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Recruitment of Housestaffs in ID BG Hospital, (Interview On 19.03 .2025) (Memo .1129 of 08 .03 .2025)

This document is a proforma application for the position of House Staff at Beleghata ID & BG Hospital in Kolkata. It requires personal details, educational qualifications, marks obtained in MBBS, working experience, and a declaration of the truthfulness of the provided information. Applicants must also submit various supporting documents along with the application.

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Jesus Mondal
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2K views3 pages

Recruitment of Housestaffs in ID BG Hospital, (Interview On 19.03 .2025) (Memo .1129 of 08 .03 .2025)

This document is a proforma application for the position of House Staff at Beleghata ID & BG Hospital in Kolkata. It requires personal details, educational qualifications, marks obtained in MBBS, working experience, and a declaration of the truthfulness of the provided information. Applicants must also submit various supporting documents along with the application.

Uploaded by

Jesus 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
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PROFORMA OF APPLICATION

Application for the post of House Staff


Beleghata ID & BG Hospital, Beleghata, Kolkata-700010
(FILL IN BLOCK LETTER)

1. Name:
2.Father’s Name:
3.Residential Address: Village--------------------------------------------------------P.O---------------------

P.S-------------------------------------District------------------------------------PIN--------------------------

4. Mobile Number:

5. Email ID :

6. Registration No:

7. Year of Passing MBBS 7.1 Internship Completion Year: 7.2. Date of Birth:
8.

3rd Gen Remarks Gen Surgery Remarks Paediatrics Remarks Gynaecology Remarks Total
MBBS Medicine (P/S/H) F.M. (300) (P/S/H) F. M. (100) (P/S/H) & Obstetrics (P/S/H) F.M. (900)
Part II F. M. (300) F.M.(200) (a)

Marks
obtained

3rd Ophthalmol Remarks E.N.T. Remarks Community Remarks Total


MBBS ogy (P/S/H) F.M.(100) (P/S/H) Medicine (P/S/H) F.M.(400)
Part I F.M. (100) F.M.(200) (b)

Marks
obtained

GRAND TOTAL ( a
+b)
F.M. (1300)

(*P- pass, *S-supple, *H-honors)


 No of honors secured during MBBS course :
 No. of chance lost during MBBS course:
9. Working Experience

Name of the Institute/Organization Type of Institute/Organization (Govt. Or Private)


A

10. Declaration:

i) I do hereby declare that the above mentioned information are true to the best of my knowledge and belief. If any of the
information is found incorrect or false at any stage of recruitment process then the authority has the right to reject my
candidature.
ii) I do hereby submitting the documents (self attested photocopy):
a) All mark sheets of MBBS examinations.
b) Documents of Honors.
c) Madhyamik admit card for DOB proof
d) 2(Two) copies of recent passport size photographs
e) Internship completion certificate
f) Medical registration certificate of WBMC/MCI
g) Chance/Attempt certificate for MBBS Examinations.
h) Aadhaar and Epic card
i) Pan Card
j) Experiences certificate if any
iii) I hope you will give me an opportunity to serve you to the best of my ability and knowledge.

Place:
Date: Thanking You

--------------------------------------------------------------
(Signature of the Applicant)

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