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    Adobe Scan Jan 11, 2023

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    neha
    This document is an application form for the position of MLHP-cum-CHO for District Panchkula under the National Health Mission, Haryana. The applicant, Neha, provides her personal details including name, father's name, date of birth, category, address, contact information, and educational qualifications. She declares that the information provided is true and acknowledges that she understands any false information could lead to rejection or termination. She completed 10th grade in 2010, 12th grade in 2013, and B.Sc. Nursing in 2017 from Maharishi Markandeshwar University.

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    Adobe Scan Jan 11, 2023

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    16 views2 pages
    This document is an application form for the position of MLHP-cum-CHO for District Panchkula under the National Health Mission, Haryana. The applicant, Neha, provides her personal details including name, father's name, date of birth, category, address, contact information, and educational qualifications. She declares that the information provided is true and acknowledges that she understands any false information could lead to rejection or termination. She completed 10th grade in 2010, 12th grade in 2013, and B.Sc. Nursing in 2017 from Maharishi Markandeshwar University.

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    This document is an application form for the position of MLHP-cum-CHO for District Panchkula under the National Health Mission, Haryana. The applicant, Neha, provides her personal details including name, father's name, date of birth, category, address, contact information, and educational qualifications. She declares that the information provided is true and acknowledges that she understands any false information could lead to rejection or termination. She completed 10th grade in 2010, 12th grade in 2013, and B.Sc. Nursing in 2017 from Maharishi Markandeshwar University.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    16 views2 pages

    Adobe Scan Jan 11, 2023

    Uploaded by

    neha
    This document is an application form for the position of MLHP-cum-CHO for District Panchkula under the National Health Mission, Haryana. The applicant, Neha, provides her personal details including name, father's name, date of birth, category, address, contact information, and educational qualifications. She declares that the information provided is true and acknowledges that she understands any false information could lead to rejection or termination. She completed 10th grade in 2010, 12th grade in 2013, and B.Sc. Nursing in 2017 from Maharishi Markandeshwar University.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    National Health Mission, Haryana

    Application Form Number NHMCHO22012216- Post : MLHP-cum-CHO for


    District:Panchkula
    Personal Details:

    Applicant's Name: NEHA


    Father Name: PREM CHAND
    Mother Name: SUNITA DEVI
    Gender: Female
    Date of Birth (DD/MM/YYYY) I Age 03/10/1994 27 (+) years
    Catcgory Code:
    102
    Category: S.C
    |Language upto matriculation level Hindi
    E-mail:soodn52@gmail.com Marital Status : Married
    Mobile No. 7015559408 IDProof: PAN
    Alternate Mobile No.:
    9896706713 D No: BIGPN2282L
    Domicile HARYANA Nationality:| INDIAN
    Permanent Address: |257-A DASHMESH ENCLAVE, DHAKOLIZIRAKPUR PUNJAB PUNJAB 140603
    Correspondence Address: |257-A DASHMESH ENCLAVE, DHAKOLI ZIRAKPUR PUNJAB PUNJAB 140603
    Council Details -

    Council Name Haryana State Nurses & Regn. No. :004677 Regn. Year :2017 Regn. Valid Upto :26/10/2025
    |Nurse Midwives Council (Panchkula)
    Is NHM Employee: NO
    Ex-Serviceman:-
    Other Details:
    Ifyou are Petitioner for CHO Recruitment? NO
    Aware about surety bond:
    Petition Number: Year of Petition:
    Title of Petition:

    FIR/Criminal Case Registered against you? NO


    FIRICriminal case detail:
    -
    NA
    Convicted by criminal court: NO
    Type, Date and Nature of case: NA
    Existing Govt. Employee: NO Date of Joining:|NA
    Employment detail (incl. dept./desgn.) |NA
    Type of employment: NA Informed Department: NA

    |NHM Employee Detail


    Whether candidate is currently working as CH0 in Haryana: NO
    |Selection under which Category:
    |Name of District:
    Name of sub centre HWCI SC-HWC
    Working since when as CHO in Haryana Aware aboutsurety bond:

    Service Detail:
    Dismissed from govt. service: NO
    Dismissal Detail: NA
    Requisite educational qualification: YES
    Qualification Details:
    Name of examination Year Board/University Marks Total
    Percentage Study mode
    obtained| marks Grade

    10 TH/METRIC 2010 HBSE 367.00 500.00 73.4


    Regular
    MEDICAL 2013 HBSE 335.00 500.00 67
    Regular
    B. SC. NURSING 2017 MAHARISHI MARKANDESHWAR 1789.00 3200.00| 55.91
    UNIVERSITY MULLANA AMBALA Regular

    Payment Details:
    TRANSACTION ID PAYMENT PAYMENT PAYMENT REMARKS PAYMENT AMOUNT (IN RS.)
    STATUS DATE
    Oacd48c364c778159d450611 SUCCESS |11/01/2023 SUCCESS 100.00
    60a84845

    I NEHA do PREM CHAND do hereby declare that


    ja) Allthe information provided in the application are true, complete and correct to the best of my knowedge and belief.
    b)l am loar that I belong to above filled category/categories and I am aware ofit that after making final submission category
    categories can not be changed at any stage.
    c This application form has been filled and submitted by me. I am completely aware of the facts/datalpersonal detais filed in
    this form and before making final submission I have checked this data again and again.
    d) In future, I will not take any plea for any type of correction in this application form on the basis that information/data flled in
    this application form was entered/typed by somebody else (Computer operatorilnternet cafe master/any other perscn)
    )l understand that in the event of any particular information given above being found false or incorrect, my candidature for the
    above post is liable to be rejected or cancelled and in the event of any mis-statement or discrepancy in the particulars being
    detected after my appointrment, my services are liable to be terminated forthwith without any notice to me.

    Date 11/1/2023
    -

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