
attem
pts
Matric
*M.B.B.S./BDS
Affix recent
passport size
photograph
duly attested
: 2:
*M.D./M.S/MDS
*DNB/M.Ch./D.M
* Please attach proof of Recognition of MBBS/MD/MS degree by Medical Council of
India. Candidates possessing Degree/PG degree not recognized by MCI will not be
allowed to appear for interview.
10. No. of papers published: National International
11. Details of prizes, Medals, Scholarships & National/ International Awards and
Additional Qualification such as members of scientific society etc.
12. Chronological details of up to date appointment after obtaining postgraduate
qualification (attach experience certificate)
Post held From To Organisation/Employer’s
Name & Address
13. (a) Central/State Medical Council with which the
applicant is registered (attach proof) : _________________________________
(b) Medical Registration Number : _________________________________
14. Permanent Address 15. Correspondence Address:
Pin Code: Pin Code
Mobile No: Mobile No:
E. Mail I.D.: E. Mail I.D.:
16. Details of enclosures attached: As per list.
DECLARATION to be signed by the candidate
I hereby declare that I am an Indian National and all statements made in this
application are true, complete and correct to the best of my knowledge and belief. I
understand that in the even of any information being found false or incorrect, my appointment
will be liable to be terminated without any reason or prior notice. I also understand that in
case of my final selection, my appointment will be provisional subject to satisfactory police
verification.
Date: __________________
Place: __________________ (Signature of the applicant)
____________________________________________________________
: 3:
*DECLARATION TO BE SIGNED BY OBC CANDIDATES ONLY
I_______________________________ son/daughter Shri ___________________
resident of Village/ Town/ City/ District _____________State _________Community
_________________(certificate enclosed) hereby declare that I belong to
the___________________ community which is recognized as a backward class by the Govt.
of India for the purpose of reservation in services as per orders contained in Department of
Personnel and Training Office Memorandum No.36012/22/93-Estt(SCT) dated 8.9.1993. It is
also declared that I do not belong to the persons/sections (creamy layer) mentioned in
Column 3 of OM No. 36012/22/93-Estt(SCT) dated 08.09.1993 and modified vide Govt. of
India, Department of Personnel and Training OM No.36033/3/2004-Estt(Res) dated
09.03.2004.
Place:
(Signature of applicant)
Date: (in running handwriting)
*Note: The closing date for receipt of application will be treated as the date of reckoning for
OBC status of the candidate and also, for assuming that the candidate does not fall in the
creamy layer.
CERTIFICATE / NO OBJECTION BY THE PRESENT EMPLOYER
(In case candidate is in Govt. / Semi Govt. / PSU/ Autonomous Body service etc.)
No… … … … … … … … … Date… … … … … … … … … …
Forwarded with the remarks that there is no objection to the selection/appointment of
Dr. ____________________________________________to the post applied for at JIPMER,
Puducherry.
Date:-__________________ Signature of the employer with
Office Stamp
: 4:
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES
APPLYING FOR APPOINTMENT TO POST UNDER THE GOVERNMENT OF INDIA
This is to certify that Shri / Smt. / Kum*. ………………………….............………………………son /
daughter of shri ……………………………………………………of village / town………………………
…in District …………… in ………………...............…...… state belongs to ……………….community
which is recognised as a backward class under :-
(1) Resolution No.12011/68/93-BCC© dated 10th September 1993, published in the Gazette of
India - Extraordinary - part 1, Section 1, No.186 dated 13th September 1993.
(2) Resolution No.12011/9/94-BCC dated 19th October 1994, published in the Gazette of India -
Extraordinary - part 1, Section 1, No.163, dated 20th October 1994.
(3) Resolution No.12011/7/95-BCC, dated 24th May, 1995, published in Gazette of India -
Extraordinary - part 1, Section 1, No.88, dated 25th May 1995.
(4) Resolution No.12011/44/96-BCC, dated 6th December 1996, published in Gazette of India -
Extraordinary - part 1, Section 1, No.210, dated 11th December 1996.
(5) Resolution No.12011/68/93-BCC, published in Gazette of India - Extraordinary - No.129,
dated the 8th July 1997.
(6) Resolution No.12011/12/96-BCC, published in Gazette of India - Extraordinary - No.164,
dated the 1st Sept 1997.
(7) Resolution No.12011/99/94-BCC, published in Gazette of India - Extraordinary - No.236,
dated the 11th Dec 1997.
(8) Resolution No.12011/13/97-BCC, published in Gazette of India - Extraordinary - No.239,
dated the 3rd Dec 1997.
(9) Resolution No.12011/12/96-BCC, published in Gazette of India - Extraordinary - No.166,
dated the 3rd Aug 1998.
(10) Resolution No.12011/68/93-BCC, published in Gazette of India - Extraordinary - No.171,
dated the 6th Aug 1998.
(11) Resolution No.12011/68/98-BCC, published in Gazette of India - Extraordinary - No.241,
dated the 27th Oct 1999.
(12) Resolution No.12011/88/98-BCC, published in Gazette of India - Extraordinary - No.270,
dated the 6th Dec 1999.
(13) Resolution No.12011/36/99-BCC, published in Gazette of India - Extraordinary - No.71,
dated the 4th April 2000.
Shri/Smt./Kum*. ………………….and/or his/her family ordinarily reside(s) in the….……………….
District of the …………………… State. 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 OM NO.36012/22/93 - Estt (SCT), dated 08.09.1993)
and modified vide Government of India, Department of Personnel and training O.M No.36033/3/
2004-Estt.(Res) dated 09.03.2004.
Place :....................... Signature_____________________________
Dated : ..................... District Magistrate/Dy. Commissioner etc.
*Strike out whichever is not applicable (With seal of office)
NB: (a) The term 'ordinarily' used here will have the same meaning as in section 20 of the
Representation of People’s Act., 1950.
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The Authorities competent to issue OBC caste certificates are indicated below :-
(i) District Magistrate / Additional Magistrate / Collector / Deputy Commissioner /Additional Deputy
Commissioner / Deputy Collector / 1st class Stipendiary Magistrate / Sub - Divisional Magistrate
/ Taluk Magistrate / Executive Magistrate / Extra Assistant Commissioner (not below the rank of
1st class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate/ Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tahasildar, and
(iv) Sub-Divisional Officer of the area where the Candidate and or his family resides.
: 5:
CHECK LIST FOR THE POST OF SENIOR RESIDENT ON REGULAR BASIS
IN THE DISCIPLINE/DEPARTMENT OF________________
(Put a cross (X) wherever applicable)
1. Certificate of Date of Birth Attached :
2. Passport size photograph affixed and :
attested by a Gazetted Officer
3 Degree Certificate for MBBS
Internship completion Certificate,
Medical Registration Certificate attached. :
4. Mark Sheets, Attempt Certificate
for M.B.B.S :
5. Character Certificate attached :
6. No Objection Certificate from the present :
Employer (if employed)
7. Degree Certificate for MD/MS/PG. Dip. :
8. Bank Draft attached :
9. Application duly signed :
10. Community certificate attached (if applicable):
Signature of the Candidate: ________________________
Date : ________________________
: 6:
BIO-DATA
Name of the department:
1. Applicant’s Name (in BLOCK LETTERS):-
2. Father’s Name :-
3. Date of Birth of Applicant :-
4. Educational/Academic/Technical/Professional Qualifications:-
Examination
Passed
Subject Name of College/
Institution
Name of
University
Year of
Passing
with %
of Marks
No.of
attempts
M.B.B.S.
M.D./M.S
DNB/M.Ch/D.M
05. No. of papers published:-
National International
06. Details of prizes,
1. Medals :
2. Scholarships :
3. National/ International Awards and
additional qualification such as membership of scientific societies etc.
07. Any other information of meritorious nature.
Date: __________________
Place: __________________ (Signature of the applicant)
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