GOVERNMENT OF WEST BENGAL. DEPARTMENT OF HEALTH & FAMILY WELFARE nto th Aw Nursing & Midwil for the Session : 2011 Applications ate invited for admission in two year A.N.M. (R) Training Course from the eligible female candidates living in the Panchayet areas in the districts of Uttar Dinajpur, Howrah, Uttar 24 Parganas, Nadia, Purba Medinipur,Paschim Medinipur, Burdwan & Hooghly in Nursing Training Schools under Govt. of West Bengal. Total No. of Seats + 200 (Two hundred) Reservation of Seats 22% seats for Scheduled Case candidates, 6% seats for Scheduled Tribe candidates, 10% sets for OBC(A) candidates, 7% seats for OBC(B) candidates, 2% seats for candidates belonging to Orphanages and Inmates of Destitute Homes recognized by the Social Welfare Department, Govt. of West Bongal, 2.5 % Seats for Lady ivil Defence Volunteers under Civil Defence Department, Govt. of West Bengal. Instructions: 1) Only female candidates are eligible to apply for the training course. 2) The candidate must be a citizen of India and a permanent resident of the Gram Panchayet area of the concerned District of West Bengal uninterruptedly for at least five years preceding the date of submitting application, 3) Residence: The candidate must be a permanent resident of the Gram Panchayet area of the concerned District for which she applies. 4) Age Between 17 years —30 years as on 01.01.2016 5) Candidates must be able to read, write and express in Bengali/Nepali. © Minimum Educational Qualification : Passed Higher Secondary Examination(10+2) from West Bengal Council of Higher Secondary Education or passed equivalent examination from any recognized Council/Board. 7) Selection will be made strictly on the basis of marks obtained in compulsory subjects (Languages out of which English must be one and Three Elective Subjects (best three) except Environmental Education] in the H.S, Examination (10#2) or equivalent Examination. The applications of candidates from the Vocational Stream will not be considered. Selection is subject to verification of marks-sheet from H.S.Council/ concerned authority. 8) Applications are to be made as per Proforma below at column 18. All the columns are to be filled up properly. Application will not be entertained if any column is left blank/not filled up properly. % Applications should be accompanied with original/self-attested photocopies (whichever is applicable) of each of the following documents. If any of the documents is not submitted with the application, the application will be rejected (this will be followed strictly). a. Self attested photocopy of Mark sheet of H.S (10+2) or equivalent examination. b. Age Proof Certificate- Self-attested photo copy of Admit Card or Certificate of Madhyamik or Equivalent Exam, ©. Original copy of the Residential Certificate to be issued only by a B.D.O. of Local Block/ Sabhadhipati of local Zilla Parishad / Sabhapati of local Panchayet Samity/ Pradhan of local Gram Panchayet as per the prescribed format mentioned at page Nos.Q) 4. In case of SC, ST, OBC(A) & OBC(B) candidates applications should be accompanied by self-attested photocopy of Candidate's own Scheduled Caste/Scheduled ‘Tribe/ OBC(A) /OBC(B) certificate issued by the Sub-Divisional Officer. e. Incase of Civil Defence Volunteers, Certificates issued by the Officer-in-Charge of the concemed Department to the effect of availing Civil Defence Training and Membership Certificate, Casualty Service, Civil Defence with Serial No. issued by the Office Commanding Casualty Service, Civil Defence, Calcutta have to be submitted by the Candidates, £. In case of Orphanage, original copy of the Residential Certificate issued by the Superintendent of the concerned Home towards Orphanage and inmateship in the concerned Destitute Homes recognized by the Social Welfare Deptt., Govt. of West Bengal, for at least five years. 2 One recent self signed passport size colour photograph which is to be affixed on the top right hand corner of the application form. h, One self-addressed envelopes with appropriate postage stamps, 10. Applications are to be submitted to- ‘The Principal , Dr. H.C, M. Memorial Health School, P.O.- Singur, Dist- Hooghly, PIN-712409 1. Applications must be sent only by Registered Post with A.D// Speed Post! Courier. Last date of receiving applications is 31/08/2016, Application(s) will be not be entertained if sent by ordinary Post or reaches the receiving institution after scheduled date (i.e. 31/08/2016) 12. No individual intimation will be given to the candidate about the rejection of application. 13. To provide employment to the candidate on completion of the training is not to be taken as an obligation on the part of the Govt, of West Bengal. 14, The provisionally selected candidates will be called at the Dr. H.C. Memorial Health School, P.O.- Singur, Dist- Hooghly, PIN- 712409 for necessary medical check up. The candidates who will fail to appear on the specified date will not be reconsidered.. Medically fit candidates will be called for training according to the serial number of the selected panel. To ensure training for all medically fit candidates is not to be taken as an obligation on the part of the Govt. of West Bengal. 15, The selected candidates shall have to undergo training residentially in any of the Govt. training schools in West Bengal. 16. During the said training period each of the trainees will be given stipend @ Rs.500/- (or as per existing Govt. Rule) per month for 2(two) years only. Out of the said stipend money, an amount of Rs.12/-(may be increased) per month will be deducted towards the charge for residential purpose. A certain amount of money to be fixed by concemed school authority may have to be paid per month by each candidate towards the messing charge. ing if any unlawful activity ot violation of rules and regulations of the training course is committed by any candidate or document submitted by any candidate for admission into the training course is found to be false, she will be summarily discharged from@B) 18. Pro-forma of application: Applic a for Admission to the ANM(R) Course for the Session : 2016-2018 (Applied £07 sssssvseeeesssserenseeeeeneeen District) To ‘The Principal, Dr. H.C.M. Memorial Health School, PO. Singur, Dist- Hooghly, Enrolment No. ss PIN- 712409 (To be filled in by the receiving institution) Affix here self signed recent colour passport size photograph Madam, T would like to apply for admission to ANM (R) Training Course for ensuing Session 2016 - 2018. In this connection the requisite particulars and documents are given below: 1, Name (In block letters) 2, Father's Name 3. Husband’s/ Guardian’s Name 4, Present Address(With Pin Code) & Phone No. 5. Permanent Address (With Pin Code) 6. The name of the Gram Panchayet/ Panchayet Samity where the Candidate resides 7. Date of Birth Age (As on 01.01.2016) 9, Educational Qualification 10. Details of Higher Secondary or Equivatent Examination. ‘Name & | Nameofthe | RollNo. | Yearo® | TotalMarks | Total Marks | Percentage ‘Address of the | Council/ | (mentioned in | Passing ) (Aggregate) | obtained in | of marks of School Board | Admit Card) [Excepting | [Languages (out | column (4) Environmental | of which subjects Education) | Eng.must be one) +3 Hlective subjects (best three except Environmental Education)] a B © ad e f11. Whether belong to SC/ST/ OBC(AYOBC(B) Category 4) ‘Yes/No [please (v') wherever applicable](If yes, detailed statement and documents in support of the statement) 12, Whether an inmate of the Destitute ‘Yes/No [please (V) wherever applicable] (If Home/Orphanage recognized by the yes, details of statement) Govt. of West Bengal Name & Address | Number & date of | Period of ] Specific Name ofthe | Whether applied ofHome & | the order forher | inmateship | statement of her | father/mother! | other than in Registration No. inclusion iftransferred | local guardian | Orphanage Quota from one home | nd address | in this session, if toother daring | before her | yes, mention in last S years | inmateship details @ é e i e _f 13. Whether undergone Civil Defence Yes/No [please (¥) wherever applicable] Volunteers Training (tyes, detailed particulars) Name & Address | Year & period | Si. No. of ‘Name & — | Whether already | Whether applied ofthe Training | of Training | certificateto | Designation of | engaged | other than in CD. Centre the effect of | the Officer | anywhere by | Quota in for this ‘Training issued Virtue of certificate | Training, 1fs0 | mention in details, details a b © a e f 14, Marital Status (Strike out which are not applicable) Unmarried/ married/ widow/ Divorce or legally separated 15, [hereby declare that the above mentioned particulars furnished by me are true to the best of my knowledge and belief. I am able to read, write and speak in Bengali/ Nepali. Date: Place: Yours faithfully, Signature of the Applicant. Phone No.6) Residential Certificate to be issued by the competent authority in the following Pro-forma (Applicable to the candidate of all categories). 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