ररषषषय आररगय अभभयरन, ररषषषय आययष भमशन, पयणण जरललर आणण

द दयसमरट बरळरसरलण ब ठरकरण आपलर दवरखरनर

हलहदह
Recruitment Process for Various Posts for Advertisement No. :CHA/03/2024
जजहहरजत कमजमक : CHA/03/2024 सजठठ हवहवध पदजमसजठठ भरतठ पककयज

अरर क (Application No)

CHA/03/2024/309

इइगजजत ननव (FullName in English) PRAJWAL SHRIPAD KADAM

मरनठठत ननव (FullName in Marathi) पजवल शजपनद कदम

जर ननव बदललल असलल तर इइगजजत

बदललल पपरन
र नव (If Name Changed,
Changed FullName in English)

वडडलनइचल/पनलकनइचल ननव SHRIPAD VASANT KADAM

(Father's/Guardian's FullName)

आईचल ननव (Mother's FullName) SUVARNA SHRIPAD KADAM

ललइग (Gender) पपरष (Male)

वववनहहक सससतज (Marital Status) अवववनहहत (Unmarried)

MCSR (लहनन कपटपइबनचज घघषरन) ननयम, 2005 नपसनर तपमहम पनत आहनत कन? (Are लनगप ननहम (Not Applicable)
you Eligible according to MCSR (Declaration of Small Family) Rules,
2005 ?)

पवगर (Category) खपलन (OPEN)

जनत (Caste) HINDU

पघटजनत (Sub-Caste) MARATHA

तपमहनलन कघरतयन पवगनरतपन अजर खपलन (OPEN)

करनयचन आहल ? (From which
Category you want to apply ?)

ई-मलल आयडज (Email ID) prajwal.kadam.2120@gmail.com

मघबनईल क (Mobile No) 9850035259

जनमतनरमख (Date of Birth) 09-04-2002

आधनर क (Aadhaar No) 722428999439

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पतवयवहनरनचन पतन (Correspondence SR. NO. 13 GAJANAN COLONY , OPP. AKASHWANI , NEAR
KARDEKAR CHOWL , HADAPSAR , PUNE-411028, PUNE,
Address)
MAHARASHTRA-411028

कनयमचन पतन (Permanent Address) SR. NO. 13 GAJANAN COLONY , OPP. AKASHWANI , NEAR
KARDEKAR CHOWL , HADAPSAR , PUNE-411028, PUNE,
MAHARASHTRA-411028

तपमचयनकडल महनरनषषनचल ववध अधधवनस पमनरपत आहल कन? (Whether You have valid हघय (Yes)
Domicile Certificate of Maharashtra?)

रनषषमयतव (Nationality) भनरतजय (Indian)

तपमहम रनषषमय आरघगय अलभयनन कमरचनरम आहनत कन? (Are you employee of National हघय (Yes)

Health Mission ?)

MS-CIT ककइवन समतपलय पलशकर यशसवजररतयन पपरर कललल आहल कन? (Has Successfully ननहम (No)
Completed MS-CIT or Equivalent Training?)
मरनठठचल पपरलसल जनन आहल कन? (Whether Possesss Adequate Knowledge of हघय (Yes)
Marathi?)

शशकणणक/तरहततक/वयरवसरययक अभयरसकम मरहलतत तपशतल (Details of Educational/Technical/Professional

Course Information) :

परषकर उततणर वषर एकदण गयण टककणवररष गणर (असलयरस)

परषकर सतर (Examination
(Examination) (Passing भमळरलण (Percentage) (Grade [If
Level)
Year) (Total Any])
Marks
Obtained)

ववशणष ववषय एकदण गयण गणर अथवर शणणत समतयलय रपरहतररत

बररर/यययनवभसरटष
(असलयरस) (Total Out नमदद आलण कर? टककणवररष
(Board/University)
(Specialisation [if Of Marks) (mention Grade (equivalent
or Category converted
Any])
instead of Percentage)
Marks)

Graduate Degree BACHLOR OF 2022 658 65.80 A

SCIENCE (REV.2019)

SAVITRIBAI PHULE PUNE MICRO-BIOLOGY 1000 Y 65.80

UNIVERSITY

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अनयभवरचर तपशतल (Details of Experience Information) :

सहसथणचर पकरर (Type of सहसथणचण नरव आणण पतर तररखणपरसदन एकदण अनयभव(Total यनययकततचण सवरप
Organisation) (Organisation Name (From Date) Experience) (Nature of the
and Address) Appointment)
पद (Post Held) तररखणपयरत (To वणतन तपशतल
Date) (Salary Detail)

महननगरपनललकन SHARP SERVICES 01-06-2022 01 Years, 08 ननसशचत वलतननवर (Fix

Months, 00 Days
(Corporation) Payment)

LAB TECHNITIAN 01-02-2024 12500

आपण अरर कणलणलष पदण (The Posts you have applied for) :

अरर कणलणलष पदण (Post Applied)

MULTIPURPOSE HEALTH WORKER (MPW) (AAPALA DAWAKHANA)

अरर फफ मलणदन तयमचयरकरदन ऑनलरइन रककम परपत झरलष (Online Amount Received from you as
Application Fees) :

वयवलरररचत तररषख वयवलरर आयरत (Transaction ID) रककम (Amount)

(Transaction Date)
15-03-2024 15Mar2024161851909226YSW 300.00

एकदण रककम (Total Amount) 300.00

आपण आपलरर कणलणलयर करगदपतरहचत यरदष (List of documents you have uploaded) :

अनय. क (Sr. No) अपलरर कणलणलयर करगदपतरहचर तपशतल (Details of documents uploaded)

1 रइ दम 100 वपकसलल आणर उइ चज 140 वपकसलल असलललन अजरदनरनचन फघटघ (Applicant Photo having
Width 100 Pixel and Height 140 Pixel)

2 रइ दम 100 वपकसलल आणर उइ चज 50 वपकसलल असलललम अजरदनरनचज सवनकरम (Applicant Signature

having Width 100 Pixel and Height 50 Pixel)

3 आधनर कनडर / डनयसवहइ ग लनयसनस / पपन कनडर / पनसपघटर सनरखन फघटघ आयडज (Photo ID Like
Aadhar Card / Driving License / PAN Card / Passport)

4 वयनचन पपरनवन - शनळन सघडलयनचन दनखलन (Proof of Age - School Leaving Certificate)

5 अधधवनस पमनरपत (Domicile Certificate)

6 अजनरतजल ननवनचन पपरनवन एस. एस. सज. असवन ततसम शवकणरक अहतनर (Proof of name in
application form (S.S.C. or equivalent Educational Qualification)

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 7 रनषषमय आरघगय लमशन आससनपनलवरमल कमरचनरम असलयनचन पपरनवन (Proof of being an
Employee of the National Health Mission establishment )

8 यन वयनतररकत पनततलशज इतर कघरतलहम सइबइधधत दसतऐवज (Apart from this any other
Documents related to Eligibility)

9 शवकणरक पनततन टप बमधयल नमपद कललललम सवर बघडर/पदवज पमनरपतल एकनच पजडजएफ फनइलमधयल अपलघड
करन (Upload All Board/Degree Certificates which are mentioned in Educational
Qualification Tab in Single PDF File)

10 सरनसरम शलरज पपइइट रपनइतरर पमनरपत ( CGPA Conversion Certificate )

11 अनपभव टप बमधयल नमपद कललललम सवर अनपभव पमनरपतल एकनच पजडजएफ फनइलमधयल अपलघड करन
(Upload All Experience Certificates which are mentioned in Experience Tab in
Single PDF File)

DECLARATION
मज, यनदवनरल , ग
भरलललम सइपपरर मनहहतज मनझयन मनहहतजपमनरल सतय आणर बरघबर आहल . मज कघरतजहम भभनतक मनहहतज लपवलललम ननहम, तस
यलसल सनदर कललललम कघरतजहम मनहहतज फसवज, चपककचज ककइवन असतय आढळलयनस, म
हघणयनस जबनबदनर असपन पदनवरमल ननवड दल खजल रदद हघणयनस जबनबदनर आहल . म
आणर मज तयनइचल पनलन करणयनस सहमत आहल . मज यनदवनरल यन ननयमनइचज सइपपरर कनयदल शजरतन, ववधतन आणर शपदधतन सवजकनरतघ.
मलन समजतल कक हन अजर सबलमट करन मज यन सवनरचज शपदधतन, ववधतन आणर/ककइवन नयनययतन सवजकनरलम आहल . म
आवशयक कनगदपतल अपलघड करणयनचल वचन घलतघ, तयनत अयशसवज झनलयनस मनझन ननवडजचन दनवन मइजपर कललन जनरनर ननहम.
मज दसतऐवज पडतनळरजचयन वलळज तसलच ननवड पककयलचयन वलळज ननयमनइनपसनर सवर आवशयक मपळ पमनरपतल सनदर करणयनचल
वचन घलतघ, असल न झनलयनस मनझन ननवडजचन दनवन मइजपर कललन जनरनर ननहम असल मलन समजतल.

I,hereby,solemnly and sincerely affirm that each and every statement made and the entire information
filled in the above online application form is true and correct to the best of my knowledge. I have not
concealed any material information, however if any information submitted herein is found fraudulent,
incorrect or untrue, I understand that I am liable to criminal prosecution and my selection to the Post
is also liable to be cancelled. I have carefully read the rules & regulations of Recruitment and I agree
to abide by them. I hereby accept in entirely the legality, validity and correctness of these rules. I
understand by submitting this application I have accepted the correctness, validity and/or justifiability of
all these and that. I undertake to upload all the required Documents, failing which I understand that
my claim for selection shall not be granted. I undertake to submit all the required original certificates
at the time of Document Verification as well as at the time of selection process as per the rules,
failing which I understand that my claim for selection shall not be granted.

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Online Application Submit Date : 15-03-2024

Signature of Applicant

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