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fiÁ˝ ±ıLÕ ‹ÌՉΥŒ ÷flÌ¿ı fl∞VÀÕÛ ◊›ı·Î ˢ‰Î Ωı¥±ı.
(a)
‰›‹›Î˝ÿÎ — μ‹ıÿ‰ÎflfiÌ ‰› ÷Î. 30-4-2010fiÎ fl˘…
21 ◊Ì 35 ‰Ê˝ ‰E«ıfiÌ Ë˘‰Ì Ωı¥±ı.
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’Á_ÿ ◊›ı·Î μ‹ıÿ‰Îfl˘fiapple_ ±_Ï÷‹ ÷⁄Ì⁄Ì ’flÌZÎHÎ DGAFMS
ÎflÎ ÏfiÏ‹˝÷ ‹ıÏÕ¿· ⁄˘ÕÛ ÎflÎ ¿fl‰Î‹Î_ ±Î‰Âı.
APPLICATION FORM FOR SHORT SERVICE COMMISSION IN THE MILITARY NURSING SERVICE
2010 (USE BLOCK CAPITAL LETTERS ONLY)
Name of Applicant (Give one box Gap between firt Maiden/ Sarname):
(as per matriculation certificate. Leave one box between parts of name)
(b) Name of Applicant in Hindi :
(c) Have you ever changed your name (after matriculation) : Yes/No.
(d) If Yes :
(ii) New Name of Applicant (Give one Box Gap betwwen First/Maiden/Surmane)
(As per Central/State Gazette Notification/any other authority) :
(ii) New Name in Hindi
(Enclose photocopy of Gazette Notification/any other authority cleart highlighting your new name
2. Date of Birth :
3. Age as on 30-4-2010 :
4. Marital Status : Single / Married / Divorcee / Widow
5. Father’s Name :
6. Husband’s Name :
(for married women) :
(a) Husband’s Occupation :
(i) Defence ((Rank & Unit) :
(ii) Civilian (Designation & Organization) :
(b) Details of Children :
7. Nationality : (a) Self (b) Spouse (if married)
8. Details of Bank Demand Draft : Draft No. Dated
Drawn on Bank
Payable at Delhi.
9. Postal Address for Communication (with Pin code)
(a) Post Address :
(b) Phone No.with (S.T.D. Code)
(c) E-mail Address
(d) Permanent Home Address (with Pin code) :
10. Details of qualification :
Sl.
Year of Year of % of
No.
Qualification College University
Enrolment Passing Marks
a
b
BSc (Nursing)
P C BSc (Nursing)
c MSc (Nursing)
d Any other professional Courses
11. Whether the college is recognized by INC : YES / NO
12. Nursing Registration
SRN_______________ Date _______________ Place of Issue _______________
SRN_______________ Date _______________ Place of Issue _______________
13. Details of NCC training (indicate A, B, C certificate & enclose offested copy the certificate) :
Affix passport
size photograph
duly attested by
Gazetted Officer
14. Years of Service. 1. Clinical 2. Teaching
15. Particulars of present employment with date
DECLARATION
I hereby solemnly declare that all the statements made in the application are true and correct to the best of my knowledge and belief.
If at any stage information furnished by me is found to be false or incorrect. I will be liable for disciplinary action or termination of
service as deemed fit.
Dated:
Signature of candidate
IMPORTANT
Note : (1) The allotment of service depends on availability of vacancies and service exigencies.
(2) The following documents should be enclosed (attested copies only) (a) Matriculation certificate / School leaving Certificate
(page indicating date of birth) (b) Nursing registration certificate . (c) MSc (Nursing)/BSc (Nursing) /PC B.Sc nursing examination
degree certificate (d) Character certificate. (e) Proof of Indian Nationality (f) No Objection certificate from the present
employer, if employed. (g) Two self addressed envelope (27cm X 12 cm) with stamp affixed of Rs 6 /- each. (h) A nonrefundable
damand draft in SBI f Rs 150/-(Rupees one hundred and fifty only) in Favour f DGAFMS (APF) Fund, payble at SBI,
Cent Sect, New Delhi. Candidate should write her name and address on the rear side of the Demand Draft.
(3) All the documents should be properly tagged with the application in the same order as listed in point (2) above
(4) Incomplete application and loose documents/envelope/draft which are like to be detached while in tranjit/handling will be
rejected and no correspondence will be entertained in this regard. Similar and recent photo on the application from as well as
on the admit cards should be pasted and not stapled. DGMS-4B will not be held responsible for loss of any documents while
handling at any stage.
(5) This induction is being done predominantly for General Duty Nursing Officer (Ward Sister). Even the candidates with PG
Degree will be given Ward Sister posting initially.
(TO BE SUBMITTED IN TRIPLICATE ON A-4 SIZE PAPER)
Admit Card : Written Test / Interview for grant of
Short Service Commission in MNS-Year 2010
(1) Name:
(2) Visible Indentification Marks : (i)
(ii)
(3) Roll No:
Date of Written Test :
Time : 0930 Hours
Test Center :
Note :
(i) Only Column 1 & 2 will be filled by the candidate in capital letters.
(ii) Please carry this letter and a ball point pen/fountain pen along with you.
(iii) Produce the following during interview :
(a) Proof of Identity (b) Matriculation certificate/School Leaving Certificate (indicating date of birty) (c) Nursing registration
cetrificate. (d) MSc (Nursing)/BSc (Nursing)/PC B.Sc (Nursing)certificate & marklists. (e) Proof on India Nationality. (f) No Objection
certficate from the present employer, if employed. (g) NCC Certificate h) Passport Size Photograph-05
Signature of the Issuing Authority
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