PROVINCIAL HEALTH SERVICES ACADEMY

Government of Khyber Pakhtunkhwa

Department of Health
____________________________________________________________________________________

Post Applied For _______________________

Note: Use Capital letters and leave spacesbetween words
Name:

Father Name:

CNI No: - -

Domicile: ___________________

Date of Birth _____/_______/_____________ (DD/MM/YYYY) Age (as on 18-10-2019)_______

Gender: Male Female

Are you disabled person? Yes No

Postal Address: ________________________________________________________________________

_____________________________________________________________________________________

Phone No: (Office) _________________________ (Residence) _________________________________

(Mobile) _________________________________

Academic Information:

Certificate/ Major Obtained Total %age Board/University

Degree Name Subject Marks/CGPA Marks/CGPA
Matric/Equivalent
Intermediate/
Equivalent
Bachelor/
Equivalent
Master/
Equivalent
MS/M.Phil/
Equivalent
Other

Job Relevant Experience: (Experience of Govt./Semi Govt./well reputed organization will be

considered only)

Job Designation Deptt:/Organization/Institution Nature of Job From To

Total Experience Years Months Days

__________________
Signature of Applicant
-----------------------For Office Use only------------------------------------------------------------------------------------------

Date of Entry_____/_____/2019 By_________________________ Signature _____________