Applicant Details

Personal Details
Application Sequence No
NHMCHO1045542

Candidate's Full Name

CHANDRABHAN PATEL

Marital Status Nationality

Unmarried Indian

Father's Name

KRIPA SHANKAR PATEL

Mother's Name

PHOOLPATTI DEVI

Post Applied Details

Post Applied Post Code

Community Health Officers - CCHN 01

Category Gender

OBC Male

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

Secondary Certificate

29/Jun/1997

Age as on 14.07.2022
25 Years 0 Months 15 Days
 Are you UP domiciled Are you Physically Handicapped (PH) (degree of
disability 40% or above)?
Yes
No

Examination Center Choice 1 Examination Center Choice 2

Varanasi Prayagraj

Examination Center Choice 3

Lucknow

Contact Details
Mobile Number

6387083863 Email ID

cbp29697@gmail.com

Present Address

Address Line 1
VILLAGE PASIYAHI KHURD POST PASIYAHI KHURD

State

Uttar Pradesh

Country

India

District Pin Code

Jaunpur 222161

Permanent Address

Is Permanent Address same as Present Address?

Yes

Address Line 1

VILLAGE PASIYAHI KHURD POST PASIYAHI KHURD

State
Uttar Pradesh
 Country

India

District Pin Code

Jaunpur 222161

Matriculation (10th) Details

Name of the Board/Council

U. P. BOARD

Subject Combination

HINDI ENGLISH MATHEMATICS SCIENCE SOCIAL SCIENCE DRAWING

Institute Name

SWAMI S S I C GOVINDPUR ROHANIA VARANASI

Year Of Passing Percentage of Marks

2013 76.16

Intermediate (12th) Details

Name of the Board/Council

U. P. BOARD

Subject Combination

GENERAL HINDI ENGLISH PHYSICS CHEMISTRY BIOLOGY

Institute Name

S P B S I C KHALISPUR VARANASI

Year Of Passing Percentage of Marks

2015 80.00

Essential Qualification Details

 Degree Name University Name/Board Name

General Nursing and Midwifery HERITAGE SCHOOL OF NURSING

Year Of Passing Percentage of Marks

2021 69.83

Are you registered as Nurse and Midwife from UP Nurses & Midwives Council and have valid registration certificate
at the time of online submission of application.

Yes

Kindly enter your certificate registration no. issued by the UTTAR PRADESH NURSES & MIDWIVES COUNCIL.

103272

Have you been engaged for Covid Management as outsourced/temporary HR/contractual and worked at Public
Health facilities and/or worked for Management of Covid through administration under Department of Medical
Health and Medical Education in Uttar Pradesh?

No

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.In case of any falsification found in shared
details, my candidature may be cancelled for the said position and Legal action may be initiated.

Version 14.04.01