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APPLICATION FORM
FOR THE POST OF MEDICAL OFFICERS / File No. …………….
WOMEN MEDICAL OFFICERS (BS-17 / ADHOC)
Preference of Hospital opted by candidate Dated: ………………
1- _________ 2-.__________3-____________

CANDIDATE NAME

FATHER’S NAME

AGE AT
DATE OF BIRTH
CLOSING DATE

GENDER RELIGION

MARTIAL
NATIONALITY
STATUS

CNIC. # DOMICILE

GRADUATION
COUNTRY
INSTITUTE
POST GRADUATION
COUNTRY
INSTITUTE
PMC.# / PMDC (Old)
VALIDITY
Reg.#
RESIDENTIAL
ADDRESS

MOBILE# TEL (Res)

EMAIL

DATE OF SUBMISSION

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2. ACADEMIC QUALIFICATION:
Certificate / Institutions Subject / Result Exam Marks % Distinctions
Degree / Country Specialty Date Attempts / Total age / Medal

Matric / SSC

Intermediate
/ HSSC
PMDC Level - I
MBBS, BDS, etc.
PMDC Level - II a
Diploma etc.
(1 Years after Level I)
PMDC Level - II b
M.Phil, MPH, MCPS etc.
(2 Years after Level I)
PMDC Level - III
FCPS, PhD, MD, MS, etc.
(4 Years after Level I)
PMDC Level - IV
2nd Fellowship,D.Sc etc
(2 Years after Level III)

Any Other

3. MBBS (Detail):
1st Prof. 2nd Prof. 3rd Prof. Final Prof. Total

Marks / Total

Attempt

Percentage
Distinctions/Medals
(Subject)
Any Other
(Note: Please attach attempt certificates, Mark sheets evidence of Distinctions & Medal).

5. SERVICE RECORD:
Department / Govt. / Duration
Post Held From To
Institution Private Y - M - D

__________________
Candidate’s Signature

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