2/5/22, 10:55 PM NVS Form 2021

Applicant Details HelpDesk

Personal Details

Application Sequence No

NVS2100904390

Candidate's Name

SUVRA DAS

Father's Name Mother's Name

TUSAR KANTI DAS SUPRAVA DAS

Nationality
Indian

Post Applied Details

Post Applied Post Code

Female Staff Nurse (Group B) 03

Exam City Choice 1 Exam City Choice 2

Bhubaneshwer Cuttack

Exam City Choice 3 Category

Rourkela UR

Gender Date of Birth (DD-MM-YYYY) same as Matriculation/

Secondary Certificate
Female
30/Dec/1996

Age as on 10.02.2022

https://www.digialm.com/EForms/PayUAfterPaymentAction.do?74494ZZ1258ZZonline 1/5
2/5/22, 10:55 PM NVS Form 2021

25 Years 1 Months 11 Days Are you Physically Handicapped (PH) (degree of

disability 40% or above)?
No

Are you an Ex-Service man? Are you an employee of NVS?

No No

Were you originally domiciled in the state of Jammu Are you a Candidate with 3 years continuous service in
and Kashmir between 01.01.1980 and
31.12.1989? Central Govt. provided the posts are in
same or allied
cadres?
No
No

Contact Details

Mobile Number

8658125352 Email ID

dsuvra7@gmail.com

Present Address

Address Line 1

AT-ISHANIBRAHMAPUR, POST-KHENTALO

Address Line 2
PS-KISHORENAGAR, DIST-CUTTACK

Country

India

State District
Odisha Cuttack

Pin Code

754131 Is Permanent Address same as Present Address?

Yes

Permanent Address

Address Line 1

AT-ISHANIBRAHMAPUR, POST-KHENTALO

https://www.digialm.com/EForms/PayUAfterPaymentAction.do?74494ZZ1258ZZonline 2/5
2/5/22, 10:55 PM NVS Form 2021

Address Line 2

PS-KISHORENAGAR, DIST-CUTTACK

Country

India

State District

Odisha Cuttack

Pin Code
754131

Matriculation (10th) Details

Name of the Board/Council

CENTRAL BOARD OF SECONDARY EDUCATION

Year Of Passing Institute Name

2013 KIIT INTERNTL SCHOOL

Subject Combination CGPA Obtained

CBSE 7.6

Intermediate (12th) Details

Name of the Board/Council

COUNSIL OF HIGHER SECONDARY EDUCATION

Year Of Passing Institute Name

2015 SB WOMENS COLLEGE

Subject Combination Percentage of Marks

ARTS 52.3

Educational Qualifications Details

https://www.digialm.com/EForms/PayUAfterPaymentAction.do?74494ZZ1258ZZonline 3/5
2/5/22, 10:55 PM NVS Form 2021

Degree Name

B.Sc Nursing

Institute Name
Specialization KALINGA INSTITUTE OF NURSING AND SCIE
Nursing NCES

Year Of Passing

2019

Percentage of Marks

76

Desirable Details

Do you have working Knowledge of Hindi/Regional Language and English?

Yes

Work Experience Details

Are you Registered with Indian/ State Nursing Council?

Yes

Do you have Practical experience of two years in Hospital/Clinic?

Yes

Previous Work Experience Details (latest to earliest)

Sr. Post Organization Pay Nature of GP/Pay From Date To Date No. of
No. Held Band Duties Level years of
Performed Service

1 GNM KIIMS 180000 NICU LEVEL 01/11/2019 05/02/2022 2 Year(s)

2 3
Month(s)

Total Work Experience

https://www.digialm.com/EForms/PayUAfterPaymentAction.do?74494ZZ1258ZZonline 4/5
2/5/22, 10:55 PM NVS Form 2021

2 Year(s), 3 Month(s)

I confirm that the experience entered by me in the table above is true.Any deviation found
in these details at a later stage will lead to appropriate action against me.

Payment Details

Amount Payment Mode

1200 online

Payment Status Payment Transaction No.

Successful 14671537898

Candidate Documents/Images Upload Details

Photo Signature

Declaration

I hereby, solemnly declare that information provided by me in the form

is true to the best of my
knowledge and belief. I understand that my candidature is subject to the
conditions laid down in
the advertisement brochure. I further declare that I am not involved in any
criminal case and/or no
such case is pending against me in any court of law.

Version 14.03.01

https://www.digialm.com/EForms/PayUAfterPaymentAction.do?74494ZZ1258ZZonline 5/5