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The document outlines a form for updating staff nurse information, requiring details such as name, date of birth, qualifications, appointment mode, and service history. It includes sections for contract and regular appointment details, registration dates, and any service breaks or unauthorized absences. The form concludes with a declaration for verification by the applicant and the head of the institution.

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cocmentortn
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5 views1 page

FORMAT 2

The document outlines a form for updating staff nurse information, requiring details such as name, date of birth, qualifications, appointment mode, and service history. It includes sections for contract and regular appointment details, registration dates, and any service breaks or unauthorized absences. The form concludes with a declaration for verification by the applicant and the head of the institution.

Uploaded by

cocmentortn
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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1 Name of the Staff Nurse

(Only Regular Staff Nurse)


2 Date of Birth
3 Qualification
4 Present Station
5 Mode of appointment MRB / Through DME
Selection committee / Others (to be specified)

6 Appointment as Contract Staff Nurse:


a) Proceedings reference no. with date of DM & RHS

b) Date of Joining as Contract Staff Nurse

7 Date of joining as Regular Nurse (A copy of Contract to


regular appointment order to be enclosed)
A) Proceedings ref. No with date of DM&RHS

B) Date of Joining as Regular Staff Nurse


8 Regular Nurse appointment batch and year
9 Date of Registration in the post of Staff Nurse
(A copy of Regularisation order to be enclosed)
10 Date of completion of probation
11 Break in service, if any
12 Unauthorised absence, if any
13 Any other remarks

FORMAT FOR UPDATION IN CNL CNL No:

SIGNATURE OF THE APPLICANT

DECLARATION
I Certify that the supportive documents have been verified and declare that the above details are true to the
best of my knowledge and as per Records
SIGNATURE OF THE DEAN/JDHS/DDHS
HEAD OF INSTITUTION

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