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Junior Resident Form

The document is a checklist and application form for the position of Junior Resident at GMERS Medical College, Himmatnagar. It outlines the required enclosures, personal information, educational qualifications, teaching experience, and registration details that candidates must provide. Additionally, it includes an undertaking statement for the applicant to confirm the accuracy of the information submitted.

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rohankanani
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147 views3 pages

Junior Resident Form

The document is a checklist and application form for the position of Junior Resident at GMERS Medical College, Himmatnagar. It outlines the required enclosures, personal information, educational qualifications, teaching experience, and registration details that candidates must provide. Additionally, it includes an undertaking statement for the applicant to confirm the accuracy of the information submitted.

Uploaded by

rohankanani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GMERS MEDICAL COLLEGE HIMMATNAGAR S.

K-383001
Check List of Enclosures for post of Junior Resident
Name of the Candidate: Subject:

Sr. Attested photocopies of Yes/ Not Remarks if any


No Documents No Applicable
1 MBBS/BDS Mark Sheet.

2 FINAL MBBS/BDS Attempt


Certificate.
3 P.G. MARK SHEET
4 P.G. Attempt Certificate

5 MBBS/BDS GMC
Registration Certificate.
6 MS/MD/MDS-GMC
Registration Certificate.
7 MBBS/BDS Degree Certificate

8 MS/MD/MDS Degree Certificate

9 Teaching/Clinical Exp. Certificate

10 Internship Completion Certificate

11 Birth Date Certificate: School-


Leaving
12 Research Publication

13 NOC/ Reliving order

14 CCC+ (Desirable)

15 Pan Card

16 Aadhar card

Verified by:-
G.M.E.R.S. MEDICAL COLLEGE & HOSPITAL, HIMMATNAGAR (S.K)
GUJARAT MEDICAL EDUCATION RESEARCH SOCIETY,
(An organization of Government of Gujarat)
HIMMATNAGAR 383001 (NORTH GUJARAT –INDIA)
AFFIX
PASSPORT
APPLICATION FORM SIZE PHOTO

1. Post applied for : Subject: ______________________

2. Name of Candidate______________________________________________________

& Address __________________________________________________________

(In BLOCK LETTERS) __________________________________________________________

Telephone No. with code (Phone)____________________________ Mobile __________________

Email ID : _________________________________________________________________________

3. Date of Birth : ____ _____ _____ Age ______ Year______ Month

4. Gender: Male/Female Category :( OTHER/SEBC/SC/ST) __________

5. Present Job : _____________________________________ Place ________________________

6. Educational Qualification :
Sr. Examination Year of University Only final year
No. Passing
Total Marks Percentage Attempt

1. MBBS /BDS/FMG

2. MD/MS/DNB/MDS

7. Details of teaching Experience


Sr. Teaching Post Head Name of Institution Date Total Period
No.
From To Years Month
8. Details of Research Papers Publication/ Presentation:

National/ No. of Year of Name of journal Whether journal


International Paper Publication is an indexed Name of Article
Published Published journal (yes/No)
1 2 3 4 5 6

9. Details of Gujarat Medical Council/Gujarat Dental Council Registration

Registration No.U.G _____________________ P.G _____________________________

Date of Registration No.U.G _____________________ P.G _____________________________

10. Name of Two Referees (with phone No)

1____________________________________

2____________________________________

10. List of Enclosures (Attested Copies in following order)

Attested Photocopies in Following Please tick (√ ) Attested Photocopies in Following Please tick (√ )
order Order
(1) Final MBBS Mark sheet (8) Teaching Exp. Certificate

(2) Final MBBS Attempt (9) Internship Completion Certificate


Certificate
(3) P.G. Mark sheet (10) School –Leaving Certificate/Birth
Date Certificate
(4) P.G Attempt Certificate (11) Research Publication

(5) MBBS/BDS ; GMC (12) NOC / Reliving Order


Registration Certificate
(6) P.G GMC Registration (13) Aadhar card
Certificate
(7) MBBS and PG Degree (14) Pan Card
Certificate

Undertaking

I declare that information stated above is true to the best of my Knowledge. If above
Information is found to be false; I am bound to obey the decision of Selection Committee.

Place:
Date:
Signature of Applicant

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