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LGB REGIONAL INSTITUTE OF MENTAL HEALTH
(Govt. of India, Ministry of Health & Family Welfare)
Post Box No. 15: FAX No. (03712) 233623
TEZPUR:: 784001 :: ASSAM
Dated 28th April,2015

No. LGB/Estt/246/01/Part-III/1646

ADVERTISEMENT
Applications in the prescribed format are invited from the citizens of India for filling up
the following posts by direct recruitment / deputation / Re-employment on contractual basis as
specified below so as to reach by 02.06.2015. Those who have applied for the post of AMS in
response to the Advt. No.LGB/Estt/246/01/Part-III/2048 dated 03.06.2014 may submit
willingness with updated BIO-DATA without prescribed fee.
Sl.
No.

Post

1 Medical Superintendent
2 Deputy Medical
Superintendent
3 Assistant Medical
Superintendent

No.
of
posts
1
1

Pay Band + Grade Pay

Age
Limit

Rs.37,400-67,000 + GP 8,700 + NPA

Rs. 15,600-39,100 + GP Rs. 7,600 + NPA

56 years
50 years

Rs.15600 39100 + GP Rs.6600 + NPA

45 years

Essential Qualification for Medical Superintendent: (i) A Medical qualification included in

the I or II Schedule or Part II of the third Schedule to the Indian Medical Council Act of 1956
(persons possessing qualifications included in part II or third schedule) should also fulfill the
conditions specified in Section 13 (3) of the Act. (ii) A Postgraduate qualification, e.g. MD or
MS or a recognized qualification equivalent thereto And / or Masters in Hospital Administration
or a Post Graduate Degree recognized as equivalent to Masters in Hospital Administration by the
Medical Council of India.
Desirable: PG degree holder in Psychiatry.
Experience: 10 years experience in Hospital Administration, preferably in a hospital with 300
beds, after obtaining the P.G. Degree in a senior position.
Essential Qualification for Deputy Medical Superintendent : (i) A Medical qualification
included in the I or II Schedule or Part II of the third Schedule to the Indian Medical Council Act
of 1956 (persons possessing qualifications included in part II or third schedule) should also fulfill
the conditions specified in Section 13 (3) of the Act. (ii) A Postgraduate qualification, e.g. MD or
MS or a recognized qualification equivalent thereto And / or Masters in Hospital Administration
or a Post Graduate Degree recognized as equivalent to Masters in Hospital Administration by the
Medical Council of India.
Desirable: PG degree holder in Psychiatry.
Experience: 5 years experience in Hospital Administration of a Hospital with at least 300 beds
after obtaining the P.G. Degree in a senior position.

Essential Qualification for Assistant Medical Superintendent : (i) A recognized medical

qualification included in the First or Second schedule or Part-II of the Third Schedule (other than
Licentiate qualifications) to the Indian Medical Council Act of 1956. Holders of educational
qualifications included in Part II of the Third Schedule should also fulfill the conditions
stipulated in sub-section (3) of Section 13 of the IMC Act, 1956 and (ii) Post Graduate degree in
any medical specialty.
Desirable: (i) Experience in Hospital Administration. (ii) PG degee holder in Psychiatry.
Essential Experience: 3 years experience in the specialty after PG Degree.
GENERAL CONDITION
(1) Candidates who do not fulfill the entire requirement of advertisement need not apply. (2) All
Medical Qualifications should be recognized under MCI (3) Allowances will be as per Central
Government rates as adopted by this Institute from time to time. (4) Candidates working in
State/Central Govt./ PSU/Autonomous Body must apply through proper channel or submit No
objection certificate (5) Relaxation in upper age limit will be applicable in case of SC /ST /OBC
candidates as per Central Govt. norms. (6) In case of deputation, vigilance clearance / integrity
certificate/Complete ACR dossiers/ attested copies of last 5 years ACRs of the applicant from
the parent department will be required. (7) Certificate regarding Major /Minor penalty imposed,
if any, on the officer during the last 10 years/service period, whichever is less, will be required.
(8) Incomplete application or applications received after the last date will be summarily rejected.
(9) The application in prescribed FORMAT is to be accompanied with a Bank Draft of Rs. 100/to be drawn in favour of the Director, LGBRIMH, Tezpur, and attested copies of mark sheets,
certificate and one PP size photograph so as to reach to the Administrative Officer, LGBRIMH,
Tezpur-784001 latest by 02.06.2015. (10) Application Format may be downloaded from
www.lgbrimh.org (11) Qualified candidate/s retired at the age of 60 years may apply for
appointment on contractual basis up to the age of 62 years. (12) Canvassing in any form will be
treated as disqualification.
Director

LGB REGIONAL INSTITUTE OF MENTAL HEALTH

(APPLICATION FORM)
Advt. No.LGB/Estt/246/01/Part III/ 1646

Date 28th April, 2015

1. Name of post applied for with category : MS/DMS/AMS

Please affix a
recent
Passport size
photograph
with your
signature
across

2. Full Name________________________________________________________
3. Fathers/Husband Name _____________________________________________
4. (a) Date of Birth____________________________________________________
5. Category : UR/SC/ST/OBC
6. Demand draft/IPO No._____________ Dated_________drawn on___________
7. Sex:

Male

Female

8. Category:

SC

ST

OBC

General

9. Address for Communication with pincode : ______________________________

___________________________________________________________________
___________________________________________________________________
Mobile Phone/Fax/Email No.____________________________________________
10. Permanent Home Address with pincode: _______________________________
____________________________________________________________________
____________________________________________________________________
11. Academic and Professional Qualifications
Degree/ Subjects
Percentage of
Name of Board/
Diploma
Marks/Grade/Div. Univ./Institution

Duration of
study

12. Publications, if any: (Please attach list of papers published in indexed and
non-indexed journals)

Month &
Year of
Passing

13. Prizes, Honours, Awards Distinctions, if any: ___________________________________

___________________________________________________________________________
14. Chronological record of experience as DMS/AMS or equivalent posts in a 500/300
bedded hospital in Govt. Set up/PSU/Autonomous body after PG degree:
(Use additional sheets, if necessary)
Name &
address
of
Organization

Post held

Duration
From
To

Scale of Pay

Nature of duties
Performed

15. Please give the names, designation & address (E-mail, Fax & Phone numbers) of two
referees under whom you have worked and conducted research work if any.
i)

__________________________________________________________________

ii)

__________________________________________________________________
DECLARATION

I hereby declare that all 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 of the information
being found false or incorrect, my candidature for the examination/interview is liable to be
rejected. In the event of any mis-statement / discrepancy in the particulars being detected at
any stage even after my selection, my services are liable to be terminated without any notice.
Place:_____________________
Date:____________________
Signature of candidate
Note: Please strike out which is not applicable.

Certificate to be given by the Head of the Office / Deptt. of the Applicant

(To be filled up only in case of Transfer /Transfer on Deputation post)

1. It is certified that particulars furnished by the official are correct as per service record.
2. It is certified that no disciplinary / vigilance case is pending or contemplated against
the applicant and he is clear from the vigilance angle.
3. His integrity is certified.
4. He will be relieved of his duties to take up assignment in the LGBRIMH on his
selection.

Signature /Name /Designation with office seal