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Chief Medical Officer Application Form

This document is an application format for the position of Chief Medical Officer at the West Bengal State Electricity Distribution Company Limited. It includes sections for personal information, educational qualifications, experience details, and a declaration by the candidate. Applicants must provide supporting documents and attestations as specified in the format.

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ASIM MONDAL
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36 views2 pages

Chief Medical Officer Application Form

This document is an application format for the position of Chief Medical Officer at the West Bengal State Electricity Distribution Company Limited. It includes sections for personal information, educational qualifications, experience details, and a declaration by the candidate. Applicants must provide supporting documents and attestations as specified in the format.

Uploaded by

ASIM MONDAL
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

West Bengal State Electricity Distribution Company Limited

(A Government of West Bengal Enterprise)


FORMAT OF APPLICATION AGAINST NOTIFICATION NO. MPP/2017/05 DATED: 26/05/2017
RECRUITMENT FOR THE POST OF CHIEF MEDICAL OFFICER

To, AFFIX SELF


The Addl. General Manager (HR&A) ATTESTED
Recruitment & Manpower Planning Cell PASSPORT SIZE
Vidyut Bhavan, 7th Floor,’C’ Block, Kolkata-91 PHOTOGRAPH

1. Name of the Post Applied for : CHIEF MEDICAL OFFICER


2. Name of the Candidate (in block letters) :

3. Father’s/Husband’s Name :

4. Correspondence Address :

5. Permanent Address :

6. Mobile No. / Telephone No. :


7. E-mail ID :

8. Date of Birth & Age as on 01.01.2017 :


9. Gender (Male/Female) :
10. Nationality :
11. Regd. No. For Medical Practice (Document to be enclosed) :
12. Qualification : Please specify in details as per the format outlined below

Course Mode
Name of the Division/
Examination Year of - Full time/
Qualification Board/Council/ Class/Grade
Passed Passing Part time/
Institute/University Point
Others

Educational

Professional

13. Whether belongs to SC / ST / OBC (A) / :


OBC (B) /Physically Challenged Category
[Copy of certificate(s) to be enclosed]

Page 1 of 2
14. Experience Details :

Scale of Pay /
Type of Org. Band Pay &
Name of
SI No. Govt./PSU/ Post (s) held From To Grade Pay
Organization
Pvt./Others (for PSU/ Govt.
only)

*** Self-attested copy of the relevant experience details is to be enclosed. ***


Note: Please attach separate sheet for narrating Job Responsibilities/Experience.

15. Special Achievements in the relevant fields (if any):

16. Last Pay Drawn :

i) Scale of Pay/Pay Band :


ii) Grade Pay :
iii) Basic Pay :
iv) Gross Salary :

17. List of Credentials enclosed :


a)
b)
c)
d)

D E C L A R A T I O N

I, hereby, declare that the particulars furnished herein are true to my knowledge. If any information is
found to be false subsequently by the authority, my candidature for the post is liable to be rejected.

Date:

Place:
Signature of the Candidate

Page 2 of 2

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