Online Recruitment Management System

APPLICATION FORM

PERSONAL DETAILS

1. Post Applying For *	:
2. Applied For State *	:
3. Applicant Name (As in 10th Certificate) *	:
4. Father's Name(As in 10th Certificate) *	:
5. Date Of Birth *	:
6. Mobile No. *	:
7. Email Address	:
8. Gender *	:
9. Age as on	:
10. Category *	:
11. Physically Challenged	:
12. District of Domicile	:
13. Present Contact Address *	:
		If same as present Address
14. Permanent Contact Address *	:

15. QUALIFICATION DETAILS

Exam Passed

Name of Board/University

Year Of Passing

Month of Passing

Marks(excluding 4th optional)
Full Mark	Marks Secured	Percentage

Duration Of Course

Full/Part Time

16. Experience Details

Name of the Employer

Post Held

From Date

To Date

Salary

Whether OSH&FW Post

Description

Total Experience
Total Experience(Under OSH&FW Society)

DECLARATION

I do hereby declare that the information furnished above are true to the best of my knowledge and belief and that, if at any stage, it is found that any of the above material information is false / incorrect or is suppressed by me, my candidature / appointment under Odisha State Health & Family Welfare Society (OSH&FWS), Odisha is liable to be rejected/terminated.I also declare that I have never been disengaged from service under the OSH&FWS,Odisha on administrative ground such as disobedience/poor performances/misbehavior/criminal activity etc.

Further, I undertake that I shall produce all original certificates/documents in support of the above information at the time of interview/certificate verification.

List of District Preferences