ONLINE APPLICATION REGISTRATION FOR NURSING ASSISTANT GRADE - II 2026

USER ID MRBNAW26006505
POST APPLYING FOR NURSING ASSISTANT GRADE - II

PERSONAL DETAILS
NAME GANESAN V
NATIONALITY INDIAN
GENDER MALE
DO YOU HAVE COMMUNITY CERTIFICATE ISSUED YES
BY TAMIL NADU GOVERNMENT?
COMMUNITY BC
SUB CASTE SENGUNTHAR
ISSUING AUTHORITY OF COMMUNITY CERTIFICATE ZONAL DEPUTY TAHSILDAR
COMMUNITY CERTIFICATE NUMBER TN-5202601124735
COMMUNITY CERTIFICATE PLACE OF ISSUE SANKARANKOVIL
COMMUNITY CERTIFICATE ISSUING DATE 17-JAN-2026
ARE YOU DIFFERENTLY ABLED? NO
HAVE YOU PASSED THE 10TH STANDARD AND NO
POSSESS CERTIFICATE FOR HAVING
SUCCESSFULLY COMPLETED THE TRAINING
COURSE FOR NURSING ASSISTANT IN ANY OF THE
GOVERNMENT MEDICAL INSTITUTIONS IN THE
STATE PRIOR TO 20.11.2012?
DATE OF BIRTH (AS PER SSLC MARK SHEET) 25-DEC-1980
AGE AS ON 01-07-2026 45 YEARS 6 MONTHS 6 DAYS
EMAIL ID GANESANV163@[Link]
MOBILE NUMBER 8012927445
WOULD YOU LIKE TO GIVE FATHER AND MOTHER FATHER AND MOTHER
NAME OR GUARDIAN NAME
FATHER'S NAME VEDHANAYAGAM
MOTHER'S NAME ANGAMMAL
ARE YOU MARRIED? YES
NAME OF SPOUSE MEENATCHI
NATIVITY TENKASI - TAMIL NADU
RELIGION HINDU
ARE YOU ALREADY IN GOVERNMENT SERVICE? NO

PHOTO ID PROOF DETAILS

PHOTO ID PROOF VOTER ID
PHOTO ID PROOF NUMBER MPY1882901

PERMANENT ADDRESS
ADDRESS 1/66, MIDDLE STREET, SUBBULAPURAM
STATE TAMIL NADU
DISTRICT TENKASI
CITY / VILLAGE VAYALI

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 PINCODE 627753

CORRESPONDENCE ADDRESS
ADDRESS 1/66, MIDDLE STREET, SUBBULAPURAM
STATE TAMIL NADU
DISTRICT TENKASI
CITY / VILLAGE VAYALI
PINCODE 627753
MOTHER TONGUE TAMIL
WHETHER ANY CRIMINAL CASE HAVE BEEN FILED NO
AGAINST YOU?

EDUCATIONAL QUALIFICATION

EXAMI NAME OF PERIOD OF DURAT NAME OF MONTH DO TOTAL TOTAL PERCE MEDIU CERTIFI HAVE
NATIO BOARD / STUDY ION INSTITUTI & YEAR YOU MAXIMU OBTAINE NTAGE M OF CATE YOU
N CERTIFICA FROM - TO OF ON OF HAVE M D OF INSTR ISSUED STUDI
TE STUDY PASSIN MARKS MARKS MARKS MARK UCTI DATE ED
COURSE (NO. G FOR S ON TAMIL
NAME OF THE AS
YEARS CERTIF ONE
& ICATE OF
MONT COURSE THE
HS) ? LANG
UAGE
(PART-
1)
10TH / TAMIL --- - - MARCH - 500 385 77.00 TAMIL 17- YES
SSLC NADU 1996 JUN-199
STATE 6
BOARD
CERTIF TRAINING JANUARY 1 KILPAUK JANUAR YES 200 154 77.00 ENGLI 05- NO
ICATE COURSE 2012 - YEARS MEDICAL Y 2013 SH JUN-201
COURS FOR JANUARY 1 COLLEGE, 3
E NURSING 2013 MONT CHENNAI
ASSISTAN H (S)
TS

ARE YOU ELIGIBLE TO AVAIL PSTM PREFERENCE? NO

OTHER QUALIFICATION
DO YOU HAVE ANY OTHER QUALIFICATION? YES

NAME OF THE INSTITUTION NAME MONTH & DO YOU HAVE TOTAL TOTAL PERCENTA CERTIFICATE
QUALIFICATION YEAR OF MARKS FOR MAXIMUM OBTAINED GE OF ISSUED DATE
PASSING THIS MARKS MARKS MARKS
QUALIFICATI
ON
HSC AMC G HSS MARCH YES 1200 0773 64.42 05-JUN-1998
KARIVALAMVANDANAL 1998
LUR

UPLOAD DOCUMENTS
DOCUMENT NAME FILE NAME
COMMUNITY CERTIFICATE [Link]
SSLC CERTIFICATE [Link]
COURSE CERTIFICATE [Link]
COURSE CERTIFICATE MARKSHEET [Link]
OTHER QUALIFICATION CERTIFICATE 1 [Link]

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 DECLARATION
I HEREBY DECLARE THAT ALL THE PARTICULARS FURNISHED IN THIS APPLICATION ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF
MY KNOWLEDGE AND BELIEVE. IN THE EVENT OF ANY INFORMATION BEING FOUND FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED
BEFORE OR AFTER THE SELECTION, ACTION CAN BE TAKEN AGAINST ME BY THE MRB.
I HEREBY DECLARE THAT I WILL NOT BE A PARTY TO ANY KIND OF CANVASSING ON MY BEHALF.
I FURTHER DECLARE THAT I FULFIL ALL THE ELIGIBILITY CONDITIONS PRESCRIBED FOR ADMISSION TO THIS POST.
I HAVE INFORMED MY EMPLOYER IN WRITING THAT I AM APPLYING FOR THIS POST AND FURNISH THE NOC FOR THIS PURPOSE (IF
APPLICABLE).
I HAVE GONE THROUGH THE INSTRUCTIONS ETC. TO CANDIDATES AND THE BOARD'S NOTIFICATION FOR THIS RECRUITMENT, BEFORE
FILLING UP THE APPLICATION FORM AND I AM ELIGIBLE TO APPLY FOR THIS POST.
I DECLARE THAT I POSSESS THE MEDICAL STANDARDS PRESCRIBED FOR THE POST(S) WHICH I AM NOW APPLYING.
I CERTIFY THAT I HAVE NOT BEEN DEBARRED / DISQUALIFIED BY THE BOARD OR ANY OTHER RECRUITING AGENCY.
I AM NOT A DISMISSED GOVERNMENT EMPLOYEE.
THERE IS NO CRIMINAL CASE FILED AGAINST ME IN THE POLICE STATION / COURT.
THERE IS NO VIGILANCE CASE FILED AGAINST ME.
I HEREBY DECLARE THAT MY CHARACTER / ANTECEDENTS ARE SUITABLE FOR APPOINTMENT TO THIS POST.
I DECLARE THAT I DO NOT HAVE MORE THAN ONE LIVING SPOUSE / I AM UNMARRIED.
I ACCEPT THAT IF ANY SUPPRESSION / INCORRECT / FALSE / MISLEADING INFORMATION SUBMITTED IN THE ONLINE APPLICATION WILL
RESULT IN THE REJECTION OF MY CANDIDATURE WITHOUT FURTHER NOTICE.

☑ I ACCEPT THE ABOVE DECLARATION.

SUBMITTED DATE : 23-JAN-2026 (SIGNATURE OF THE CANDIDATE)

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