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in/RegistrationSlip

All India Institute of Medical Sciences

Ansari Nagar, New Delhi - 110608
APPLICATION FORM - Nursing Officer Recruitment Common Eligibility Test (NORCET-4)

Candidate Profile Candidate ID: 6141341477 Registration No: 52101736 Registration Date: 04/05/2023

Candidate Name: NIMMANA SANDHYA Date of Birth: 16 Dec 1997

Gender: Female Category: SC

Father's Name: NIMMANA KRISHNA Mother's Name: NIMMANA NAGAMANI

Persons with Benchmark Disability Status: No PWBD Category: NA

Nationality: INDIAN State of Domicile: ANDHRA PRADESH

Applied for :
Nursing Officer Recruitment Common Eligibility Test (NORCET-4)

Are you a Government Employee : Yes

Name of Institution / Organisation: Type of Job Present Position held: Date of Date Of Type of orgination Total No
MEDICAL AND HEALTH Status: COMMUNITY HEALTH Appointment: Relieving : : of Days :
DEPARTMENT OF ANDHRA Regular OFFICER CUM MLHP 05/12/2021 05/05/2023 State Government 516
PRADESH

Are you a Ex-Service men : No

Contact Details

Address for Permanent: Correspondence Address:

1-114, PAVARA, SAMARLAKOTA , EAST GODAVARI, , Pavara , 1-114, PAVARA, SAMARLAKOTA , EAST GODAVARI, , Pavara , ANDHRA
ANDHRA PRADESH, India, 533450 PRADESH, India, 533450

Mobile No: 1. 7032012289 ,        2. No E-Mail ID: sandhyanimmana40@gmail.com

Qualification Details

Qualifying Exam University Name Collage Name Admission Passing

Date Date

B.Sc (Hons.) Nursing / B.Sc Nursing from an Indian Dr.NTR UNIVERSITY OF SWATANTRA COLLEGE 05/12/2016 26/04/2021
Nursing Council recognized Institute or University HEALTH SCIENCES AP OF NURSING

Registration Number with Nursing Council of India/State Nursing Council

Registered as Registration No:(Nurse) Registration No.: (Midwife) State Name of Nursing Council: Issuing Date of Registration:

Nurse and Midwife 219072 218625 ANDHRA PRADESH 23/07/2021

Valid Photo Identity (To be presented in original at the Examination Center along with Admit Card)

ID Proof: Adhar Card ID No: 865163985752 Place of Issue: INDIA Issue Date: NA Valid Till: NA

Payment Details

Mode: Online Date: 05/05/2023 Transaction ID: 13414772293 Amount: 2400

Do you have experience : Yes

Organisation Name Designation Job Type Start Date End Date Total
Day's

Other / MEDICAL AND HEALTH DEPARTMENT OF COMMUNITY HEALTH OFFICER On 05 Dec 05 May 516
ANDHRA PRADESH CUM MLHP Contract 2021 2023

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Examination City Opted:

State: State : State :
Exam City (Preference 1): Exam City (Preference 2): Exam City (Preference
ANDHRA ANDHRA ANDHRA
VISAKHAPATNAM VIJAYAWADA 3): GUNTUR
PRADESH PRADESH PRADESH

UNDERTAKING/DECLARATION: I hereby declare that the information furnished by me in the Registration/Application Form is correct and nothing has been
concealed. In case any information furnished by me is found to be false/incorrect/untrue than i shall be liable to civil/criminal prosecution and my claim to
admission/appointment/registration/ service in the Institute may be cancelled/terminated.

Signature of Candidate
Thumb of Candidate

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