West Bengal Health Recruitment Board

BENFISH TOWER GN 31, Sector-V, Salt Lake, Kolkata - 700091

Applied Post:
Registration No:
Candidate Name:
Father Name:
Date of Birth:
Category:
Gender:
Sr.
No.
Exam Name Board / University / Institute
Year of
Passing
Percentage
of Marks
1
2
3
Mobile:
Email ID:
Address:
Physically Challenged:
Nature of Physically Challenged:
EDUCATIONAL QUALIFICATION:
Registration Date:
Marital Status:
Nationality:
Mother Name:
Domicile State:
323724
CLASS X
08100569004
(Acknowledgement Slip for Recruitment of Staff Nurse, Grade II)
Female 14/03/2014
SC
SUDHA MALO
58
West Bengal
Higher Secondary (10+2) Examination
Passed General Nursing & Midwifery Certificate from
Nursing Training School recognized by West Benga
Staff Nurse, Grade II
28/09/1988
promilads@gmail.com
Whether you are registered under West Bengal Nursing Council ? - Yes
WEST BENGAL NURSING COUNCIL
323724
55
JHUMA MALO
NABAGRAM, PANCHPOTA, KOLKATA, West Bengal - 700152
2006
2013
INDIAN
WEST BENGAL BOARD OF SECONDARY
EDUCATION
55
2004
WEST BENGAL COUNCIL OF HIGHER
SECONDARY EDUCATION
Unmarried
No
DWIJENDRA LAL MALO

DECLARATION
I hereby declare that I full fill all the condition of eligibility criteria laid down in the advertisement for the post and all the statements made in the application are true, complete
and correct to the best of my knowledge and belief. In the event of may information being found false/incorrect or ineligibility being detected before or after the written Test/
Interviews, my candidature will stand automatically cancelled

Place Signature of the candidate in running hand

Date: (*) Unsigned applications will be summarily rejected
LEFT THUMB IMPRESSION:
Form Print Date:
EXPERIENCE DETAILS:
Post Name Organization Name Period From Period To Emoluments Draw
11000 15/07/2013
14/03/2014 - 23:18
14/03/2014 STAFF NURSE VISION CARE HOSPITAL