Department of Health and Family Welfare, Punjab

Department of Health and Family Welfare, Punjab

Parivar Kalyan Bhawan, Sector 34, Chandigarh

Name of the Post:......

1. / Registration No. / : / 2. / Roll No. / :
3. / Name / : / 4. / Father's Name / :
5. / Mother's Name / : / 6. / Nationality / :
7. / Date of Birth / : / 8. / Age as on 01/01/2011 / :
9. / Do you claim age relaxation (Y/N) / 10. / If Yes mention relevant category
11. / Gender (M/F) / : / 12. / Marital Status (Married/ Unmarried) / :
13. / Category in which applied / :
14. / Category (Gen/ SC(M&B),SC(RO)/ BC / : / 15. / Sub Category ( PH,FF,Sports/ Ex. Servicemen) / :
16. / Rank in written test / : / 17. / Marks obtained in written test / :
18. / Contact No. / : / 19. / E-mail address / :
20. / Correspondence Address (in block letters) / :
21. / Permanent Address (in block letters) / :

22.Educational Qualification

Examination passed / Year of Passing / Subjects taken / Name and Address of School from which 8th class and 10th class passed / Board/ Univ. / Marks Obtained / Total Marks / %age / Whether School located in Urban/ Rural area
8th
10th
12th

23.Professional Qualification

Sr. No. / Examination Passed / Month & Year of Passing / Board/ University / Marks Obtained / Total Marks / %age
1.
2.
3.
4.

24.Internship/Training Completion if any :

A)Period of internship/training from...... to ......

B)Name of the Institute/ Hospital......

25.Higher Qualification, if any:

Sr. No. / Examination Passed / Month & Year of Passing / Board/ University / Marks Obtained / Total Marks / %age
1.
2.
3.
4.

26.Experience:

Sr. No. / Department/ Organization / Post held / Name of Office/ Institution / From / To / Remarks

27.Have you passed Punjabiupto Matric

or its equivalent standard ......

28.Declaration:

I hereby declare that:-

a)All statements made in this application and online form already submitted are true, complete and correct to the best of my knowledge belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the selection action can be taken against me by the department.

b)I fulfill all conditions of eligibility as given in the advertisement and other relevant instructions.

Place: Chandigarh

Dated:...... Signature of Candidate

Encl:

For Office use only

Instructions for the candidate attending counseling for the post of Radiographers.

Candidate should download the application format available on www.pbhealth.gov.in

The schedule of the counseling is displayed on our website www.pbhealth.gov.in. Candidates are advised to attend counseling as per the date mentioned against their name in the list. The counseling will be held strictly according to the schedule.
Candidates are required to reach the counseling centre at least 30 minutes before thestart counseling.
Candidate must bring the online filled application form, receipt of fee confirmation and Identity proof such as Driving License/Voter Card/Passport/PAN card for entry in the examination hall. A candidate, whodoes not bring the Admit Card, roll no. and identity proof, will not be allowed for counseling under any circumstances.
Candidates should attach self attested copies of the document with Application form as per seriatim given belowand also bring original documents at the time of counseling:

A)8th Pass Certificate

B)10th Pass Certificate

C)12th Pass Certificate

D)Degree/Diploma Certificate

E)Internship/Training Certificate if any

F)Higher Qualification Certificates if any

H)Experiencecertificates from competent authority

I)Reservation certificate from competent authority

J)Punjabi Pass Certificate

K)Copy of On Line Format

M)Proof of fees deposited

N)Original and proper stamped Certificate from District Education Officer of the concerned districts/Executive magistrate/ principal of concerned school where the candidate have passed8th and 10th class for claim of 8th and 10th schools located in rural areaof punjab state (format of certificate enclosed)

O)Date of Birth Certificate

P)Two passport size Photographs

For the claim of rural background number the 8th and 10th class should be passed from the school located in rural area. Rural area means the area not within the limits of urban local bodies such as Municipal Corporation, Municipal Council, Nagar Panchayat or Notified Area Committee and candidate should bring the certificate in original as per specimen given below:-

(Specimen of Certificate showing school falls in rural area)

(To be issued by Executive Magistrate /District Education Officer/ Principal of Concerned school)

It is certified that Sh./Miss ______S/D/o Sh. ______R/o ______whose date of birth as per record/ certificate is ______have passed 8th / 10th class from the schools as under:-

i)8th class from school ______(Name of the school) during the year ______.

ii)10th class from school ______(Name of school) during the year ______.

It is also certified that______(Name of school) falls in rural area of District ______of Punjab State and it does not fall within the limit of urban area such as Municipal Corporation, Municipal Council, Nagar Panchayat or Notified Area Committee.

Signature with seal of certifying authority

Specimen signature of the Candidate

1. ______

2. ______

3. ______

(Signature attested with seal of certifying authority)

Mobile phone or electronic devices of any kind are not allowed to be taken in counseling room.
All candidates are expected to maintain order and discipline within the counselingroom/hall. Disorderly conduct on the part of a candidate may result in his/herexpulsion from the counseling room/centre and cancellation of his/hercandidature.
Smoking and consumption of refreshments shall not be allowed in the counselingCentre/ Hall.
No TA/DA will be given to the candidates.
Counseling may last till evening and candidate should make their own arrangement for stay.
No other opportunity for checking the documents and counseling will be allowed in any circumstances and norequest for change of date for counseling will be entertained.
Venue Of Counselling: DIRECTORATE OF HEALTH AND FAMILY WELFARE PUNJAB ,SECTOR 34-A CHANDIGARH