Recruitment For Block ASHA Facilitator(Contractual) under District
* Mandatory Field
Post Applied For *:
Applied For Sub-Division : *:
Applied For Block: *:
Name *:

Father's/Husband's Name *:

Nationality*:
                             
Gender*:
Category*:
Date Of Birth*:
Age as on (1st January, 2014)*:
Email:
Mobile No*: 
Present Address*:
Village/City/Road/Post Office*:
Block* :
Sub-Division*:
District*:
Pin*:
State*:
Permanent Address*:
Village/City/Road/Post Office*:
Block* :
Sub-Division*:
District*:
Pin*:
State*:
Whether Present Address same as Permanent Address     
Educational Qualification :
Qualification
Name Of Institute/Board/University
Year of Passing

Subject

Total Marks

Marks Obtained
% Of Marks Obtained
Grade/Division

        ( * You can add Maximum 6 rows)

Experience(If Any):-  
Name of Project
Project Activities

Name of Post in Project (Designation)

Organization Conducting the project

From(dd/mm/yyyy)

To(dd/mm/yyyy)

Duration of work in month

Remarks

        ( * You can add Maximum 4 rows)

Computer knowledge (MS Office and Internet) :-
PIN*:- (Please Specify 4 digit PIN number for uploading Photograph & Signature)
I hereby declare that I fulfil the eligibility criteria for the post in terms of educational qualifications (including percentage of marks obtained in the examination and certificate course), experience, age, etc. and I am aware that mere calling for Test or Interview shall not entail me as fulfilling the conditions of eligibility. I certify that the information given in the application is correct and complete to the best of my knowledge and nothing has been concealed/distorted. I understand that if at any time I am found to have concealed/distorted any material information my candidature/appointment is liable to summary termination without notice or compensation.
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