ONLINE APPLICATION REGISTRATION FOR AUXILIARY NURSE MIDWIFE /

VILLAGE HEALTH NURSE 2023 & 2025

USER ID MRBVHNW25011951
POST APPLYING FOR AUXILIARY NURSE MIDWIFE / VILLAGE HEALTH
NURSE

PERSONAL DETAILS
HAVE YOU ALREADY APPLIED FOR THIS AUXILIARY NO
NURSE MIDWIFE / VILLAGE HEALTH NURSE POST
AS PER NOTIFICATION NO:10/MRB/2023?
NAME CHITHRA R
NATIONALITY INDIAN
GENDER FEMALE
DO YOU HAVE COMMUNITY CERTIFICATE ISSUED YES
BY TAMIL NADU GOVERNMENT?
COMMUNITY MBC/DNC
SUB CASTE VANNIAKULA KSHATRIYA
ISSUING AUTHORITY OF COMMUNITY CERTIFICATE ZONAL DEPTY TAHSILDAR
COMMUNITY CERTIFICATE NUMBER TN-5201911201654
COMMUNITY CERTIFICATE PLACE OF ISSUE VILLUPURAM
COMMUNITY CERTIFICATE ISSUING DATE 20-NOV-2019
ARE YOU DIFFERENTLY ABLED? NO
ARE YOU A DESTITUTE WIDOW? NO
DATE OF BIRTH (AS PER SSLC MARK SHEET) 20-APR-2001
AGE AS ON 01-07-2025 24 YEARS 2 MONTHS 11 DAYS
EMAIL ID RAJAMANIKKAMBHARATHIRAJA@[Link]
MOBILE NUMBER 9087887236
WOULD YOU LIKE TO GIVE FATHER AND MOTHER FATHER AND MOTHER
NAME OR GUARDIAN NAME
FATHER'S NAME RAJAMANIKKAM
MOTHER'S NAME KALAIVANI
ARE YOU MARRIED? YES
NAME OF SPOUSE DHIVIYAMANI
NATIVITY KALLAKURICHI - TAMIL NADU
RELIGION HINDU
ARE YOU ALREADY IN GOVERNMENT SERVICE? NO

PHOTO ID PROOF DETAILS

PHOTO ID PROOF VOTER ID
PHOTO ID PROOF NUMBER NZJ2403491

PERMANENT ADDRESS
ADDRESS NO.121, NORTH STREET, [Link], ULUNDURPET
STATE TAMIL NADU
DISTRICT KALLAKURICHI

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 CITY / VILLAGE ULUNDURPET
PINCODE 606107

CORRESPONDENCE ADDRESS
ADDRESS NO.121, NORTH STREET, [Link], ULUNDURPET
STATE TAMIL NADU
DISTRICT KALLAKURICHI
CITY / VILLAGE ULUNDURPET
PINCODE 606107
MOTHER TONGUE TAMIL
WHETHER ANY CRIMINAL CASE HAVE BEEN FILED NO
AGAINST YOU?

EDUCATIONAL QUALIFICATION

ELIGIBLE QUALIFICATION

HAVE YOU PASSED THE EDUCATIONAL QUALIFICATION FOR THE POST OF AUXILIARY NURSE MIDWIFE / VILLAGE HEALTH NURSE PRIOR TO
15.11.2012.
NO

EXAMI NAME OF PERIOD DURAT NAME OF MONTH DO TOTAL TOTAL PERC MEDI CERTIF CERTIFI HAVE
NATIO BOARD / OF STUDY ION INSTITUT & YEAR YOU MAXIMU OBTAINE ENTAG UM ICATE CATE YOU
N CERTIFICA FROM - TO OF ION OF HAVE M D E OF OF REGIST ISSUED STUDI
TE STUDY PASSIN MARKS MARKS MARKS MARK INST ER NO DATE ED
COURSE (NO. G FOR S RUCT TAMIL
NAME OF THE ION AS
YEARS CERTIF ONE
& ICATE OF
MONT COURSE THE
HS) ? LANG
UAGE
(PART
-1)
10TH / TAMIL --- - - MARCH - 500 376 75.20 TAMIL - 25- YES
SSLC NADU 2016 MAY-20
STATE 16
BOARD
12TH / TAMIL --- - - MAY - 1200 769 64.08 TAMIL - 16- YES
HSC NADU 2018 MAY-20
STATE 18
BOARD
CERTIF TWO NOVEMBE 2 ANM NOVEMB YES 1400 1028 73.43 TAMIL 5148 01- NO
ICATE YEARS R 2022 - YEARS TRAINING ER 2024 NOV-20
COURS MULTI - NOVEMBE 1 SCHOOL 24
E PURPOSE R 2024 MONT HEALTH
HEALTH H (S) AND
WORKERS FAMILY
(FEMALE) WELFARE
TRAINING TRAINING
COURSE / CENTRE
AUXILIARY
NURSE
MIDWIFER
Y
TRAINING
COURSE

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 EXAMINATION ARE YOU A REGISTERED DATE OF REGISTRATION TAMIL NADU REGISTRATION REGISTRATI
AUXILIARY NURSE MIDWIFE / NURSES AND CARD TYPE ON VALID
VILLAGE HEALTH NURSE MIDWIVES UPTO
WITHIN THE TAMIL NADU COUNCIL
NURSES AND MIDWIVES REGISTRATION
COUNCIL NUMBER
REGISTERED IN YES 28-AUG-2025 34787 RENEWAL CARD 27-
TAMIL NADU AUG-2030
NURSES AND
MIDWIVES

EXAMINATION ARE YOU ELIGIBLE TO AVAIL PSTM HAVE YOU STUDIED IN TAMIL HAVE YOU STUDIED YOUR DIPLOMA
PREFERENCE? MEDIUM FROM 1ST STANDARD TO COURSE IN TAMIL MEDIUM?
12TH STANDARD?
PSTM YES YES YES

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
TYPEWRITTING SOCIAL WELFARE FEBRUARY NO - 02-JUN-2022
TRAINING CENTRE 2022

COVID DUTY CERTIFICATE

HAVE YOU WORKED IN COVID PERIOD? NO

UPLOAD DOCUMENTS
DOCUMENT NAME FILE NAME
COMMUNITY CERTIFICATE [Link]
SSLC CERTIFICATE [Link]
HSC CERTIFICATE [Link]
COURSE CERTIFICATE [Link]
COURSE CERTIFICATE MARKSHEET [Link]
TAMIL NADU NURSES AND MIDWIVES COUNCIL REGISTRATION [Link]
CERTIFICATE
PSTM CERTIFICATE (1ST TO 12TH STANDARD & CERTIFICATE PSTM18_MERGED.PDF
COURSE)
OTHER QUALIFICATION CERTIFICATE 1 [Link]

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.

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 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 : 09-DEC-2025 (SIGNATURE OF THE CANDIDATE)

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