Professional Documents
Culture Documents
Pa.e 1 o/ %
APPLICATION FOR THE POST OF CIVIL ASSISTANT SURGEONS/DENTAL ASSISTANT SURGEONS IN DIRECTOR OF PUBLIC HEALTH & FAMILY WELFARE, ANDHRA PRADESH: HYDERABAD Latest Passport Size Photo Attested by Gazetted Officer
()*+),,)-
Medical Council Registration Number Post Applied !or Surname Gender !ather#s Name Category
59395 CAS
Religion
SC
%f &es Category
Are you a person $ith no isability 'hether belongs to ()* no Ser+ice Men Category
ADDRESS
ANDHRA PRADESH ,ehsil- "loc.- Mandal TENA!" 5-2%-50&1'(&o 0ouse No )*SR"N"+ASA RA,' City TENA!"
State
SCHOOL DETAILS
istrict
GUNTUR
Class %/ / /%
Place
TENA!" 1992
&ear of Passing
istrict
GUNTUR
TENA!" TENA!"
1993 199%
GUNTUR
GUNTUR
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0,1 Po23al
Pa.e 2 o/ %
/%% /%%% %1 1
N")ETAN ST*PAU!S H"GH SCH,,! ST*PAU!S H"GH SCH,,! ST*PAU!S H"GH SCH,,! ST*PAU!S H"GH SCH,,!
PH"RANG"PURAM 1995
GUNTUR
PH"RANG"PURAM 1996
GUNTUR
PH"RANG"PURAM 1997
GUNTUR
PH"RANG"PURAM 1998
GUNTUR
Pa.e 1&2
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Pa.e 3 o/ %
Name Of Course
Name Of College-2ni+ersity
Ma)imum Mar.s &ear of Mar.s in Obtained all in all Passing &ears &ears
M11S
PG DETAILS
2%50
1%58
Name Of Course
Name Of College-2ni+ersity
Sum of Sum of Ma)imum Mar.s Mar.s in Obtained &ear of in all all &ears Passing &ears of of 3ualifying 3ualifying ()am ()am
CONTRACT DETAILS
Name of %nstitute
'or.ed 2nder
Period !rom Period ,o 4dd* Place 4dd*mm*yyyy5 mm*yyyy5 03-0%-2012 12-07-2012 Ru2al 13-07-2012 19-05-2013 Ru2al
20-05-2013
25-09-2013 Ru2al
05-01-2007
Period ,o 0%-01-2008
DECLARATION %6 r7 .A.ARLAMUDI .IRAN .UMAR S-o6 -o VEN.ATA RATNAM Certify that the particulars gi+en abo+e are correct to the best of my .no$ledge and belief7 % also agree that in the e+ent of any of the particulars furnished in my application being found to be incorrect or false at a later date my appointment $ill be cancelled summarily7 %6 r7 .A.ARLAMUDI .IRAN .UMAR S-o6 -o /(N8A,A RA,NAM $ill abide by the rules under $hich % may be appointed in regular ser+ice6 if selected7 % $ill 9oin in the place $here % am posted $ith in the stipulated time specified by the authorities failing $hich % forefeit my rights to be appointed in this recruitment7
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Pa.e % o/ %
19&09&2013
Pa.e 2&2
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