|
|
| Post
applied for |
|
| Full
Name |
|
| Date of
Birth |
|
| Place
and State of Birth |
|
| Height
(in cm) |
|
| Weight
(in Kg) |
|
| Nationality
& Religion |
|
| Education
Standard |
|
| Command
over English |
|
| Marital
Status |
|
| No. of
children |
|
| Occupation
of Father/ Husband/ Guardian |
|
| Name
and address of Training School's in General Nursing & Midwifery giving
dates
|
|
| West
Bengal Nursing Council (General & Midwifery) Registration Number with
Dates : |
|
| Enter particulars of
clinical experience after completion of training. Maintain chronological order
: |
| Name of
Institute |
|
| Area
worked |
|
| Date |
|
| Total
Experience |
|
| Post -
basic qualifications if any, giving place & dates
|
|
| Present
Name of the Institute
|
|
| Reasons
for leaving the last or present appointment
|
|
| Last
Drawing Salary of Rs. |
|
| Give
names and contact addresses of two people well known in the locality where you
reside and one from the Matron of the last or present hospital, for references
of conduct & character
|
|
Reference (1)
|
|
| Reference
(2) |
|
| Reference
(3) |
|
| Local
Guardian's Address & Phone Number |
|
| Permanent
address |
|
| If
non-resident give the name and address of the nearest relative staying in
Calcutta stating Relationship
|
|
| Upload
your CV |
|
|
|
|
