Application Form - Compulsory Government Service (Resident Service ) Page 2
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2APPLICATION FORM
Please download three copies and submit the three attested copy at the time of counseling )
COMPULSORY GOVERNMENT SERVICE (RESIDENT SERVICE )
Speciality: ______________________ Degree/ Diploma:______________
Area of study OU/SVU/AU
:________________________________
Affix Photo
Local
Non Local
Name of College and Place:
________________________________
1.Name of the Candidate
:____________________________
(Full Name in block letter including surname)
2.Reg.No. (Dr.NTR UHS)
:_______________________________________
3.Email-id
:_______________________________________
4.Phone / Mobile No.
:_______________________________________
5.Address for communication
:_______________________________________
_______________________________________
_______________________________________
6. Sex : Male/Female
7. Community : OC/BC/SC/ST
8. Date of Birth
:
D
D
M M
Y
Y
Y
Y
9.Father’s / Husband / Wife (1) Address
:______________________________________
_______________________________________
_______________________________________
(2) Contact No :_______________
10. Theory Marks obtained in the Diploma / Degree /Super Specialty exam :_____________
11. Whether Spouse is working in Govt. service or doing PG :
Yes / No
12. Details of Bank Account
:
1) Name of the Bank
:______________________________________
2) Branch
:______________________________________
3) Account No
:______________________________________
4) IFSC code
:______________________________________
13. PAN No.
:______________________________________
Signature of Candidate
Signature of the Principal
(For office use only)
Allotted for posting from _________________ to _______________ in DME/APVVP/ Others ,
In _____________________________________________________College / Hospital.
Signature of Counseling Authority
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