ADVT.No.

03/2018/DOC/WOU, Mumbai
OIL AND NATURAL GAS CORPORATION LIMITED
WOU-MUMBAI
Roll No. _________
BIO-DATA
WALK-IN-INTERVIEW FOR THE POST : GENERAL DUTY MEDICAL OFFICER
Passport size
DATE OF INTERVIEW : _____________________
photograph
REGISTRATION NO. : ________________________ Valid upto date :_______________________ to be affixed
MOBILE NO. : ________________________ EMAIL ID ___________________________ here
USE BLOCK LETTERS

1] NAME OF THE CANDIDATE : DR.______________________________________________

2] FATHER’S NAME : _________________________________________________
3] DATE OF BIRTH(as on SSC Board : _________________________________________________
Certificate)
4] PRESENT ADDRESS FOR : _________________________________________________
COMMUNICATION _________________________________________________
_________________________________________________
5] WHETHER SC/ST/OBC/GEN/PWD : _________________________________________________
6] QUALIFICATIONS :
Sr Examination Board/ University Passing Class % of Subjects Taken
No Passed year Marks
1 SSC

2 HSC
3 1st yr. MBBS

4 2nd yr. MBBS

5 3rd yr. MBBS – Part-I

3rd yr. MBBS – Part-II

6 Internship completion
cert.& Degree
certificate
7 Additional
Qualification
7] EXPERIENCE :
Sr Work Place Post Held Period Pay Scale Nature of Duties
No From To

I certify that the above information is correct and supporting documents are enclosed.
Place:
Date :

(Signature of the candidate)